Evaluation of the Dental Wellness Plan Community …Dental Clinic Characteristics • CHC dental clinics employed an average of 2.8 full-time-equivalent (FTE) dentists, 2 FTE dental

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March 2016Survey Report

Julie C. Reynolds*†Visiting Assistant Professor

Jennifer Sukalski*†Graduate Research Assistant

Susan C. McKernan*†Assistant Professor

Brooke McInroy*Survey Research Manager

Raymond A. Kuthy*†Professor

Peter C. Damiano*Director* and Professor†

University of IowaPublic Policy Center*College of Dentistry†

University of Iowa Public Policy Center •209 South Quadrangle, Iowa City, IA 52242-1192 O - 319.335.6800 • F - 319.335.6801 • www.ppc.uiowa.edu

Evaluation of the Dental Wellness PlanCommunity Health Center Experiences in the First Year

www.ppc.uiowa.edu

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ContentsExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Dental Wellness Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Survey Instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Response Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Dental Clinic Characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Changes in Clinic Operations after DWP Implementation . . . . . . . . . . . . . . 11

Clinic Experiences with DWP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Participation in DWP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Overall Experience with DWP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

DWP Training and Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

DWP Administration and Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

DWP Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Experience with PreViser Risk Assessment . . . . . . . . . . . . . . . . . . . . . . . 16

Dental Score Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Comparisons with Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Appendix 1: Iowa FQHC Locations . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Appendix 2: Dental Wellness Plan and Medicaid Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Appendix 3: Descriptive Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

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Executive SummaryIntroduction

The Dental Wellness Plan (DWP) provides dental benefits for members enrolled in the Iowa Health and Wellness Plan (IHAWP), Iowa’s version of the Medicaid expansion and was enacted through bi-partisan legislation to provide comprehensive health care coverage to low income adults. The DWP was implemented on May 1, 2014, and is administered by Delta Dental of Iowa. It has a unique earned benefits structure aimed at encouraging preventive health care-seeking behaviors. Enrollees earn additional covered services when they return for regular periodic recall exams every 6-12 months. The aim of this study was to examine the experiences of Iowa’s community health center (CHC) dental clinics during the first year of the Dental Wellness Plan (DWP).

Methods

In May 2015, online surveys were administered to directors of all CHC dental clinics in Iowa (n=14). Descriptive analyses were conducted for all survey questions. All results are presented unweighted; analyses were conducted using IBM SPSS Version 21. Results from this survey are compared with a previous survey of Iowa CHC dental directors conducted in 2013 when appropriate.

Key Findings

Dental Clinic Characteristics

• CHC dental clinics employed an average of 2.8 full-time-equivalent (FTE) dentists, 2 FTE dental hygienists, and 6.8 FTE dental assistants. These are slightly less than the mean numbers of dental staff in 2013.

• Almost half of responding clinics were too busy to treat all patients who requested appointments, which is higher than reported busyness levels from 2013.

• Clinics’ mean broken appointment rate over the past 12 months was 20% (range 7%-40%, n=10).

• The total number of patients served at Iowa’s FQHC dental clinics increased from 58,417 in 2012 to 60,998 in 2014.

Changes in Clinic Operations after DWP Implementation

• An average of 16% of clinics’ patients had DWP insurance in 2014, and the average percent of uninsured clinic patients decreased from 22% in 2013 to 13% in 2014.

• On average, clinics were reimbursed approximately $109,874 by DWP in 2014.• A majority of clinics reported that the number of child patients, and their treatment needs,

either stayed the same or decreased. However, all respondents reported that the number of adult patients, and their treatment needs, increased either ‘somewhat’ or ‘substantially.’

Clinic Experiences with DWP

• Seven respondents (70%) reported their overall experience with DWP was ‘somewhat positive,’ two (20%) said ‘somewhat negative,’ and one (10%) did not know.

• Seven respondents (70%) said said the DWP had either a ‘very positive’ or ‘somewhat positive’ effect on the clinics’ financial health, whereas three (30%) did not know.

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DWP Administration and Coverage

• The four administrative issues perceived by the most respondents as a ‘major problem’ were intermittent eligibility, difficulty of eligibility determination, time spent on paperwork, and limited services covered. The three administrative issues perceived by the most respondents as ‘no problem’ were reimbursement rate, fear of government investigation, and slow payment.

• Five respondents (50%) reported either ‘very positive’ or ‘somewhat positive’ experiences with the earned benefits structure, whereas five reported ‘very negative’ or ‘somewhat negative’ experiences.

DWP Patients

• A majority of respondents reported that the following patient-related issues were ‘major problems’: complexity of patient dental treatment needs, broken appointments, complexity of past medical history, and patient non-compliance with recommended treatment.

• Specialist referral and intermittent eligibility were the two issues ranked as ‘major problems’ by the highest number of respondents (n=9).

Experience with PreViser Risk Assessment

• Nine respondents (90%) reported that their clinics were currently using the PreViser risk assessment.

• Among clinics currently using the PreViser risk assessment, four clinics (44%) had a positive experience using it, and five (56%) had a negative experience.

• A majority of respondents reported that the PreViser risk assessment was ‘not at all helpful’ for each of the following activities: discussing patients’ oral health, discussing patients’ systemic health, facilitating communication with patients’ other health care providers, and using it with the clinics’ non-DWP patients.

Comparisons with Medicaid

• Six respondents (60%) said that it is has been more difficult to refer DWP patients to specialists compared to Medicaid patients.

• When asked how DWP administration compared to Medicaid, the issue most commonly reported as better in DWP was reimbursement rate (n=7). Half or more of respondents rated the following issues as worse in DWP compared to Medicaid: time spent on paperwork, difficulty of eligibility determination, and limited services covered.

• The ability to refer to dental specialists was the only patient-related issue perceived as worse in DWP by a majority of respondents.

This study is part of a broader evaluation of the DWP that includes provider adequacy, provider surveys, cost, and outcomes. It will be followed by another consumer survey to measure changes in member experiences when they have been in the plan for a greater length of time.

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BackgroundThe aim of this study was to examine the experiences of Iowa’s community health center (CHC) dental clinics during the first year of the Dental Wellness Plan (DWP).

Dental Wellness PlanThe DWP is the dental insurance plan for members enrolled in the Iowa Health and Wellness Plan (IHAWP), Iowa’s version of the Medicaid expansion, which was enacted through bi-partisan legislation to provide comprehensive health care coverage to low income adults. The IHAWP was implemented on January 1, 2014. It replaced the IowaCare program with plans that offer more covered services and a broader provider network. Dental coverage under the IowaCare program included only tooth extractions that had to be provided at one of two locations in Iowa: University of Iowa Hospitals and Clinics in Iowa City or Broadlawns Dental Clinic in Des Moines.

The DWP was implemented on May 1, 2014, and is administered by Delta Dental of Iowa.

Eligibility

IHAWP offers coverage to adults aged 19-64 years with income between 0-133% of the Federal Poverty Level (FPL) who are not otherwise eligible for Medicaid. All IHAWP members are automatically enrolled in the DWP. As of May 2015 (when this survey was conducted), 125,070 adults were enrolled in the DWP.

Services

The DWP has a unique earned benefits structure to encourage preventive health care-seeking behaviors. Members earn additional covered services when they return for regular periodic recall exams. All members are eligible for a “Core” set of benefits upon enrollment that includes emergency and stabilization services. When they return for a periodic recall exam within 6-12 months of an initial comprehensive exam, members become eligible for “Enhanced” services. After receiving a second recall exam within 6-12 months, members become eligible for “Enhanced Plus” services. Figure 1 summarizes dental services covered in each earned benefit tier.

Figure 1. Earned benefits through Iowa DWP

Provider Incentives

The DWP also includes several provider incentives. First, provider reimbursement is approximately 50% higher than Medicaid. Second, a Bonus Pool program incentivizes participating DWP general dentists based on the number of exams performed on DWP members. The Bonus Pool for dental specialists is based on the number of unique DWP patients seen. This includes providers working at CHCs. General dentists are only eligible for the Bonus Pool if they complete an online risk assessment form for each new DWP patient and update it annually; providers are also reimbursed on a fee-for-service basis for conducting each risk assessment.

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When federally qualified health centers (FQHCs) provide care to patients enrolled in traditional Medicaid, they are paid a certain amount per visit (i.e., encounter payments). This is different from private providers who are reimbursed on a fee-for-service (FFS) basis. In the DWP, FQHCs are paid FFS for services provided to DWP patients. However, each quarter, if the amount they were reimbursed is less than what they would have received had they been paid by encounter, they receive a wrap payment to bring them up to the encounter-based amount.

Provider Network

As of January 2015, the DWP provider network consisted of 646 active dentists, 549 (85%) of whom were general dentists and 96 (15%) were dental specialists.1 Of the 646 active dentists, 144 providers were located in public safety net sites, including FQHCs, non-federally qualified CHCs, academic institutions, and Indian Health Service clinics. Slightly over half (n=49) of the dental specialists were affiliated with the University of Iowa, which included all 6 participating endodontists. The mean county dentist-to-population ratio in DWP was 4.8 general dentists per 1,000 enrollees, with provider availability of general dentists ranging from 0 to 70.2 full-time equivalents (FTEs) per county. 19 out of 99 Iowa counties did not have any general dentists in private practice accepting new DWP patients.

1 McKernan SC, Pooley M, Kuthy RA, Momany ET, Damiano PC. Iowa Dental Wellness Plan: Evaluation of Baseline Provider network. A Policy Brief. Iowa City, IA: UI Public Policy Center. http://ppc.uiowa.edu/sites/default/files/dwp_provider_report.pdf.

http://ppc.uiowa.edu/sites/default/files/dwp_provider_report.pdf

http://ppc.uiowa.edu/sites/default/files/dwp_provider_report.pdf

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MethodsIn May 2015, online surveys were administered to directors of all CHC dental clinics in Iowa (n=14). An introductory email was sent prior to the survey distribution, and two reminder emails were sent (two and four weeks after the first). Email addresses of dental directors were provided by the Iowa Primary Care Association. A map of Iowa CHCs can be found in Appendix 1.

Results from this survey are compared with a previous survey of Iowa CHC dental directors. In 2013, the University of Iowa Public Policy Center conducted an online survey of all CHCs in Iowa that provided direct dental services (n=152), including 12 FQHCs and 3 non-federally qualified CHCs. Several questions from the 2013 survey were included in the 2015 survey to allow comparisons before and after DWP implementation.

Survey InstrumentSurvey questions were either original or adapted from other sources. These sources include the 2013 Public Policy Center survey to Iowa CHC dental directors about the capacity of the public dental safety net3, as well as a 2015 Public Policy Center survey to private practice dentists in Iowa about their experiences with the Dental Wellness Plan. The survey instrument was approved by Iowa Medicaid prior to distribution. A copy of the survey is located in Appendix 2.

AnalysesDescriptive analyses were conducted for all survey questions. Due to the small respondent group size, no comparative analyses were conducted. All results are presented unweighted; analyses were conducted using IBM SPSS Version 21.

Response RatesIn total, 11 out of 14 CHC dental directors responded to the survey for an overall response rate of 79%. Among the nine respondents who indicated who completed the survey, eight were dental directors and one was a dental clinic manager.

LimitationsThere are several limitations to this study. First, there are few CHCs in the state of Iowa, limiting our ability to perform analyses beyond descriptive statistics. Second is the potential for recall bias, which may have impacted respondents’ ability to provide accurate information about events that occurred up to two years prior. Finally, although questions were asked about the overall clinics’ experiences with the DWP, respondents’ own personal experiences may have influenced their responses.

2 Note: one CHC did not have an active dentist as of April 2015, which is why the number of surveys administered in 2015 was one fewer than in 2013.

3 Reynolds JC, McKernan SC, Kuthy RA, Adrianse NB, Mani S, Damiano PC. Public Dental Safety Net in Iowa: Capacity and Readiness for Health Care Reform. Journal of Healthcare for the Poor and Underserved (accepted for publication; publication date May 2016).

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ResultsDental Clinic CharacteristicsCHC dental clinics employed an average of 2.8 full-time-equivalent (FTE) dentists, 2 FTE dental hygienists, and 6.8 FTE dental assistants (Table 1). These are slightly less than the mean numbers of dental staff in 2013. There were 10 clinics that provided information about dentist staffing in both 2013 and 2015, and 7 clinics that provided information about dental hygienist and dental assistant staffing in both 2013 and 2015. Among these, the number of FTE dentists decreased in 4 clinics, stayed the same in 4, and increased in 2; the number of FTE dental hygienists decreased in 2 clinics, stayed the same in 4, and increased in 1; and the number of FTE dental assistants decreased in three clinics, stayed the same in 2, and increased in 2.

Table 1. Clinic staffing

2013*N=14

Mean (Range)

2015N=11

Mean (Range)Dentists 3.0 (1.0-8.6) 2.8 (1.0-5.0)Dental hygienists 2.4 (0.5-7.0) 2.0 (0.5-4.0)Dental assistants 7.8 (2.9-18.6) 6.8 (1.5-12.0)

*From 2013 survey of Iowa CHC dental clinics

We asked respondents about busyness of their dental clinics during the past 12 months. Almost half were too busy to treat all patients who requested appointments, which is higher than reported busyness levels from 2013 (Table 2).

When we asked dental directors about the change in their clinics’ busyness over the past 12 months, four clinics (36%) were ‘much busier,’ six (55%) were ‘somewhat busier,’ and one (9%) had no change in busyness.

Table 2. Clinic busyness during the previous 12 months

2013*N=14N(%)

2015N=11N(%)

Too busy to treat all requesting appointments; sometimes lost patients because it took too long to get an appointment

1 (7%) 5 (46%)

Provided care to all requesting it, but often took a long time to get an ap-pointment

5 (36%) 3 (27%)

Provided care to all requesting it, and could see all patients in a reasonable timeframe

5 (36%) 2 (18%)

Not busy enough, could accommodate more patients 2 (14%) 0Clinic limited, no new patients taken 1 (7%) 1 (9%)


Clinics’ mean broken appointment rate over the past 12 months was 20% (range 7-40%, n=10). Three clinics (30%) had a broken appointment rate greater than 20% (Table 3).

Table 3. Broken appointment rates over the previous 12 months

2013*N=12N(%)

2015N=10N(%)

Under 10% 3 (21%) 1 (10%)11-20% 6 (43%) 6 (60%)21-30% 4 (29%) 2 (20%)31-40% 1 (7%) 1 (10%)


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Measuring the time until the third next available appointment is a reliable estimate of appointment wait times since it is not subject to last-minute cancellations. The mean time to the third next available appointment at CHC main dental clinics was 25 days (range 7-60). This is higher than findings from the 2013 survey, in which it was 13 days (range 1-30). In 2013, only one clinic (9%) had a wait time greater than four weeks, whereas in 2015 three clinics (30%) had wait times over seven weeks (Table 4).

Table 4. Time to third next available appointment*

2013N=11N(%)

2015N=10N(%)

2 weeks 7 (64%) 6 (60%)15 days – 4 weeks 3 (27%) 1 (10%)29 days – 6 weeks 1 (9%) 043 days – 8 weeks 0 1 (10%)>8 weeks 0 2 (20%)

*Main clinic only, does not include satellite clinics (if applicable)

In the 2015 survey, we asked about the number of total patient dental visits and total dental patients served during each of the previous two years. Table 5 shows the patient visit results from the 2013 and 2015 surveys. Clinics had an average of 14,386 (range 5,656 - 20,505) patient visits in 2013, and an average of 13,370 (range 5,693 - 20,390) in 2014. When asked in the 2013 survey about total patient visits in 2012, clinics reported an average of 18,334 (range 8,000 – 33,537). Only seven respondents in 2015 and four respondents in 2013 completed these survey items, which affects generalizability of the results to all Iowa CHC dental clinics.

Table 5. Total patient visits during the calendar year

2012*N(%)

2013N(%)

2014N(%)

5,000 - 9,999 1 (25%) 2 (29%) 2 (33%)10,000 - 14,999 1 (25%) 2 (29%) 2 (33%)15,000 - 19,999 1 (25%) 1 (14%) 020,000 1 (25%) 2 (29%) 2 (33%)


Due to the low response rates about the number of unique patients, we used health center data from the Health Resources and Services Administration (HRSA) to report on this information.4 Figure 2 shows the number of unique patients served at all of Iowa’s FQHCs that have a dental clinic, including those that did not participate in our survey. The total number of patients served at Iowa’s FQHC dental clinics increased from 58,417 in 2012 to 60,998 in 2014. Note: these data do not include patients served at non-federally qualified health centers.

4 Health Resources and Services Administration. 2014 Health Center Profile: Health Center Program Grantee Data. HRSA 2015. http://bphc.hrsa.gov/uds/datacenter.aspx?q=d&year=2014&state=IA#glist Accessed 7 Dec 2015.

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Figure 2. Total unique dental patients served during the calendar year*

*From HRSA Health Center Program Grantee data

The 2015 survey also inquired about the percent of dental clinics’ patients by type of dental insurance in both 2013 and 2014. Table 6 shows the mean percentage of clinic patients with each type of dental insurance. An average of 16% of clinics’ patients had DWP insurance in 2014. The average percent of uninsured clinic patients decreased from 22% in 2013 to 13% in 2014. Only seven respondents completed this survey item, which may affect the generalizability of results to all Iowa CHC dental clinics.

Table 6. Mean percent of patients by dental insurance type

Insurance Type 2013 Mean (Range)

2014 Mean (Range)

Medicaid 54 (25-86) 50 (23-85)CHIP/hawk-i 3 (0-6) 2 (0-5)Dental Wellness Plan N/A 16 (0-48)IowaCare* 53 N/APrivate/Commercial Insurance 13 (3-25) 15 (4-25)Uninsured 22 (4-50) 13 (4-25)Unknown Status <1 (0-1) <1 (0-1)

*Broadlawns Medical Center only

We asked approximately how much each clinic was reimbursed by DWP for dental services in 2014. On average, clinics were reimbursed approximately $109,874 by DWP that year. This ranged from $496 to $216,000.

Table 7 shows the average percentage of clinic revenue that comes from patient-related and non patient-related sources. In 2014, an average of 12% of clinic revenue came from DWP. However, only four respondents completed this survey item, which may affect the generalizability of results to all Iowa CHC dental clinics.


Table 7. Mean percent of dental clinic revenue from patient and non-patient sources, 2013 and 2014

2013 Mean (Range)

2014 Mean (Range)

Patient Revenue*Medicaid 69 (61-80) 60 (53-78)CHIP/hawk-i 2 (0-4) 2 (0-5)Dental Wellness Plan - 12 (0-27)

Private/Commercial Insurance 13 (5-16) 13 (6-16)Uninsured/Sliding scale/Self-pay 14 (2-21) 12 (3-19)

Non-patient RevenueFederal grants (e.g., Section 330) 2 (0-8) 2 (0-7)State and local grants <1 (0-1) <1 (0-1)Other 0 0

*IowaCare not listed, only seen at Broadlawns in 2013.

Changes in Clinic Operations after DWP Implementation

We asked whether respondents thought that the DWP has resulted in an increase, decrease, or no change in 1) the total number of unique patients visiting their clinic and 2) the proportion of their clinic patients with dental insurance (Table 8). Eight respondents (89%) believed that DWP had caused an increase in each of these aspects.

Table 8. DWP-related changes in CHC patients

Major increase

Minor increase

No change Decrease

Unique patients that have visited your dental clinic, N(%) 2 (22%) 6 (67%) 1 (11%) 0

Proportion of your clinic patients with insurance that covers dental services, N(%) 3 (33%) 5 (56%) 1 (11%) 0

Respondents were also asked about their clinics’ experiences during the year that DWP was implemented (2014) compared to the year before (2013). A majority of clinics reported that the number of child patients, and their treatment needs, either stayed the same or decreased (Figure 3). However, all respondents reported that the number of adult patients, and their treatment needs, increased either ‘somewhat’ or ‘substantially.’ Similarly, reported need for dentists, hygienists, and dental assistants increased at a majority of clinics.

Figure 3. Iowa CHC dental clinic experiences during 2014 compared to 2013


Some clinics have already made, and some are considering making, a number of changes to their clinic operations to accommodate increased demand for care. The most common changes that clinics had already made were hiring additional staff (Figure 4); whereas the most common changes clinics were considering making in the future were hiring dental assistants, adding or expanding a satellite clinic, and hiring dental hygienists (Figure 5).

Figure 4. Changes made to clinic operations (n=11)

Figure 5. Changes in clinic operations under consideration (n=10)

Clinic Experiences with DWPParticipation in DWP

FQHCs are required to accept all patients regardless of ability to pay. However, three respondent CHCs are not federally qualified and may only accept children as patients. Therefore, some may not have experiences with the DWP program. Ten respondents (91%) reported currently accepting DWP patients.

Results presented in this section are limited to the 10 dental clinics that currently accept DWP patients.

Overall Experience with DWP

Seven respondents (70%) reported their overall experience with DWP was ‘somewhat positive,’ two (20%) said ‘somewhat negative,’ and one (10%) did not know. Six respondents (60%) said they would


‘definitely’ or ‘probably’ recommend DWP participation to other Iowa dentists, whereas four (40%) said they ‘definitely’ or ‘probably’ would not.

When asked about the effect of DWP on clinics’ financial health, seven respondents (70%) said it had either a ‘very positive’ or ‘somewhat positive’ effect, whereas three (30%) did not know.

We asked respondents’ opinions about certain aspects of the DWP, including access to care, dentist autonomy and policy involvement, and ethical responsibility to treat DWP patients. Table 9 shows respondents’ level of agreement with these issues. Eight respondents (80%) agreed that without the DWP program, its patients would not have access to adequate dental care. However, five respondents (50%) disagreed with the statement that dentists have an ethical obligation to treat DWP patients.

Table 9. Attitudes toward aspects of the DWP program

Agree DisagreeNot sure/

Don’t know

Without the DWP program, these low income patients would not be able to get adequate dental care, N(%) 8 (80%) 2 (20%) 0

The DWP program respects dentists’ professional judg-ment concerning patient care, N(%) 6 (60%) 4 (40%) 0

Dentists can have an impact on the policies of the DWP program, N(%) 7 (70%) 2 (20%) 1 (10%)

Dentists have an ethical obligation to treat DWP patients, N(%) 4 (40%) 5 (50%) 1 (10%)

DWP Training and Communications

At the time of the survey, nine clinics (90%) had participated in training activities provided by Delta Dental of Iowa about the DWP program. Among those who had participated in such training, one third each found it ‘very,’ ‘somewhat,’ or ‘a little helpful’ (Figure 6).

When asked about the helpfulness of communications from Delta Dental and Iowa Medicaid about DWP, eight clinics (80%) found Delta Dental’s communications ‘somewhat’ or ‘very helpful,’ whereas five clinics (50%) evaluated Iowa Medicaid communications similarly (Figure 6).

Figure 6. Helpfulness of DWP training, and communications from Delta Dental and Iowa Medicaid

DWP Administration and Coverage

When asked about clinics’ experiences with Delta Dental’s administration of the DWP, six respondents (60%) reported either ‘very positive’ or ‘somewhat positive’ experiences, three respondents (30%)


reported ‘somewhat negative’ or ‘very negative’ experiences, and one respondent (10%) did not know.

Respondents perceived some issues with DWP administration as more problematic than others. Figure 7 shows respondent’s ratings of the extent to which each issue is problematic. The four issues perceived by the most respondents as a ‘major problem’ were intermittent eligibility, difficulty of eligibility determination, limited services covered, and time spent on paperwork. The three issues perceived by the most respondents as ‘no problem’ were reimbursement rate, fear of government investigation, and slow payment.

Figure 7. Rating of administration of DWP (n=10)

When asked about their clinics’ experiences with the earned benefits approach, five respondents (50%) reported either ‘very positive’ or ‘somewhat positive’ experiences, whereas five reported ‘very negative’ or ‘somewhat negative’ experiences.

Table 10 presents respondents’ attitudes toward aspects of the earned benefits approach. Eight respondents (80%) agreed that the earned benefits approach is an effective way to reward people who return for regular checkups. However, nine (90%) agreed that the earned benefits approach makes it difficult to provide comprehensive treatment to DWP patients, and seven (70%) agreed that it prevents DWP patients from getting the care they need when they need it.

Table 10. Attitude toward aspects of earned benefits approach


Don’t know

Is an effective way to reward people who return for regu-lar checkups, N(%) 8 (80%) 2 (20%) 0

Makes it difficult to provide comprehensive treatment to DWP patients, N(%) 9 (90%) 1 (10%) 0

Will increase the likelihood that patients return for regu-lar exams, N(%) 4 (40%) 3 (30%) 3 (30%)

Prevents DWP patients from getting the care they need when they need it, N(%) 7 (70%) 3 (30%) 0

Will increase the likelihood that patients will take better care of their oral health, N(%) 2 (20%) 5 (50%) 3 (30%)

DWP Patients

Respondents were asked about their attitudes regarding several DWP patient-related issues. None of the respondents’ believed that DWP patients make other patients feel uncomfortable in the office (Table 11). However, six respondents (60%) agreed that oral health problems are more severe in DWP patients compared to others.


Table 11. Attitudes regarding DWP patient issues


Don’t know

DWP patients make other patients feel uncomfortable in the office, N(%) 0 8 (80%) 2 (20%)

Oral health problems of DWP patients are more severe than those of other patients, N(%) 6 (60%) 3 (30%) 1 (10%)

When asked the extent to which certain patient-related issues were problematic, a majority of respondents reported that the four issues listed in Figure 8 were ‘major problems.’ The complexity of DWP patients’ dental treatment needs was the issue rated as a ‘major problem’ by the highest number of respondents.

Figure 8. Rating of patient-related issues as problematic (n=10)

Provider Network and Specialist Referral

When asked whether respondents were concerned that their CHC was the only practice in the area that accepts DWP patients, two respondents (20%) agreed, seven disagreed, and one did not know.

We also asked about the extent to which 1) a lack of local DWP providers and 2) referrals to dental specialists were problematic in the DWP. Five respondents (50%) reported that a lack of local DWP providers was a ‘major problem,’ whereas nine respondents (90%) rated specialist referral similarly (Figure 9). Specialist referral and intermittent eligibility were the two issues ranked as ‘major problems’ by the highest number of respondents (n=9).

Figure 9. Rating of provider network issues as problematic (n=10)

Endodontists, oral surgeons, and orthodontists were reported to be the specialists that were most difficult to refer to (Table 12). The rating for orthodontists is notable given that orthodontics are not a covered service within DWP.


Table 12. Difficulty referring DWP patients to the following specialists:

N(%)Endodontists 8 (80%)Oral Surgeons 5 (50%)Orthodontists 5 (50%)

Periodontists 3 (30%)Prosthodontists 3 (30%)None of the above 1 (10%)

Experience with PreViser Risk Assessment

Nine respondents (90%) reported that their clinics were currently using the PreViser risk assessment; eight (89%) of those currently use it with all of their DWP patients, whereas one (11%) uses it with most of them.

The most common reasons that clinics were using the PreViser risk assessment were reimbursement, the bonus pool program, and the electronic submission of results (Figure 10). For the one clinic not currently using the PreViser risk assessment, the reason for not using it was the time needed to complete it.

Among clinics currently using the PreViser risk assessment, four clinics (44%) had a positive experience using it, and five (56%) had a negative experience.

Figure 10. Reasons providers use the PreViser risk assessment

Among clinics currently using the PreViser risk assessment, the most common team member to collect the information was the dental assistant (n=4), whereas in three clinics the hygienist collected the information and in one clinic the dentist did. However, the dentist was the most common team member to discuss the information (n=5), whereas the hygienist did in two clinics, the dental assistant in one clinic, and no one in one clinic.

We asked about how helpful the PreViser risk assessment was or would be in activities such as discussing patients oral and systemic health, or for potential use with non-DWP patients. Responses about its helpfulness are presented in Table 13. For all four activities, a majority of respondents reported that the PreViser risk assessment was ‘not at all helpful.’


Table 13. Helpfulness of the PreViser risk assessment

Very helpful

Some-what

helpful

A little helpful

Not at all

helpful

Not sure/ Don’t know

Discussing patients’ oral health, N(%) 0 3 (33%) 1 (11%) 5 (56%) 0Discussing patients’ systemic health, N(%) 0 1 (11%) 3 (33%) 5 (56%) 0Facilitating communication with patients’ other health care providers, N(%) 0 0 1 (11%) 6 (67%) 2 (22%)

Use with clinic’s non-DWP patients, N(%)0 1 (11%) 3 (33%) 5 (56%) 0

Table 14 shows all respondents’ open-ended comments about how the PreViser risk assessment could be improved. Comments include technical issues, issues with the 100% compliance requirement, accuracy of the assessment, and concerns about the responsibility of improving risk level being placed with the provider rather than the patient.

Table 14. Most important change that could be made to improve the PreViser risk assessment

Open-ended commentsThe inability to remove duplicate entries and the lack of robust reporting tools are two problems that we face.Not requiring 100% compliance or not having to be done once between January 1 - December 31 of each year. If a patient [came in] May 2015 and the PreViser was done in November 2014, PreViser doesn’t necessarily need to be done since it has only been 6 months. However, if the patient fails to come for their recall in November 2015 and doesn’t come until 2016, then this patient disqualifies you for the wrap around. Even if the patient comes for their recall in January 2016, you fail for the wrap around in the year 2015, even though they are still in “compliance” with their recall schedule. It should be based off of when their recall dates are and not a calen-dar year.Shorter/quicker scoring doesn’t always seem accurate of riskIt appears to be a trap - if your patients aren’t returning for tx the dentist/clinic is will most like-ly be blamed instead of the patients not showing up. the problem is not identifying patients that have disease - the problem is the patients usually have these dental diseases of choice (caries, perio) because of their own behavior and lack of motivation and value for treatment. it would appear that the dentist will be blamed for patients not getting healthier when in reality the pa-tients should bear the responsibility for their own health.

Dental Score Questionnaire

DWP members are encouraged to complete a Dental Score Questionnaire, which is an online oral health risk assessment that provides customized information about members’ oral health. Members are then encouraged to bring their results to discuss with their dental provider. Only three (30%) respondents were aware of the Dental Score Questionnaire. Among those, two reported that none of their patients had brought the questionnaire results to their appointment, and one reported that some of their patients have brought it. When asked how helpful the Dental Score Questionnaire was in facilitating discussions with patients about their oral health, the one clinic whose patients had brought in their results reported that it was ‘a little helpful.’

Comparisons with Medicaid

Respondents were asked to compare DWP with Medicaid on several aspects, including specialist referral, administration and patient-related issues. Six respondents (60%) said that it is has been more difficult to refer DWP patients to specialists compared to Medicaid patients, and three (30%) said specialist referral is similarly difficult for patients in both programs.

When asked how DWP administration compared to Medicaid, the issue most commonly reported as better in DWP was reimbursement rate (n=7) (Figure 11). Half or more of respondents rated the following issues as worse in DWP compared to Medicaid: time spent on paperwork, limited services covered, and difficulty of eligibility determination.


Figure 11. Rating of DWP administration compared to Medicaid (n=10)

For all but one patient-related issue, seven (70%) or more respondents reported the issues were the same in both programs (Figure 12). The ability to refer to dental specialists was the only patient-related issue perceived as worse in DWP by a majority of respondents.

Figure 12. DWP patient-related issues compared to Medicaid patients


Open-Ended CommentsRespondents were asked to provide open-ended comments about how the DWP could be improved and any other thoughts about the DWP. Tables 15 and 16 show the open-ended comments that were provided. Improvement to the PreVisor risk assessment was a common theme, as well as concerns with the earned benefits structure.

Table 15. Open-ended comments about most important change to DWP

What is the most important change that could be made to improve the Dental Well-ness Plan?

1) Insurance education at the provider level is time consuming, the amount of information to support claims requires additional staff resources, PREVISER is difficult to implement with the current patient demand.

2) Easier simpler previser3) Better reporting tools in Previser and for Wellness to track patients seen, which patients

are comprehensive and which have completed HRA.4) More leniency in the core benefits especially (ineligible) caries restoration that can

become larger in six months. If patient needs a full denture in one arch and a partial in the second arch, it is better to fabricate the full denture with the permanent removal partial denture.

5) Being able to provide srp [scaling and root planing] and restorative in core benefits stage.

Table 16. Additional comments from respondents about the DWP

We are interested in any other comments you may have about the Dental Wellness Plan

1) It is difficult to keep up with the rules of documentation needed for different procedures for billing. Checking patient eligibility should be easier and up to date on the website.

2) Please edit Previser to only a comprehensive option for HRA’s. We also need better reporting tools in Previser to allow us to track completed HRA’s and which patients are comprehensive and need those HRA’s.

3) XXXXX, XXXXX, and other at DWP are WONDERFUL. The support offered to providers and staff is night-and-day different from that offered by Medicaid. Values from 2013 versus 2014 were not entered in an effort to avoid shewing your data…. The dentist/Dental Director was different at this location in 2013 and 2014, so significantly more patients were seen in 2014 due to that. I have no[t] seen an improvement in oral hygiene practices in this population Almost every DWP patient is high risk for both caries and periodontal disease. Even with regular recalls (with education) and stressing the importance of improved oral hygiene, I have yet to see much improvement in this population. This is most discouraging.

4) The accountability development of the patient has not translated to the patient. It seems that more burden is placed on the provider and the staff.


ConclusionsClinics perceived an increased demand for dental care during the previous 12 months – primarily from new adult patients – as well as a need for more dental staff of all types. They also reported being busier compared to results from a 2013 survey. However, the number of total patients served did not increase substantially the year DWP was implemented. The staffing that would be needed to address the needs of a larger population with severe needs did not appear to have occurred. The number of dentists, hygienists, and assistants was actually lower in some clinics than in 2013, even though demand increased.

From 2013-2014, there were considerable changes to the percentage of patients with different types of insurance. The biggest change was the increase in the percentage of patients with DWP, along with the decrease in the percentage of patients without insurance.

The oral health status of patients in the DWP was perceived to be much lower and thus treatment needs much higher than for Medicaid-enrolled adults. The majority reported that the oral health status of DWP patients was more severe than their other patients and the majority also indicated that the complexity of the oral health problems of DWP patients was a major problem in their clinic.

A majority of clinics reported that their overall experiences with the DWP were positive. However, clinics were split in their overall experiences with specific aspects of the program, such as the earned benefits structure and the PreViser risk assessment. For example, half of dental directors reported a positive overall experience with the earned benefits structure, and half reported a negative overall experience. There was a disconnect in the perceptions of the earned benefits structure: while most respondents agreed that it is an effective way to reward people who return for regular checkups, most also agreed that it makes it difficult to provide comprehensive care and prevents DWP patients from getting the care they need when they need it.

Similarly, there was nearly even division on the overall experiences with the PreViser risk assessment. However, when asked whether the assessment was helpful for specific activities such as discussing patients’ oral health, a majority of dental directors rated it as not helpful with any listed activity.

Clinics perceived some DWP administrative- and patient-related issues as problematic. The two issues rated by the most respondents as major problems were intermittent eligibility of DWP members and referring patients to specialists. In addition to intermittent eligibility, three other administrative issues were perceived to be major problems by a majority of clinics: difficulty of eligibility determination, limited services covered, and time spent on paperwork. Four patient-related issues were perceived as major problems by a majority of clinics: broken appointments, complexity of dental treatment needs, complexity of medical history, and patient non-compliance with recommended treatment.

Some administrative issues were perceived to be worse in DWP compared to Medicaid, and some were perceived to be the same or better. However, most patient-related issues were perceived as the same in both DWP and Medicaid by a majority of respondents. Half or more of respondents rated the following issues as ‘worse’ in DWP compared to Medicaid: time spent on paperwork, limited services covered, and difficulty of eligibility determination. However, reimbursement rate was rated as better in DWP by a majority of respondents.


Appendix 1: Iowa FQHC Locations

*Image provided by the Iowa Primary Care Association, Dec 2015. This map does not include non-federally qualified health centers.


Appendix 2: Dental Wellness Plan and Medicaid Survey InstrumentsNote: As this survey was administered entirely online, the formatting in the document is slightly different from the formatting in the online version.


!

! Survey of Heritage

!

Dental Wellness Plan

CHC Survey

2015

This survey is being conducted by researchers at the Public Policy Center and the College of Dentistry at the

University of Iowa.

If you have any questions or comments, please contact: Peter C. Damiano, DDS, MPH

Professor, College of Dentistry and Director, Public Policy Center

209 South Quadrangle, University of Iowa Iowa City, IA 52242-1192

(800) 710-8891 [email protected]

INSTRUCTIONS: This questionnaire is about your dental clinic’s experience with Dental Wellness Plan program. Once you begin, you can close the survey at any time and come back later, starting where you left off.

In order for the results of this study to reflect all CHC dental clinics in Iowa, it is important that we hear from you. Several questionnaire items inquire about dental clinic data; if you do not currently have access to the data, please utilize other health center staff to obtain the necessary information. However, if any question asks about information that you are unable to obtain, please skip to the next question.

Thank you in advance for your participation.


2

1. Does your clinic currently accept Dental Wellness Plan patients?

1 Yes 2 No IF NO SKIP TO Q30

2. Which best describes your clinic’s experience with the Dental Wellness Plan? 1 Very positive 2 Somewhat positive 3 Somewhat negative 4 Very negative 5 Not sure/Don’t know

3. Based on your clinic’s experiences, please read the following statements about the Dental Wellness Plan (DWP) and indicate the degree to which you disagree or agree.

Stronglydisagree Disagree Agree

Stronglyagree

Notsure/Don’tknow

WithouttheDWPprogram,theselowincomepatientswouldnotbeabletogetadequatedentalcare

TheDWPprogramrespectsdentists’professionaljudgmentconcerningpatientcare

DentistscanhaveanimpactonthepoliciesoftheDWPprogram

DentistshaveanethicalobligationtotreatDWPpatients

THE DENTAL WELLNESS PLAN

This survey is about your clinic’s experiences with the Dental Wellness Plan (DWP) in Iowa. As you are aware, the DWP is the dental portion of the Iowa Health and Wellness Plan, Iowa’s Medicaid expansion program for adults

with incomes 0-133% of the Federal Poverty Level who were not previously eligible for Medicaid. The Dental Wellness Plan began on May 1, 2014, and is administered by Delta Dental of Iowa.

3

4. Based on your clinic’s experiences, please indicate the degree to which you agree or disagree with the following statements about the Dental Wellness Plan earned benefits approach:


Stronglyagree

Notsure/Don’tknow

Theearnedbenefitsapproachisaneffectivewaytorewardpeoplewhoreturnforregularcheckups

TheearnedbenefitsapproachmakesitdifficulttoprovidecomprehensivetreatmenttoDWPpatients

Theearnedbenefitsapproachwillincreasethelikelihoodthatpatientsreturnforregularexams

TheearnedbenefitsapproachpreventsDWPpatientsfromgettingthecaretheyneedwhentheyneedit

Theearnedbenefitsapproachwillincreasethelikelihoodthatpatientstakebettercareoftheiroralhealth

EARNED BENEFITS APPROACH

For those unfamiliar with the Dental Wellness Plan benefits: The DWP uses an earned benefits approach. Members can earn additional covered benefits by going to the dentist for regular exams. There are three levels of coverage:

i. Core Benefits are available after a patient’s first dental exam. This level includes diagnostic, preventive, emergency, and stabilization services.

ii. Enhanced Benefits are available if a patient returns for a second exam 6-12 months after the first. This level includes Core Benefits plus routine restorative, endodontic care, and extractions.

iii. Enhanced Plus Benefits are available if a patient returns for a third exam 6-12 months after the second, and as long as the patient returns every 6-12 months for recall exams. This level covers Enhanced Benefits plus crowns, full and partial dentures.

Members who do not return for recall exams every 6-12 months will only be eligible for Core Benefits.


3

4. Based on your clinic’s experiences, please indicate the degree to which you agree or disagree with the following statements about the Dental Wellness Plan earned benefits approach:


Stronglyagree

Notsure/Don’tknow

Theearnedbenefitsapproachisaneffectivewaytorewardpeoplewhoreturnforregularcheckups

TheearnedbenefitsapproachmakesitdifficulttoprovidecomprehensivetreatmenttoDWPpatients

Theearnedbenefitsapproachwillincreasethelikelihoodthatpatientsreturnforregularexams

TheearnedbenefitsapproachpreventsDWPpatientsfromgettingthecaretheyneedwhentheyneedit

Theearnedbenefitsapproachwillincreasethelikelihoodthatpatientstakebettercareoftheiroralhealth

EARNED BENEFITS APPROACH

For those unfamiliar with the Dental Wellness Plan benefits: The DWP uses an earned benefits approach. Members can earn additional covered benefits by going to the dentist for regular exams. There are three levels of coverage:

i. Core Benefits are available after a patient’s first dental exam. This level includes diagnostic, preventive, emergency, and stabilization services.

ii. Enhanced Benefits are available if a patient returns for a second exam 6-12 months after the first. This level includes Core Benefits plus routine restorative, endodontic care, and extractions.

iii. Enhanced Plus Benefits are available if a patient returns for a third exam 6-12 months after the second, and as long as the patient returns every 6-12 months for recall exams. This level covers Enhanced Benefits plus crowns, full and partial dentures.

Members who do not return for recall exams every 6-12 months will only be eligible for Core Benefits.


4

5. Which best describes your clinic’s experiences with the earned benefits approach? 1 Very positive 2 Somewhat positive 3 Somewhat negative 4 Very negative 5 Not sure/Don’t know

6. Have you or your staff participated in any training activities provided by Delta Dental about the Dental Wellness Plan? (e.g., webinars) 1 Yes 2 No à Go to question 8

7. How helpful was the training in helping you or your staff understand the program better? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know

8. How helpful are communications from Delta Dental in keeping you or your staff informed of important Dental Wellness Plan updates? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know

9. How helpful are communications from Iowa Medicaid in keeping you or your staff informed of important Dental Wellness Plan updates? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know


5

10. Which best describes your clinic’s experiences with Delta Dental’s administration of the Dental Wellness Plan? 1 Very positive 2 Somewhat positive 3 Somewhat negative 4 Very negative 5 Not sure/Don’t know

11. Based on your clinic’s experiences, please read the following statements about the Dental Wellness Plan (DWP) and indicate the degree to which you disagree or agree.


Stronglyagree

Notsure/Don’tknow

ItisdifficulttoprovidecomprehensivetreatmenttoDWPpatients

DWPpatientsmakeotherpatientsfeeluncomfortableintheoffice

OralhealthproblemsofDWPpatientsaremoreseverethanthoseofotherpatients

DWPpoliciesandchangesarecommunicatedeffectivelytomyclinic

Iamconcernedabouthavingtheonlyclinic/practiceintheareathatacceptsDWPpatients

12. Which types of specialists, if any, has your clinic had trouble referring your DWP patients to? Select all that apply. 1 Oral surgeon 2 Orthodontist 3 Periodontist 4 Endodontist 5 Prosthodontist 6 None of the above


6

13. Compared to your Medicaid patients, has it been easier, the same, or more difficult to refer your clinic’s DWP patients to dental specialists (in general)? 1 Much easier 2 Somewhat easier 3 Same 4 Somewhat more difficult 5 Much more difficult

14. Does your clinic currently use the PreViser risk assessment with any of your DWP patients?

1❏ YES

If your clinic currently uses the PreViser risk assessment, please answer a-b below.

a. Do you use it with all, most, or some of your clinic’s DWP patients? 1❏ All

2❏ Most

3❏ Some

b. Below are some reasons that dentists may choose to use the PreViser risk assessment. Please type the numbers 1, 2, and 3 to indicate the three most important reasons your clinic uses it (where 1 = most important). (will appear in random order)

Reimbursement for completing it Time needed to complete it Degree of helpfulness for patient care Electronic submission Bonus pool program

Other, please describe:

Not sure/ I am not responsible for this decision.

Go to Question 15

2❏ NO If your clinic does not currently use the PreViser risk assessment, please answer a below, and then go to Question 23.

a. Below are some reasons that dentists may choose not to use the PreViser risk assessment. Please type the numbers 1, 2, and 3 to indicate the three most important reasons your clinic does not use it (where 1 = most important). (will appear in random order)

Reimbursement for completing it Time needed to complete it Degree of helpfulness for patient care Electronic submission Bonus pool program

Other, please describe:

Not sure/ I am not responsible for this decision.

Go to Question 23

PREVISER RISK ASSESSMENT

The PreViser risk assessment is an online risk assessment tool to determine the risk of oral disease of your patients.


7

15. Who in your clinic usually collects the information in the PreViser risk assessments? 1 Dentist 2 Hygienist 3 Dental Assistant 4 No one 5 Other (type in)

16. Who in your clinic usually discusses the information in the PreViser risk assessments? 1 Dentist 2 Hygienist 3 Dental Assistant 4 No one 5 Other (type in)

17. How helpful is the PreViser risk assessment in facilitating discussions with patients about their oral health? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know

18. How helpful is the PreViser risk assessment in facilitating discussions with patients about their systemic health? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know

19. How helpful is the PreViser risk assessment in facilitating communication with patients’ other health care providers? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know


8

20. How helpful would the PreViser risk assessment be to use with your clinic’s non-DWP patients? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know

21. Which best describes your clinic’s experience with the PreViser risk assessment? 1 Very positive 2 Somewhat positive 3 Somewhat negative 4 Very negative 5 Not sure/Don’t know

22. What is the most important change that could be made to improve the PreViser risk assessment?

23. Were you aware of the Dental Score questionnaire? 1 Yes 2 No à Go to question 26

24. How many of your clinic’s DWP patients have brought their Dental Score risk assessment to a dental visit? 1 All 2 Most

DENTAL SCORE QUESTIONNAIRE

The Dental Score is an online risk assessment questionnaire that patients can complete on their own to better understand their risk for oral diseases. Upon completing the questionnaire, patients are

encouraged to bring the results to their next dental visit to discuss with their provider.


9

3 Some 4 Few 5 None à Go to question 26

25. How helpful is the Dental Score in facilitating discussions with patients about their oral health? 1 Very helpful 2 Somewhat helpful 3 A little helpful 4 Not at all helpful 5 Not sure/Don’t know

26. Below are some issues that dentists may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan. (1 = No problem and 5 = Major problem) Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.Administration-related issues:

DENTAL WELLNESS PLAN MEDICAID

No Major Problem Problem


DWP is ______ than Medicaid


a. Time spent on paperwork 1 2 3 4 5 NS Better Same Worse NS

b. Denial of payment 1 2 3 4 5 NS Better Same Worse NS

c. Slow payment 1 2 3 4 5 NS Better Same Worse NS

d. Reimbursement rate 1 2 3 4 5 NS Better Same Worse NS

e. Intermittent eligibility 1 2 3 4 5 NS Better Same Worse NS

f. Difficulty of eligibility determination 1 2 3 4 5 NS Better Same Worse NS

g. Limited services covered 1 2 3 4 5 NS Better Same Worse NS

i. Fear of government investigation (e.g., chart audits)

1 2 3 4 5 NS Better Same Worse NS


10

27. Below are some patient-related issues that dentists may have with dental insurance plans. Please circle the number to indicate your opinion about the degree to which that issue is a problem in the Dental Wellness Plan, where 1 = “No problem” and 5 = “Major problem.” Then, please circle whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

DENTAL WELLNESS PLAN MEDICAID

No Major Problem Problem


DWP is ______ than Medicaid


a. Broken appointments 1 2 3 4 5 NS Better Same Worse NS

b. Complexity of patient medical history 1 2 3 4 5 NS Better Same Worse NS

c. Complexity of patient dental treatment needs 1 2 3 4 5 NS Better Same Worse NS

d. Patient non-compliance with recommended treatment 1 2 3 4 5 NS Better Same Worse NS

e. Not enough general dentists in the area accepting patients with the plan

1 2 3 4 5 NS

Better Same Worse NS

f. Ability to refer to dental specialists 1 2 3 4 5 NS Better Same Worse NS

28. Has the Dental Wellness Plan had a positive, negative, or no effect on your dental clinic’s financial health? 1 Very positive 2 Somewhat positive 3 No effect 4 Somewhat negative 5 Very negative 6 Not sure/Don’t know

29. Would you recommend DWP participation to other Iowa dentists? 1 Definitely yes 2 Probably yes 3 Probably no 4 Definitely no

YOUR CLINIC’S OVERALL EXPERIENCE AS A DWP PROVIDER

11

30. The following questions ask about your dental clinic’s experiences during the year that the Dental Wellness Plan started (2014) compared to the year before (2013).

Increased

substantially

Increasedsomewhat

Stayedthe

same

Decreasedsomewhat

Decreasedsubstantially

Thenumberofchildpatientsseekingdentalcareatourdentalclinichas:

Thedentaltreatmentneeds,onaverage,foreachchildpatienthas:

Thenumberofadultpatientsseekingdentalcareatourdentalclinichas:

Thedentaltreatmentneeds,onaverage,foreachadultpatienthas:

Ourneedfordentalclinicspacehas:

Ourneedforstaffdentistshas:

Ourneedforstaffdentalhygienistshas:

Ourneedforstaffdentalassistantshas:

CLINIC CHARACTERISTICS Finally, we would like to ask some questions about your dental clinic to identify how the Dental Wellness

Plan has affected your clinic operations.

If you do not have direct access to data for any question in this section, please utilize other health center staff to obtain this information. However, if any question asks about information that you are unable to

obtain, please skip to the next question.


11

30. The following questions ask about your dental clinic’s experiences during the year that the Dental Wellness Plan started (2014) compared to the year before (2013).

Increased

substantially

Increasedsomewhat

Stayedthe

same

Decreasedsomewhat

Decreasedsubstantially

Thenumberofchildpatientsseekingdentalcareatourdentalclinichas:

Thedentaltreatmentneeds,onaverage,foreachchildpatienthas:

Thenumberofadultpatientsseekingdentalcareatourdentalclinichas:

Thedentaltreatmentneeds,onaverage,foreachadultpatienthas:

Ourneedfordentalclinicspacehas:

Ourneedforstaffdentistshas:

Ourneedforstaffdentalhygienistshas:

Ourneedforstaffdentalassistantshas:

CLINIC CHARACTERISTICS Finally, we would like to ask some questions about your dental clinic to identify how the Dental Wellness

Plan has affected your clinic operations.

If you do not have direct access to data for any question in this section, please utilize other health center staff to obtain this information. However, if any question asks about information that you are unable to

obtain, please skip to the next question.


12

31. [only those who reported an increased substantially or increased somewhat in Q30] What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply. 01 Expand clinic hours 02 Expand existing facilities 03 Hire general dentists 04 Hire dental specialists 05 Hire dental hygienists 06 Hire dental assistants 07 Add/expand satellite clinic 08 Improve referral network 09 Expand the scope of services provided 10 None of the above

32. [only those who reported an increased substantially or increased somewhat in Q30] What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply. 01 Expand clinic hours 02 Expand existing facilities 03 Hire general dentists 04 Hire dental specialists 05 Hire dental hygienists 06 Hire dental assistants 07 Add/expand satellite clinic 08 Improve referral network 09 Expand the scope of services provided 10 None of the above

33. Does your center have one or more satellite dental clinics? 1 Yes 2 No


13

34. Please indicate the number of staff (as of May 1, 2015) at your center for the following types of dental providers employed at your clinic.

1 FTE (full-time equivalent) = 40 hours per week

MainClinic SatelliteClinic(s)

CurrentStaff(FTEs)

CurrentStaff(FTEs)

Dentists

DentalHygienists

DentalAssistants(chairside)

35. How would you best describe your dental clinic(s) during the past 12 months? 1 Too busy to treat all requesting appointments; sometimes lost patients because it took too

long to get an appointment 2 Provided care to all requesting it, but often took a long time to get an appointment 3 Provided care to all requesting it, and could see all patients in a reasonable timeframe 4 Not busy enough, could accommodate more patients 5 Clinic limited, no new patients taken

36. Are your dental clinic(s) busier, the same, or less busy compared to 12 months ago? 1 Much busier 2 Somewhat busier 3 No change 4 Somewhat less busy 5 Much less busy

37. What is the broken appointment rate for your dental clinic over the past 12 months?

%


14

38. When is your clinic’s third next available appointment for a scheduled dental visit?

This is the average length of time (in days) between the day a patient makes a request for a dental appointment and the third available appointment for a new patient comprehensive exam or a recall exam.

MainClinic SatelliteClinic(s)

days days

The next several questions will be used to compare CHC dental clinics’ operations between the year that the Dental Wellness Plan started (2014), and the year before (2013).

For centers with both main and satellite clinics, we are interested in the combined total.

39. How many total patient dental visits did your clinic(s) have in the years 2013 and 2014?

Patient dental visits refer to total encounters, recognizing that many individuals may have visited your clinic more than once.

TotalPatientDentalVisits

2013 2014


15

40. How many total unduplicated patients were served by your dental clinic(s) in the years 2013 and 2014?

Unduplicated patients refers to unique individuals seen at your clinic(s).

TotalUnduplicatedPatients

2013 2014

41. Do you believe that the Dental Wellness Plan has caused an increase, decrease, or no change in the total number of unique patients that have visited your dental clinic? 1 Major increase 2 Minor increase 3 No change 4 Minor decrease 5 Major decrease

42. Do you believe that the Dental Wellness Plan has caused an increase, decrease, or no change in the proportion of your clinic patients with insurance that covers dental services? 1 Major increase 2 Minor increase 3 No change 4 Minor decrease 5 Major decrease


16

43. In the years 2013 and 2014, approximately what percent of your total dental patients had each of the following insurance types?

%ofTotalPatients

2013 2014

Medicaid

CHIP/hawk-i

DentalWellnessPlan ---

IowaCare[Broadlawnsonly] ---

Private/CommercialInsurance

Uninsured

UnknownStatus

TOTAL 100% 100%


17

44. In the years 2013 and 2014, approximately what percent of your total dental clinic revenue came from the following sources?

%ofTotalClinicRevenue

PATIENTREVENUE 2013 2014

Medicaid

CHIP/hawk-i

DentalWellnessPlan ---

IowaCare[Broadlawnsonly]

---

Private/CommercialInsurance

Uninsured/Slidingscale/Self-Pay

NON-PATIENTREVENUE

Federalgrants(e.g.,Section330)

Stateandlocalgrants

Other(pleasedescribe)

TOTAL 100% 100%


18

45. Approximately how much was your clinic reimbursed by the Dental Wellness Plan for dental services in 2014?

$

46. What is the most important change that could be made to improve the Dental Wellness Plan?

47. We are interested in any other comments you may have about the Dental Wellness Plan.

48. Please identify the position of the person who completed this survey. 1 Dental director 2 Dental clinic manager 3 CEO 4 CFO 5 Other (write in): ___________________

You have completed all of the survey questions. Thank you for your participation and your responses will be used to improve the Dental

Wellness Plan program.


Appendix 3: Descriptive Tables

Q1: Does your clinic currently accept Dental Wellness Plan patients?

Yes 10 (90.9)

No 1 (9.1)

Total Responding 11

Q2: Which best describes your clinic’s experience with the Dental Wellness Plan?

Very positive 0

Somewhat positive 7 (70.0)

Somewhat negative 2 (20.0)

Very negative 0

Not sure/Don’t know 1 (10.0)

Total Responding 10Missing = 1

Q3_1: Based on your clinic’s experiences, please read the following statements about the Dental Wellness Plan (DWP) and indicate the degree to which you disagree or agree.

Without the DWP program, these low income patients would not be able to get adequate dental careStrongly disagree 0Disagree 2 (20.0)Agree 6 (60.0)Strongly Agree 2 (20.0)Not sure/Don’t know 0Total Responding 10

Missing = 1


The DWP program respects dentists’ professional judgment concerning patient careStrongly disagree 0Disagree 4 (40.0)Agree 5 (50.0)Strongly Agree 1 (10.0)Not sure/Don’t know 0Total Responding 10

Missing = 1



Dentists can have an impact on the policies of the DWP programStrongly disagree 1 (10.0)Disagree 1 (10.0)Agree 6 (60.0)Strongly Agree 1 (10.0)Not sure/Don’t know 1 (10.0)Total Responding 10

Missing = 1


Dentists have an ethical obligation to treat DWP patientsStrongly disagree 1 (10.0)Disagree 4 (40.0)Agree 3 (30.0)Strongly Agree 1 (10.0)Not sure/Don’t know 1 (10.0)Total Responding 10

Missing = 1

Q4_1: Based on your clinic’s experiences, please indicate the degree to which you agree or disagree with the following statements about the Dental Wellness Plan earned benefits approach:

The earned benefits approach is an effective way to reward people who return for regular checkupsStrongly disagree 0Disagree 2 (20.0)Agree 6 (60.0)Strongly Agree 2 (20.0)Not sure/Don’t know 0Total Responding 10

Missing = 1


The earned benefits approach makes it difficult to provide comprehensive treatment to DWP patientsStrongly disagree 0Disagree 1 (10.0)Agree 5 (50.0)Strongly Agree 4 (40.0)Not sure/Don’t know 0Total Responding 10

Missing = 1



The earned benefits approach will increase the likelihood that patients return for regular examsStrongly disagree 1 (10.0)Disagree 2 (20.0)Agree 3 (30.0)Strongly Agree 1 (10.0)Not sure/Don’t know 3 (30.0)Total Responding 10

Missing = 1


The earned benefits approach prevents DWP patients from getting the care they need when they need itStrongly disagree 0Disagree 3 (30.0)Agree 3 (30.0)Strongly Agree 4 (40.0)Not sure/Don’t know 0Total Responding 10

Missing = 1


The earned benefits approach will increase the likelihood that patients take better care of their oral healthStrongly disagree 2 (20.0)Disagree 3 (30.0)Agree 1 (10.0)Strongly Agree 1 (10.0)Not sure/Don’t know 3 (30.0)Total Responding 10

Missing = 1

Q5: Which best describes your clinic’s experience with the earned benefits approach?

Very positive 0



Very negative 0

Not sure/Don’t know 0

Total Responding 10

Missing = 1


Q6: Have you or your staff participated in any training activities provided by Delta Dental about the Dental Wellness Plan? (e.g., webinars)Yes 9 (90.0)

No 1 (10.0)

Total Responding 10

Missing = 1

Q7: How helpful was the training in helping you or your staff understand the program better?

Very helpful 3 (33.3)

Somewhat helpful 3 (33.3)

A little helpful 3 (33.3)

Not at all helpful 0


Total Responding 9

Missing = 2

Q8: How helpful are communications from Delta Dental in keeping you or your staff informed of important Dental Wellness Plan updates?Very helpful 4 (40.0)





Total Responding 10

Missing = 1

Q9: How helpful are communications from Iowa Medicaid in keeping you or your staff informed of important Dental Wellness Plan updates?Very helpful 1 (10.0)



Not at all helpful 2 (20.0)


Total Responding 10

Missing = 1


Q10: Which best describes your clinic’s experience with Delta Dental’s administration of the Dental Wellness Plan?Very positive 4 (40.0)



Very negative 0


Total Responding 10

Missing = 1


It is difficult to provide comprehensive treatment to DWP patientsStrongly disagree 0Disagree 3 (30.0)Agree 4 (40.0)Strongly Agree 3 (30.0)Not sure/Don’t know 0Total Responding 10

Missing = 1


DWP patients make other patients feel uncomfortable in the officeStrongly disagree 1 (10.0)Disagree 7 (70.0)Agree 0Strongly Agree 0Not sure/Don’t know 2 (20.0)Total Responding 10

Missing = 1


Oral health problems of DWP patients are more severe than those of other patientsStrongly disagree 0Disagree 3 (30.0)Agree 0Strongly Agree 6 (60.0)Not sure/Don’t know 1 (10.0)Total Responding 10

Missing = 1



DWP policies and changes are communicated effectively to my clinicStrongly disagree 0Disagree 1 (10.0)Agree 5 (50.0)Strongly Agree 1 (10.0)Not sure/Don’t know 3 (30.0)Total Responding 10

Missing = 1


I am concerned about having the only clinic/practice in the area that accepts DWP patientsStrongly disagree 1 (10.0)Disagree 6 (60.0)Agree 2 (20.0)Strongly Agree 0Not sure/Don’t know 1 (10.0)Total Responding 10

Missing = 1

Q12_1: Which types of specialists, if any, has your clinic had trouble referring your DWP patients to?

Select all that apply. Oral Surgeon 5 (50.0)Not Selected 5 (50.0)Total Responding 10

Missing = 1


Select all that apply.Orthodontist 5 (50.0)Not Selected 5 (50.0)Total Responding 10

Missing = 1


Select all that apply.Periodontist 3 (30.0)Not Selected 7 (70.0)Total Responding 10

Missing = 1


Select all that apply.Endodontist 8 (80.0)Not Selected 2 (20.0)Total Responding 10

Missing = 1



Select all that apply.Prosthodontist 3 (30.0)Not Selected 7 (70.0)Total Responding 10

Missing = 1


Select all that apply.None of the above 1 (10.0)Not Selected 9 (90.0)Total Responding 10

Missing = 1

Q13: Compared to your Medicaid patients, has it been easier, the same, or more difficult to refer your clinic’s DWP patients to dental specialists (in general)?Much easier 0

Somewhat easier 1 (10.0)

Same 3 (30.0)

Somewhat more difficult 5 (50.0)

Much more difficult 1 (10.0)

Total Responding 10

Missing = 1

Q14: Does your clinic currently use the PreViser risk assessment with any of your DWP patients?

Yes 9 (90.0)

No 1 (10.0)

Total Responding 10

Missing = 1

Q14_1_a: Do you use it with all, most, or some of your clinic’s DWP patients?

All 8 (88.9)

Most 1 (11.1)

Some 0

Total Responding 9

Missing = 2

Q14_1_b_1: Below are some reasons that dentists may choose to use the PreViser risk assessment. Please type the numbers 1, 2, and 3 to indicate the three most important reasons your clinic uses it (where 1 = most important).

1 2 3 Not selectedReimbursement for completing it 5 (55.6) 2 (22.2) 2 (22.2) 0

Total Responding 9


Missing = 2


1 2 3 Not selectedTime needed to complete it 0 1 (11.1) 0 8 (88.9)



1 2 3 Not selectedDegree of helpfulness for patient care 2 (22.2) 0 1 (11.1) 6 (66.7)



1 2 3 Not selectedElectronic submission 0 2 (22.2) 4 (44.4) 3 (33.3)Total Responding 9

Missing = 2


1 2 3 Not selectedBonus pool program 2 (22.2) 4 (44.4) 0 3 (33.3)Total Responding 9

Missing = 2


1 2 3 Not selectedOther 0 0 0 9 (100.0)Total Responding 9

Missing = 2


1 2 3 Not selectedNot sure/I am not responsible for this decision

0 0 0 9 (100.0)



Q14_2_a_1: Below are some reasons that dentists may choose not to use the PreViser risk assessment. Please type the numbers 1, 2, and 3 to indicate the three most important reasons your clinic uses it (where 1 = most important).

1 2 3 Not selectedReimbursement for completing it

0 0 0 1 (100.0)



1 2 3 Not selectedTime needed to complete it 1 (100.0) 0 0 0



1 2 3 Not selectedDegree to helpfulness for patient care 0 0 0 1 (100.0)



1 2 3 Not selectedElectronic submission 0 0 0 1 (100.0)Total Responding 1

Missing = 10


1 2 3 Not selectedBonus pool program 0 0 0 1 (100.0)Total Responding 1

Missing = 10


1 2 3 Not selectedOther 0 0 0 1 (100.0)Total Responding 1

Missing = 10



1 2 3 Not selectedNot sure/I am not responsible for this decision.

0 0 0 1 (100.0)


Q15: Who in your clinic usually collects the information in the PreViser risk assessments?

Dentist 1 (11.1)

Hygienist 3 (33.3)

Dental Assistant 4 (44.4)

No one 0

Other 1 (11.1)

Total Responding 9

Missing = 2

Q16: Who in your clinic usually discusses the information in the PreViser risk assessments?

Dentist 5 (55.6)

Hygienist 2 (22.2)

Dental Assistant 1 (11.1)

No one 1 (11.1)

Other 0

Total Responding 9

Missing = 2

Q17: How helpful is the PreViser risk assessment in facilitating discussions with patients about their oral health?Very helpful 0





Total Responding 9

Missing = 2


Q18: How helpful is the PreViser risk assessment in facilitating discussions with patients about their systemic health?Very helpful 0





Total Responding 9

Missing = 2

Q19: How helpful is the PreViser risk assessment in facilitating communication with patients’ other health care providers?Very helpful 0

Somewhat helpful 0




Total Responding 9

Missing = 2

Q20: How helpful would the PreViser risk assessment be to use with your clinic’s non-DWP patients?

Very helpful 0





Total Responding 9

Missing = 2

Q21: Which best describes your clinic’s experiences with the PreViser risk assessment?

Very positive 0



Very negative 2 (22.2)


Total Responding 9

Missing = 2


Q23: Were you aware of the Dental Score questionnaire?

Yes 3 (30.0)

No 7 (70.0)

Total Responding 10

Missing = 1

Q24: How many of your clinic’s DWP patients have brought their Dental Score risk assessment to a dental visit?All 0

Most 0

Some 1 (33.3)

Few 0

None 2 (66.7)

Total Responding 3

Missing = 8

Q25: How helpful is the Dental Score in facilitating discussions with patients about their oral health?

Very helpful 0

Somewhat helpful 0




Total Responding 1

Missing = 10

Q26_1_a: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Time spent on paperwork1 = No problem 0

2 0

3 3 (30.0)

4 4 (40.0)

5 = Major problem 2 (20.0)


Total Responding 10

Missing = 1


Q26_2_a: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Time spent on paperworkDWP is _____ than Medicaid

Better 1 (10.0)

Same 2 (20.0)

Worse 6 (60.0)


Total Responding 10

Missing = 1

Q26_1_b: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Denial of payment1 = No problem 0

2 3 (30.0)

3 1 (10.0)

4 1 (10.0)



Total Responding 10

Missing = 1

Q26_2_b: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Denial of paymentDWP is _____ than Medicaid

Better 2 (20.0)

Same 1 (10.0)

Worse 4 (40.0)


Total Responding 10

Missing = 1


Q26_1_c: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Slow payment1 = No problem 3 (30.0)

2 3 (30.0)

3 0

4 0

5 = Major problem 0


Total Responding 10

Missing = 1

Q26_2_c: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Slow paymentDWP is _____ than Medicaid

Better 4 (40.0)

Same 2 (20.0)

Worse 0


Total Responding 10

Missing = 1

Q26_1_d: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Reimbursement rate1 = No problem 3 (30.0)

2 0

3 4 (40.0)

4 3 (30.0)

5 = Major problem 0


Total Responding 10

Missing = 1


Q26_2_d: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Reimbursement rateDWP is _____ than Medicaid

Better 7 (70.0)

Same 1 (10.0)

Worse 1 (10.0)


Total Responding 10

Missing = 1

Q26_1_e: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Intermittent eligibility1 = No problem 1 (10.0)

2 0

3 0

4 4 (40.0)



Total Responding 10

Missing = 1

Q26_2_e: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Intermittent eligibilityDWP is _____ than Medicaid

Better 1 (10.0)

Same 5 (50.0)

Worse 4 (40.0)


Total Responding 10

Missing = 1


Q26_1_f: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Difficulty of eligibility determination1 = No problem 1 (10.0)

2 0

3 1 (10.0)

4 4 (40.0)



Total Responding 10

Missing = 1

Q26_2_f: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Difficulty of eligibility determinationDWP is _____ than Medicaid

Better 1 (10.0)

Same 4 (40.0)

Worse 5 (50.0)


Total Responding 10

Missing = 1

Q26_1_g: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Limited services covered1 = No problem 1 (10.0)

2 2 (20.0)

3 1 (10.0)

4 1 (10.0)



Total Responding 10

Missing = 1


Q26_2_g: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Limited services coveredDWP is _____ than Medicaid

Better 1 (10.0)

Same 4 (40.0)

Worse 5 (50.0)


Total Responding 10

Missing = 1

Q26_1_h: Below are some issues that dentist may have with the administration of dental insurance plans. Please select a number to indicate how much you think that issue is a problem in the Dental Wellness Plan.

Fear of government investigation (e.g., chart audits)1 = No problem 3 (30.0)

2 1 (10.0)

3 2 (20.0)

4 1 (10.0)



Total Responding 10

Missing = 1

Q26_2_h: Then, please select whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Fear of government investigation (e.g., chart audits)DWP is _____ than Medicaid

Better 1 (10.0)

Same 6 (60.0)

Worse 0


Total Responding 10

Missing = 1


Q27_1_a: Below are some patient-related issues that dentists may have with dental insurance plans. Please circle the number to indicate your opinion about the degree to which that issue is a problem in the Dental Wellness Plan.

Broken appointments1 = No problem 0

2 0

3 3 (30.0)

4 3 (30.0)



Total Responding 10

Missing = 1

Q27_2_a: Then, please circle whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Broken appointmentsDWP is _____ than Medicaid

Better 1 (10.0)

Same 8 (80.0)

Worse 1 (10.0)


Total Responding 10

Missing = 1

Q27_1_b: Below are some patient-related issues that dentists may have with dental insurance plans. Please circle the number to indicate your opinion about the degree to which that issue is a problem in the Dental Wellness Plan.

Complexity of patient medical history1 = No problem 0

2 0

3 3 (30.0)

4 4 (40.0)



Total Responding 10

Missing = 1

Q27_2_b: Then, please circle whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Complexity of patient medical history


DWP is _____ than Medicaid

Better 0

Same 10 (100.0)

Worse 0


Total Responding 10

Missing = 1

Q27_1_c: Below are some patient-related issues that dentists may have with dental insurance plans. Please circle the number to indicate your opinion about the degree to which that issue is a problem in the Dental Wellness Plan.

Complexity of patient dental treatment needs1 = No problem 0

2 0

3 2 (20.0)

4 4 (40.0)



Total Responding 10

Missing = 1

Q27_2_c: Then, please circle whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Complexity of patient dental treatment needsDWP is _____ than Medicaid

Better 0

Same 8 (80.0)

Worse 2 (20.0)


Total Responding 10

Missing = 1


Q27_1_d: Below are some patient-related issues that dentists may have with dental insurance plans. Please circle the number to indicate your opinion about the degree to which that issue is a problem in the Dental Wellness Plan.

Patient non-compliance with recommended treatment1 = No problem 0

2 1 (10.0)

3 2 (20.0)

4 3 (30.0)



Total Responding 10

Missing = 1

Q27_2_d: Then, please circle whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Patient non-compliance with recommended treatmentDWP is _____ than Medicaid

Better 1 (10.0)

Same 9 (90.0)

Worse 0


Total Responding 10

Missing = 1

Q27_1_e: Below are some patient-related issues that dentists may have with dental insurance plans. Please circle the number to indicate your opinion about the degree to which that issue is a problem in the Dental Wellness Plan.

Not enough general dentists in the area accepting patients with the plan1 = No problem 1 (10.0)

2 0

3 3 (30.0)

4 3 (30.0)



Total Responding 10

Missing = 1

Q27_2_e: Then, please circle whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Not enough general dentists in the area accepting patients with the plan


DWP is _____ than Medicaid

Better 2 (20.0)

Same 7 (70.0)

Worse 1 (10.0)


Total Responding 10

Missing = 1

Q27_1_f: Below are some patient-related issues that dentists may have with dental insurance plans. Please circle the number to indicate your opinion about the degree to which that issue is a problem in the Dental Wellness Plan.

Ability to refer to dental specialists1 = No problem 0

2 0

3 1 (10.0)

4 3 (30.0)



Total Responding 10

Missing = 1

Q27_2_f: Then, please circle whether you think the Dental Wellness Plan is better, same, or worse compared to Title 19 on each issue.

Ability to refer to dental specialistsDWP is _____ than Medicaid

Better 1 (10.0)

Same 3 (30.0)

Worse 6 (60.0)


Total Responding 10

Missing = 1


Q28: Has the Dental Wellness Plan had a positive, negative, or no effect on your dental clinic’s financial health?Very positive 1 (10.0)


No effect 0

Somewhat negative 0

Very negative 0


Total Responding 10

Missing = 1

Q29: Would you recommend DWP participation to other Iowa dentists?

Definitely yes 1 (10.0)

Probably yes 5 (50.0)

Probably no 3 (30.0)

Definitely No 1 (10.0)

Total Responding 10

Missing = 1

Q30_1: The following questions ask about your dental clinic’s experiences during the year that the Dental Wellness Plan started (2014) compared to the year before (2013).

The number of child patients seeking dental care at our dental clinic has:Increased substantially 0

Increased somewhat 2 (20.0)

Stayed the same 5 (50.0)

Decreased somewhat 3 (30.0)

Decreased substantially 0

Total Responding 10

Missing = 1



The dental treatment needs, on average, for each child patient has:Increased substantially 0



Decreased somewhat 0


Total Responding 10

Missing = 1


The number of adult patients seeking dental care at our dental clinic has:Increased substantially 5 (55.6)


Stayed the same 0



Total Responding 9

Missing = 2


The dental treatment needs, on average, for each adult patient has:Increased substantially 5 (55.6)


Stayed the same 0



Total Responding 9

Missing = 2



Our need for dental clinic space has:Increased substantially 2 (18.2)





Total Responding 11


Our need for staff dentists has:Increased substantially 4 (36.4)





Total Responding 11


Our need for staff dental hygienists has:Increased substantially 5 (45.5)





Total Responding 11



Our need for staff dental assistants has:Increased substantially 5 (45.5)





Total Responding 11

Q31_1: [only those who reported an increased substantially or increased somewhat in Q30]

What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Expand clinic hours 2 (18.2)Not Selected 9 (81.8)Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Expand existing facilities 0

Not Selected 11 (100.0)

Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Hire general dentists 3 (27.3)


Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Hire dental specialists 0


Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Hire dental hygienists 6 (54.5)



Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Hire dental assistants 5 (45.5)


Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Add/expand satellite clinic 0


Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Improve referral network 1 (9.1)


Total Responding 11


What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.Expand the scope of services provided 2 (18.2)


Total Responding 11



What changes have you already made in the last 12 months to accommodate this increased demand for dental care? Select all that apply.None of the above 3 (27.3)


Total Responding 11


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Expand clinic hours 0


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Expand existing facilities 1 (10.0)


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Hire general dentists 2 (20.0)


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Hire dental specialists 2 (20.0)


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Hire dental hygienists 3 (30.0)



Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Hire dental assistants 5 (50.0)


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Add/expand satellite clinic 3 (30.0)


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Improve referral network 2 (20.0)


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.Expand the scope of services provided 2 (20.0)


Total Responding 10

Missing = 1


What changes are you considering making in the following 12 months to accommodate this increased demand for dental care? Select all that apply.None of the above 2 (20.0)


Total Responding 10

Missing = 1


Q33: Does your center have one or more satellite dental clinics?

Yes 3 (27.3)

No 8 (72.7)

Total Responding 11

Q34_1: Please indicate the number of staff (as of May 1, 2015) at your center for the following types of dental providers employed at your clinic. 1 FTE (full-time equivalent) = 40 hours per week

Main ClinicDentists 1-2 2.5-3 3.5-5 Total Responding

N (%) 6 (54.6) 3 (27.3) 2 (18.2) 11

Mean (SD) 2.57 (1.35)

Median 2.0

Range 1.0-5.0

Q34_1_2: Please indicate the number of staff (as of May 1, 2015) at your center for the following types of dental providers employed at your clinic. 1 FTE (full-time equivalent) = 40 hours per week

Satellite Clinic(s)Dentists .5-1 Not Selected Total Responding

N (%) 3 (27.3) 8 (72.7) 11

Mean (SD) 0.87 (0.2)

Median 1.0

Range 0



Main ClinicDental Hygienists .5-1 1.5-2 2.5-3 Total Responding

N (%) 5 (45.5) 1 (9.1) 5 (45.5) 11

Mean (SD) 1.89 (1.03)

Median 1.7

Range 0.5-3.0


Satellite Clinic(s)Dental Hygienists .2 1 Not Selected Total Responding

N (%) 1 (9.1) 1 (9.1) 9 (81.8) 11

Mean (SD) 0.6 (0.6)

Median 0.6

Range 1


Main ClinicDental Assistants (chair side)

1-5 6-10 Above 10 Total Responding

N (%) 4 (36.4) 5 (45.5) 2 (18.2) 11

Mean (SD) 6.2 (3.4)

Median 6.0

Range 11


Satellite Clinic(s)Dental Assistants (chair side)

1-2 Above 3 Not Selected Total Responding

N (%) 2 (18.2) 1 (9.1) 8 (72.7) 11

Mean (SD) 2.1 (0.9)

Median 2.0

Range 2


Q35: How would you best describe your dental clinic(s) during the past 12 months?

Too busy to treat all requesting appointments; sometimes lost patients because it took too long to get an appointment

5 (45.5)

Provided care to all requesting it, but often took a long time to get an appointment

3 (27.3)

Provided care to all requesting it, and could see all patients in a reasonable timeframe

2 (18.2)

Not busy enough, could accommodate more patients 0

Clinic limited, no new patients taken 1 (9.1)

Total Responding 11

Q36: Are your dental clinic(s) busier, the same, or less busy compared to 12 months ago?

Much busier 4 (36.4)

Somewhat busier 6 (54.5)

No change 1 (9.1)

Somewhat less busy 0

Much less busy 0

Total Responding 11

Q37: What is the broken appointment rate for your dental clinic over the past 12 months? Mean (SD), Minimum, Maximum of responding

Under 10% 11-20% 21-30% 31-40% Total Responding

N (%) 1 (10.0) 6 (60.0) 2 (20.0) 1 (10.0) 10

Mean (SD) 20.3 (8.3)

Median 20.0

Range 7.0-40.0

Missing = 1

Q38_1: When is your clinic’s third next available appointment for a schedule dental visit?

Main ClinicUnder 15 days 15-40 days 40-55 days 55(+) days Total

RespondingN (%) 6 (60.0) 1 (10.0) 1 (10.0) 2 (20.0) 10

Mean (SD) 25.0 (21.9)

Median 12.5

Range 7.0-60.0

Missing = 1


Q38_1: When is your clinic’s third next available appointment for a schedule dental visit?

Main Clinic14 days or less 15-28 days 29-42 days 43-56 days Greater than

57 daysTotal Re-sponding

N (%) 6 (60.0%) 1 (10.0%) 0 1 (10.0%) 2 (20.0%) 10Mean (SD) 25.0 (21.9)Median 12.5Range 7.0-60.0

Missing = 1

Q38_2: When is your clinic’s third next available appointment for a scheduled dental visit?

Satellite Clinic(s)Under 15 days 15-20 days Total Responding

N (%) 2 (66.6) 1 (33.3) 3

Mean (SD) 12.67 (8.08)

Median 14.0

Range 4.0-20.0

Missing = 8

Q39_1: How many total patient dental visits did your clinic(s) have in the years 2013 and 2014?

20135,000 - 9,999 10,000 - 14,999 15,000 - 19,999 20,000 and over Total

RespondingN (%) 2 (28.6) 2 (28.6) 1 (14.3) 2 (28.6) 7

Mean (SD) 14,386 (5,680)

Median 14,460

Range 5,656-20,505

Missing = 4

Q39_2: How many total patient dental visits did your clinic(s) have in the years 2013 and 2014?

20145,000 - 9,999 10,000 - 14,999 15,000 - 19,999 20,000 and over Total

RespondingN (%) 2 (33.4) 2 (33.4) 0 2 (33.4) 6

Mean (SD) 13,370 (6,137)

Median 12,865

Range 5,693-20,390

Missing = 5


Q40_1: How many total unduplicated patients were served by your dental clinic(s) in the years 2013 and 2014?

20130 - 4,999 5,000 - 9,999 10,000 - 14,999 Total Responding

N (%) 1 (16.7) 4 (66.7) 1 (16.7) 6

Mean (SD) 7,395 (3,130)

Median 8,124

Range 2,633-11,312

Missing = 5

Q40_2: How many total unduplicated patients were served by your dental clinic(s) in the years 2013 and 2014?

20140 - 4,999 5,000 - 9,999 Total Responding

N (%) 1 (16.7) 5 (83.4) 6

Mean (SD) 6,788 (2,602)

Median 6,901

Range 2,697-9,301

Missing = 5

Q41: Do you believe that the Dental Wellness Plan has caused an increase, decrease, or no change in the total number of unique patients that have visited your dental clinic?Major increase 2 (22.2)

Minor increase 6 (66.7)

No change 1 (11.1)

Minor decrease 0

Major decrease 0

Total Responding 11

Q42: Do you believe that the Dental Wellness Plan has caused an increase, decrease, or no change in the proportion of your clinic patients with insurance that covers dental services?Major increase 3 (33.3)

Minor increase 5 (55.6)

No change 1 (11.1)

Minor decrease 0

Major decrease 0

Total Responding 11


Q43: In the years 2013 and 2014, approximately what percent of your total dental patients had each of the follow-ing insurance types?

2013 2014

Mean (SD) Median Range Mean (SD) Median Range

Medicaid 54.0 (22.3) 60 25.0-86.0 49.5 (22.5) 48.0 23.0-85.0

CHIP/hawk-i 3.3 (2.4) 2.0 0-6.0 2.4 (1.9) 2.0 0-5.0

Dental Well-ness Plan - - - 15.9 (17.1) 8.0 0-48.0

IowaCare [Broadlawns only]

53 - - - - -

Private/ Com-mercial Insur-ance

13.3 (7.8) 15.0 3.0-25.0 15.1 (9.5) 11.0 4.0-25.0

Uninsured 21.6 (15.96) 20.0 4.0-50.0 12.6 (7.3) 12.0 4.0-25.0

Unknown Status 0.33 (.52) 0 0-1.0 0.14 (0.378) 0 0-1.0

Q43_1_1: In the year 2013, approximately what percent of your total dental patients had each of the following insurance types?

Medicaid20-39% 2 (28.6)

40-59% 1 (14.3)

60-79% 3 (42.9)

Above 80% 1 (14.3)

Total Responding 7

Missing = 4


CHIP/hawk-i0 1 (14.3)

1-3% 3 (42.9)

4-6% 3 (42.9)

Total Responding 7

Missing = 4



Private/Commercial Insurance1-9% 2 (28.6)

10-19% 4 (57.2)

Above 20% 1 (14.3)

Total Responding 7

Missing = 4


Uninsured1-9% 1 (14.4)

10-19% 2 (28.6)

20-29% 2 (28.6)

30-39% 1 (14.3)

40-50% 1 (14.3)

Total Responding 7

Missing = 4


Unknown Status0 4 (66.7)

1% 2 (33.3)

Total Responding 6

Missing = 5


Medicaid20-39% 2 (28.6)

40-59% 3 (42.9)

60-79% 1 (14.3)

Above 80% 1 (14.3)

Total Responding 7

Missing = 4


CHIP/hawk-i


0 1 (14.3)

1-2% 4 (57.2)

3-5% 2 (28.6)

Total Responding 7

Missing = 4


Dental Wellness Plan 0 2 (28.6)

1-9% 2 (28.6)

10-19% 0

20-29% 2 (28.6)

30-39% 0

Above 40% 1 (14.3)

Total Responding 7

Missing = 4


Private/Commercial Insurance 1-9% 2 (28.6)

10-19% 2 (28.6)

Above 20% 3 (42.9)

Total Responding 7

Missing = 4


Uninsured1-9% 2 (28.6)

10-19% 4 (57.2)

Above 20% 1 (14.3)

Total Responding 7

Missing = 4


Unknown Status0 6 (85.7)


1% 1 (14.3)

Total Responding 7

Missing = 4

Q44: In the year 2013 and 2014, approximately what percent of your total dental clinic revenue came from the following sources?

PATIENT REV-ENUE

2013 2014


Medicaid 68.5 (9.3) 66.5 61.0-80.0 59.8 (12.2) 54.0 53.0-78.0

CHIP/ hawk-i 2.0 (1.6) 2.0 0-4.0 1.8 (2.2) 1.0 0-5.0

Dental Well-ness Plan - - - 12.3 (11.1) 11.0 0-27.0

IowaCare [Broadlawns only]

0 0 0 - - -

Private/ Com-mercial Insur-ance

13.3 (5.5) 16.0 5.0-16.0 12.5 (4.7) 14.0 6.0-16.0

Uninsured/ Sliding scale/Self-Pay

14.0 (9.1) 16.5 2.0-21.0 11.8 (8.5) 12.5 3.0-19.0

Q44: In the year 2013 and 2014, approximately what percent of your total dental clinic revenue came from the following sources?

NON-PATIENT REVENUE

2013 2014


Federal grants (e.g., Section 330)

2.0 (4.0) 0 0-8.0 1.8 (3.5) 0 0-7.0

State and local grants 0.25 (0.5) 0 0-1.0 0.25 (0.5) 0 0-1.0

Other (please describe)__ 0 0 0 0 0 0


Q44_1_1: In the year 2013, approximately what percent of your total dental clinic revenue came from the following sources?

Patient Revenue - Medicaid60-69% 2 (50.0)

70-79% 1 (25.0)

Above 80% 1 (25.0)

Total Responding 4

Missing = 7


Patient Revenue – CHIP/hawk-i0 1 (25.0)

1-2% 2 (50.0)

3-4% 1 (25.0)

Total Responding 4

Missing = 7


Patient Revenue – IowaCare [Broadlawns only]0 4 (100.0)

Total Responding 4

Missing = 7


Patient Revenue – Private/Commercial Insurance1-9% 1 (25.0)

10-19% 3 (75.0)

Total Responding 4

Missing = 7



Patient Revenue – Uninsured/Sliding scale/Self-Pay1-9% 1 (25.0)

10-19% 1 (25.0)

Above 20% 2 (50.0)

Total Responding 4

Missing = 7


Non-Patient Revenue – Federal grants (e.g., Section 330)0 3 (75.0)

1-10% 1 (25.0)

Total Responding 4

Missing = 7


Non-Patient Revenue – State and local grants0 3 (75.0)

1% 1 (25.5)

Total Responding 4

Missing = 7


Non-Patient Revenue – Other 0 4 (100.0)

Total Responding 4

Missing = 7


Patient Revenue - Medicaid 50-59% 3 (75.0)

60-69% 0

Above 70% 1 (25.0)

Total Responding 4

Missing = 7



Patient Revenue – CHIP/hawk-i 0 1 (25.0)

1-3% 2 (50.0)

3-5% 1 (25.0)

Total Responding 4

Missing = 7


Patient Revenue – Dental Wellness Plan0 1 (25.0)

1-9% 0

10-19% 2 (50.0)

20-29% 1 (25.0)

Total Responding 4

Missing = 7


Patient Revenue – Private/Commercial Insurance 1-9% 1 (25.0)

10-19% 3 (75.0)

Total Responding 4

Missing = 7


Patient Revenue – Uninsured/Sliding scale/Self-Pay1-9% 2 (50.0)

10-19% 2 (50.0)

Total Responding 4

Missing = 7



Non-Patient Revenue – Federal grants (e.g., Section 330) 0 3 (75.0)

1-10% 1 (25.0)

Total Responding 4

Missing = 7


Non-Patient Revenue – State and local grants 0 3 (75.0)

1% 1 (25.5)

Total Responding 4

Missing = 7


Non-Patient Revenue – Other 0 4 (100.0)

Total Responding 4

Missing = 7

Q45: Approximately how much was your clinic reimbursed by the Dental Wellness Plan for dental services in 2014?$496.00 1 (25.0)

$7,000 1 (25.0)

$216,000 2 (50.0)

Total Responding 4

Missing = 7

Q45: Approximately how much was your clinic reimbursed by the Dental Wellness Plan for dental services in 2014?

0 $496 $7,000 $216,0000 Total Responding

N (%) 2 (33.3) 1 (16.7) 1 (16.7) 2 (33.3) 6

Mean (SD) $109,874 (122,572)

Median $111,500

Range $496-$216,000

Missing = 5


Q48: Please identify the position of the person who completed this survey.

Dental director 8 (88.9)

Dental clinic manager 1 (11.1)

CEO 0

CFO 0

Other (write in): 0

Total Responding 9

Missing = 2


Documents

Evaluation of the Dental Wellness Plan Community …Dental Clinic Characteristics • CHC dental clinics employed an average of 2.8 full-time-equivalent (FTE) dentists, 2 FTE dental