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CareSource will monitor patients behavior: preventive accomplishments, dentist utilization, expenses, patients only seen for emergencies, etc. Here is my unsubstantiated estimate: Cost Estimate A. First year start up 1. Space renovation plumbing, electrical, operatories, reception area, business office 2.
Supplies Total B. Following years 1. Annual rent for space 2. Miscellaneous inflation, staff raises, etc. Emergency fees for dentistry at UVMC emergency room 5. Donated money from community United Way, personal donations, etc. This can be completed by following the formula: 1. Enhance Medicaid payments to HealthPark 2. CareSource in partnership with HealthPark and the state of Ohio 2. Accept treatment approach using a small isolated clinic HeathPark to evaluate the concept.
Explanation of preventive approach for dentists b. Explanation of preventive approach for general population c. Staff training in preventive approach 5. CareSource, State of Ohio and Jill develop computer software to decide what to track and how 6. Begin seeing patients 7. Miami County Chris Cook, county health commissioner work with us to refer patients to us a. Schools; school nurses b.
WIC c. Others 8. Notify emergency rooms, local physicians 9. If we max out our resources a. Emergencies that day b.
Treatment as schedules allow Work out problems through regular meetings with CareSource and the Miami County Health Department being our best resources for patient feedback. End of First Year 1. Annual cost to operate b. Statistical profile: i. Numbers of emergency patients seen ii. They will fall into 2 groups: 1.
We would refer them if they choose to another office that accepts Medicaid. Again, 2 groups: 1. Each of our 3 hygienist lead teams are assigned a portion of our Medicaid patients. We will track the success of each team. Evaluate statistical results, compare to county clinic, decide whether to: a. Stop project b.
Needs to develop a more extensive statistical base 2nd year HealthPark Beta site only c. Enlarge Beta site to entire county of dentists When expand proposal to County Pre-expansion 1. The American Dental Association has a similar program. Exhibit E 2. Due to the present economy, all dentists in Miami County have excess capacity and may be amenable to supporting this program making the clinic unnecessary. Local dentist involvement would allow more Medicaid patients to be seen in their local communities, which will reduce no shows as transportation becomes less of an issue.
CareSource expands software to track results for all dentists After Expansion 1. Focus on developing at least one dentist to participate in each community so travel distance is no longer a problem. Create recognition system for participating Dentists newspapers, online, etc. County Dental Clinic a. Divert all community support funds from the clinic to the County Health Department to fund preventive dental activities in the county.
Allow the clinic to operate as all other dental offices in the county who choose to treat Medicaid patients. Use CareSource statistical analysis and patient questionnaires to evaluate prevention effectiveness and reward effective offices with 2nd or 3rd tier dental fee schedules.
Following Year 1. State of Ohio evaluate if successful, offer to replace current system in Ohio 2. Evaluate a new system to improve dental coverage for nursing homes. Question: Who is responsible for the statistical tracking to determine if this program is successful? Answer - Jill Nesbitt will consult to help with statistical management if needed, requires significant time by CareSource with oversight by the State of Ohio. Question: How will other dentists be involved past HealthPark?
The initial series of visits to prepare the patient to receive the limited restorative care is much more time consuming and low fee than they could make up in the limited restorative portion. Question: Is this too much of a radically different approach that dentists and dental organizations may not feel it can work?
Answer This is based on my observations of the overall dental health of the poor and similar observations by other dentists around the country. Question How will you keep a patient motivated between 6 month cleaning interventions? No funds will be expended to artificially support these patients any more than private pay patients pay us to support them between cleanings.
Question With poor transportation resources, how will these patients be able to reach us with only 24 hour notice? Answer I had not considered this. In other words, involve our communities in helping the poor.
Answer 1. Would evening and Saturday pre-booked appointments be available for them? However, we should attempt to track the number of patients that this truly eliminates from the program. However, I do wonder how they qualify for Medicaid and work 40 hours every week. Thought When new patients are added to the call list, they should include information on days available and how many minutes it will take them to reach us. Question Can an assistant legally chart and receive a fee for providing this service?
Answer No. This is illegal in Ohio. This is the standard legal approach. Answer Yes. With this approach, we would focus our limited resources on those who demonstrate the interest and ability to have a healthy mouth while providing emergency care only to those whose dental disease is out of control.
Fortunately, there should be fewer and fewer in this group. Question What happens when a patient disagrees with the treatment provided? Answer CareSource offers the patient a series of options switch providers, appeal decisions, file a grievance if quality of care is an issue, a state hearing, even a lawsuit. However, where quality of care is not the issue, the county Health Department could be a good resource to gather general feedback on how the patients feel about their experience at HealthPark.
Question I know Medicaid patients. They will never make it through their HealthPark letter setting the ground rules for their behavior at HealthPark. What do you think? Answer They would be given this letter Exhibit I at the emergency visit where staff would provide a brief overview.
When they return for future steps at HealthPark, they would be coached in what comes next. Remember, this program is designed to select and help primarily those who want to improve their dental health. Answer Dentistry is just a small part of the healthcare budget.
This approach could require exemptions from federal funding requirements, and the State had enough money to pay for clinics and continue cheap fixes. Due to the many pressing concerns in the State of Ohio, it was easier to ignore this problem than to spend the energy to change the entrenched system.
Question Why do you think this time will be different? There is simply not enough money available to continue propping up a failed system. Answer Under the existing program, the dentist has complete responsibility and authority to decide what dentistry to do. Some of her duties would be: 1. Disease prevention education and oral hygiene instruction 3. Tobacco cessation 4. Dietary counseling 5. Fluoride applications 6.
Sealant applications 7. Coronal polishing for all patients 8. Scaling for periodontal Type I gingivitis patients F. Coordination with Schools Most child screening programs have led to frustration by the examiners.
A significant percent of the children examined do not receive needed dental treatment. These children would be tracked to build a statistical base to evaluate success. This questionnaire will help you decide how frequently you need to see us for a cleaning.
We only need to see our healthiest patients once a year x-rays every 2 years. Name: Risk factor Reduced Risk 1 How many times a day do you eat sugary foods? Do you have dry mouth for other reasons? How many times do you eat each day?
Have you had an in-office fluoride gel or varnish in the last year? Do you use prescription strength fluoride toothpaste?
Do you have sealants in the grooves of your back teeth? How many times do you brush daily? Diagnodent Readings by dentist 21 Do you use an Electric Toothbrush? Number Fillings Between Teeth ask dentist 23 -3 Once and bedtime -2 5 times per wk. How does drinking and snacking on sugary things between meals affect my risk? A strong acid 5. See graphs below. Physical or mental disabilities make it more difficult for the person to keep their teeth clean.
Over medications cause dry mouth. Saliva is needed to wash your teeth. Vitamins are not considered a medication. What does saliva do? Saliva dilutes mouth acid. Saliva also contains small particles of calcium and phosphate that help rebuild teeth that start to decay. Research in proved that all foods, not just sugar, will lower the ph of your mouth which increases your risk of decay 7. The more fillings between your teeth, the harder it is for even floss to clean between your teeth. Appliances trap food and bacteria around your teeth which increases the acid level and potential for decay.
This fluoride protection even helps adults not only for decay, but in reducing osteoporosis! It takes food and bacteria 24 hours to organize into acid forming plaque. The more frequently you brush, the less chance this acid will form. How often should I be seen for cleanings? Dentists needed to see patients every 6 months to put in fillings or pull teeth to keep up with the decay. Today, with good dental health, we only need to see our healthy patients once yearly and x-rays every 2 years.
Instrument that uses intense light to determine depth of decay. Decay only in the enamel does not need a filling. Xylitol is a naturally occurring sugar that reduces plaque acid formation. It is much more cost effective to pay the dentists for services rendered in their own offices that are conveniently located to all dentally underserved residents, than to build a central clinic, as the one that opened in Miami County in and Shelby County in During the first year, only the dentists at HealthPark would participate.
Our pediatric dentist, oral surgeon, and periodontist will participate at our standard general dentist fees rather than using their specialty higher fee schedule. By either the second or third year, we should be ready to enlarge this trial to all Miami County dentists. Smith, and Dave Herbenick would attend a dental society meeting, using the new audiovisuals to explain the concept and enlist support. The outline of the presentation would include: 1.
Dentists would be compensated only for the CareSource patients in Miami County. Dentists would be allowed to limit how many Medicaid patients they are willing to see.
Dentists will initially be paid at the lowest of the 3 tiers of the fee schedule and this will be reevaluated the second year. A CareSource representative will make a presentation at a Western Ohio Dental Society meeting and then visit each interested dentist to discuss participation. The advantages to the dentist: a. If a patient fails on appointment, the patient will be warned, placed on the bottom of the waiting list.
After a second failed appointment, they are dismissed from the practice. Exhibit G d. Dentists will be helping the less fortunate and fulfilling their civic responsibility e. Explain the 3 tiered reimbursement system. This would significantly improve dentist participation. We will help you learn the newest ways to stop decay and gum disease. Once you stop your decay and gum disease, the cost of an annual cleaning and exam with no need for expensive repairs makes the cost of dentistry so low that it will fit into your budget once you no longer have Medicaid assistance.
Expect to wait several weeks for your name to reach the top of the list. At your first visit, we will show you the newest ways to control decay and gum disease.
At your second appointment, we will clean your teeth and evaluate how well you are keeping your mouth healthy. If your mouth is not clean, then we will not schedule you to fix your teeth. You can go to another dental office.
If your mouth is clean, we will set up a third appointment for a thorough exam and a discussion with a dentist on your dental problems. However, we will offer you these opportunities if they become available on short notice. Be on time or 5 minutes early for every appointment. We will place you on our call list. It may be weeks before you will be contacted for another appointment.
Due to our limited space, please do not bring more than two others to the office for your appointment. If more than this comes, we will not be able to treat you and this will count as a broken appointment. In 6 months, we will call you back for another cleaning and exam. If your mouth is not clean and healthy we will only provide emergency extractions. This cycle will be repeated until all your problems are treated. Then all you will need is regular 6 month cleanings. You may go to any other Medicaid provider who will see you, if you want, at any time, but to be part of our study, you should only come to our dentists at HealthPark.
You may decide to visit another office to complete any unfinished treatment. Have this office contact us for a copy of your remaining treatment and x-rays. If your mouth is not clean, you will not receive any money to have your teeth fixed, but we will call you in 6 months for another cleaning and exam. If your mouth is clean at the next cleaning, you can enter our program.
In time, you will stop your decay and gum disease. No more painful teeth, expensive fixes, just 2 cleanings per year. Many healthy patients only need 1 cleaning appointment annually. When you are healthy, you will not need other, more expensive dental care! In , Rep. Our state government will track the results of this experiment for several years. If this improves the dental health of the patients involved at a lower cost, this program may replace the current system.
If you have any questions, complaints, or good ideas to make our pilot program even better, please call us at or the Miami County Health Department Long waits in the reception room 2.
Not told why you get treatment 4. Not given a choice of treatment 5. Never shown how to stop decay and gum disease Now there is a better way A Better Way We will treat you like a real person. First - A caring staff member will review your medical health history and show you the newest ways to stop decay and gum disease. She will give you everything you need to use to be healthy and then take dental x-rays. She will clean your teeth and a dentist will examine your mouth.
You and your dentist will discuss how best to use this treatment money. In 6 months, you can return for a dental cleaning and check up. The current RRF is built around an open governmental checkbook that pays for cheap, quick, unsupervised fixes that are easy for administrators to monitor. My proposal is designed to promote behavioral change among the recipients and reward those both dentists and patients that demonstrate improved dental health with funding over time to support the gradual, continuous improvement of their dental health while only providing emergency, medically necessary care to those not interested in improving their dental health although they would be offered alternative dental locations The fact is that continually repairing, over and over, the same diseased mouths of those not controlling their dental disease bleeds off a significant amount of funding that could be used to support the behavioral change of those who are or are learning to become dentally healthy.
The dentists that are geared to provide lots and lots of cheap quick fixes are not geared to build relationships to improve the dental health of their patients and will drop out over time.
However, the significant majority of currently practicing general dentists have built their practices around developing just this type of relationship with their patients to improve their health. They will now have an economic incentive to participate. After all, being healthy is cheaper.
The following chart compares the current RRF approach with my dental proposal. Comparison of My Beta site to the Medical Home Approach Medicine began years ago to reorient physicians to develop a relationship based approach with their Medicaid patients where they assume the role of a trusted advisor who cares about the well being of the patient and helps guide them toward a healthier life style.
Obviously, since insurance companies and hospitals have pushed medicine in the opposite direction see more disease, find more billable codes to report and get paid more , this will be a wrenching change. However, medicine has one basic advantage over dentistry. The medical approach is primarily to heal disease while, dentistry primarily cuts it out.
An example is: 1. Patient visits her physician with a rash on her arm. After appropriate exam, and diagnosis, medication s are prescribed to heal the rash. If this same patient went to see a dentist with decay in a tooth, the dentist would cut out the diseased portion of the tooth and patch the resulting hole.
Now reverse their roles: 1. Patient comes in to see the physician with the arm rash and the physician tells her he has a few minutes, and, if convenient, he can cut her arm off. Would she like gold, or some of our new lifelike composites, for her replacement arm? Patient with decay visits her dentist. He tells her, after his diagnosis, that he will need to cut her tooth down for a cap.
Would she like a gold or lifelike porcelain cap? Happens everyday. Your Medical Home approach is trying to emulate the client centered approach that dentistry began in earnest 20 years ago and has developed very well. Unfortunately, government and insurance companies reward dentists for surgical procedures not for healing the disease.
It will take many years to reorient medicine into this new people centered approach. In the process, you will reduce several medical problems that dental plaque exacerbates heart disease, diabetes, early oral cancer detection, preterm deliveries. I believe that my proposal shows you how a working model Dental Home can be organized and placed into operation within years. I have included my understanding of the medical home model and how my Dental Home model compares.
The added bonus is that a healthy mouth reduces the risk of diabetes, heart disease, preterm deliveries, etc. There will be no money wasted on patients with unhealthy mouths that generate continual more decay. People with poor dental health will B. Limited Care focused on: 1. Dentists will now have the time develop new dental disease everyC. Promoting improved health to build health improvement year with or without fixes.
This D. Those with acute painful infections will still be treated quickly. Every decayed area a dentist C. Not every spot of decay needs A healthy mouth has no active thinks he sees should be fixed. Some can be healed. Little effort or compensation to What about gum disease?
Small areas of decay will progress slowly or not at all in a healthy mouth. Attract dentists that have 42 D. Any Dentist willing to fix cheap is welcome Current Policy Promotes practices that are organized to fix lots of teeth cheaply and quickly. Effect D. Proposed Policy Effect E. Burdens hospital emergency E. Eliminate emergency room rooms with Medicaid patients with coverage no reimbursement acute painful problems even needed.
All Medicaid patients when they arrive at the emergency room will be offered a list of dentists who participate initially HealthPark and assured we provide extended coverage and are encouraged to contact HealthPark. Treatment Children are allowed to continue with dental disease, being treated continually for fixes.
A preventive approach to the dental Medicaid population must include children. Engaged Leadership 1. Leadership by case manager 2. Quality Improvement Strategy 1. Data collection to determine opportunities for improvement.
Record criteria by a. Involvement of patient, family, and staff documented in computer file 4. Patient satisfaction surveys 5. Including staff in all aspects of data collection, improvement planning and implementation. Maintain written policies on operational processes. Hygienist manages the team chairside, secretary 2. General dentists is the hub.
Dental speciatlists, nutritionists, etc. Data collection the same 2. Record criteria a. Patient involvement documented in paper work, not organized for computer yet, but we have an excellent tracking system.
Already using patient surveys part of our strategic plan 5. Data collection is part of our Baldrige Training state level awards for organizational excellence only practice in Ohio 6. Problems tracked, recorded, collated, discussed, and dealt with at weekly meetings. Major problems discussed at strategic 41 planning session at 6 month intervals.
You must reach your deductible before the insurance company pays its share. Deductibles vary for individual and family plans. Usually, a plan with lower monthly premiums will have a higher copay. Compare out-of-pocket maximums: An out-of-pocket maximum is the most you can expect to pay per year, per person. Out-of-pocket maximums are how insurance companies share the cost of care with policyholders.
Check insurer ratings: Before buying a health insurance plan, be sure to check ratings from reputable sources, including AM Best, J. Specifically, look at the types of complaints filed against the company.
Are they related to coverage? Cost of the plan? Tammy Burns. Medicare Advantage Plans in Alabama. Alaska Medicaid. Arkansas Medicaid. California Medicaid. Colorado Medicaid. Anthem ConnectiCare Benefits, Inc. ConnectiCare Insurance Company. Connecticut Medicaid. Delaware Medicaid. Florida Medicaid. Idaho Medicaid.
Illinois Medicaid. Kansas Medicaid. Kentucky Medicaid. Louisiana Medicaid. Maryland Medicaid. Massachusetts Medicaid. Minnesota Medicaid. Montana Medicaid. Nebraska Medicaid. New Hampshire. New Jersey. New Jersey Medicaid. New Mexico Medicaid. New York State Medicaid. North Carolina. North Dakota. North Dakota Medicaid. Oregon Medicaid. Pennsylvania Medicaid. Rhode Island. Rhode Island Medicaid.
South Carolina. South Dakota. TennCare Medicaid.
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WebJan 14, · CareSource verifies that there are no outstanding fraud, waste and abuse issues as well as no internal quality concerns. For Pharmacy Selection - Note: Due to State Law and Medicaid requirements, members must have a referral from their healthcare provider (physician, nurse practitioner, or physician assistant) before a pharmacist may . Web1 day ago · My CareSource ® is a secure online account for CareSource ® members. *My CareSource features and experience may vary by plan or program. Not all tools listed . WebJan 14, · CareSource verifies that there are no outstanding fraud, waste and abuse issues as well as no internal quality concerns. For Pharmacy Selection - Note: Due to .