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Chronic Condition Dental Management (CCDM) Program
PEBB Board PresentationSeptember 19th, 2017
Kristen Simmons, RDH, MHA, PhDEL(c) – Chief Operating OfficerSally Kallianis – Key Account Executive
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Agenda
• Willamette Dental Group Overview
• Oral Disease Prevalence/Model of Care
• Chronic Condition Dental Management (CCDM) Program Overview
• Goals, Eligibility, Benefit Design, Opportunities & Cost
• Future Data Integration
• Early Results
2
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Willamette Dental Group Overview
• Vertically integrated delivery model
• 50+ dental office locations in OR, WA & ID
• Over 400,000 members served
• Value over Volume
• Clinical innovation
• Outstanding care3
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Dental Disease Prevalence
Tooth Decay• Bacterial infection
• Nondiscriminator
• Most common chronic disease of children & adolescents
• Bacterial infection
• Linked to many other health conditions
• Age increases risk
Source: CDC Chronic Disease Resources 4
Periodontal Disease
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Bacterial Links to Systemic Diseases
• Bacteria is always present in the mouth
• Interconnection with oral bacteria & other diseases
• Immuno-compromised patients have greater risk
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5Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Ann Fam Med. 2014;12(6)
• Multi-faceted Approach to Care
• Partnership in Patient Care
• Standardized Treatment by Risk Factor
• Provider Satisfaction
Quadruple AimBdatt.4
7Aubert et al Ann IntMed 1998; 129:605
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8
Diabetic
Non-Diabetic
Unknown
Other4,634 25%
Non-Diabetic13.529 72%
Diabetic642 3%
PEBB Patients by Diabetic Status Self Report by Patient
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Patient Engagement
• Patient Partnership
• Proactive Dental Care Plan
• Patient compliance increased & improved
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Chronic Condition Dental Management Program
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CCDM Program Goals
• Provide targeted care for those PEBB members with specific disease sets and risk factors
• Improve the oral and overall health of PEBB members with prevalent chronic conditions
• Opportunity for collaboration between dental plan and health plan carriers
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CCDM Program Overview
• Target specific high cost/high impact chronic conditions
• Diabetes & Cigarette smoking
• Quality measures & benchmarks for participation, oral health improvement
• Using plan data, ascertain program participant subset
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CCDM Program Overview
• Targeted outreach to PEBB members who fit data criteria
• Engagement efforts to encourage participation
• Removal of cost barriers for specified codes based on risk
• Copay waiver; related to disease management
• Operational redesigns, IT enhancements, care coordinators & case management
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CCDM Benefit Design
• For PEBB CCDM participants:
• No cost share for certain services
• Identified by specific CDT codes
• $5 office visit copay still applies to basic & major restorative services
• Orthodontia & implant copays still apply
• For all other PEBB WDG members:
• Continuation of existing benefits
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CCDM Eligibility
• Detailed Medical & Dental History
• Self-attested conditions of diabetic and/or smoking status
• Immediate identification & outreach to eligible patients
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CCDM Program Opportunities
• Conservative estimates of 5 – 10% of the WDG PEBB members in the high & extreme risk categories
• Reduction in the prevalence of caries & gum disease
• Greater adherence due to outreach, care coordination and removal of financial barrier
• Cost savings by reducing costly restorative treatments (long term)
• Potential – but unknown – savings on medical care
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Early Results
• 47% acceptance rate for CCDM program
• 90% utilization rate for CCDM program participants
• Services counts higher in most categories
• Higher PMPM for program participants16
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Future Data Integration
• WDG axiUm links to HIS using customized Health Level 7 (HL7) interfaces
• axiUm includes module for patient access (future functionality)
• SNOMED integration
• Two way data exchange between WDG & Health Plans
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Cost Impacts
• Increased utilization for Program participants
• Decrease in revenue from removal of $5 office visit copay
• Outreach/administrative costs
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Questions?
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