Dataset Information

Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States.

ABSTRACT: OBJECTIVE:To quantify the impact of multiyear utilization of preventive dental services on downstream dental care utilization and expenditures for children. DATA SOURCES/STUDY SETTING:We followed 0.93 million Medicaid-enrolled children who were 3-6 years old in 2005 from 2005 to 2011. We used Medicaid claims data of Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Texas. STUDY DESIGN:We clustered each state's study population into four groups based on utilization of topical fluoride and dental sealants before caries-related treatment using machine learning algorithms. We evaluated utilization rates and expenditures across the four groups and quantified cost savings of preventive care for different levels of penetration. DATA EXTRACTION METHOD:We extracted all dental-related claims using CDT codes. PRINCIPAL FINDINGS:In all states, Medicaid expenditures were much lower for children who received topical fluoride and dental sealants before caries development than for all other children, with a per-member per-year difference ranging from $88 for Alabama to $156 for Mississippi. CONCLUSIONS:The cost savings from topical fluoride and sealants across the six states ranged from $1.1M/year in Mississippi to $12.9M/year in Texas at a 10 percent penetration level. Preventive dental care for children not only improves oral health outcomes but is also cost saving.

SUBMITTER: Lee I

PROVIDER: S-EPMC6153169 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States.

Lee Ilbin I Monahan Sean S Serban Nicoleta N Griffin Paul M PM Tomar Scott L SL

Health services research 20171130 5

<h4>Objective</h4>To quantify the impact of multiyear utilization of preventive dental services on downstream dental care utilization and expenditures for children.<h4>Data sources/study setting</h4>We followed 0.93 million Medicaid-enrolled children who were 3-6 years old in 2005 from 2005 to 2011. We used Medicaid claims data of Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Texas.<h4>Study design</h4>We clustered each state's study population into four groups based on util ...[more]

PMID: 29194610

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Project description:ImportanceThere is a recommendation for children to have a dental home by 6 months of age, but there is limited evidence supporting the effectiveness of early preventive dental care or whether primary care providers (PCPs) can deliver it.ObjectiveTo investigate the effectiveness of preventive dental care in reducing caries-related treatment visits among Medicaid enrollees.Design, setting, and participantsHigh-dimensional propensity scores were used to address selection bias for a retrospective cohort study of children continuously enrolled in coverage from the Alabama Medicaid Agency from birth between 2008 and 2012, adjusting for demographics, access to care, and general health service use.ExposuresChildren receiving preventive dental care prior to age 2 years from PCPs or dentists vs no preventive dental care.Main outcome and measuresTwo-part models estimated caries-related treatment and expenditures.ResultsAmong 19 658 eligible children, 25.8% (n = 3658) received early preventive dental care, of whom 44% were black, 37.6% were white, and 16.3% were Hispanic. Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment (20.6% vs 11.3%, P < .001), higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures ($168 vs $87 per year, P < .001). Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-0.16) and caries-related treatment expenditures by $40.77 per child per year (95% CI, $30.48-$51.07). Primary care provider-delivered preventive dental care did not significantly affect caries-related treatment use or expenditures.Conclusions and relevanceChildren with early preventive care visits from dentists were more likely to have subsequent dental care, including caries-related treatment, and greater expenditures than children without preventive dental care. There was no association with subsequent caries-related treatment and preventive dental care from PCPs. We observed no evidence of a benefit of early preventive dental care, regardless of the provider. Additional research beyond administrative data may be necessary to elucidate any benefits of early preventive dental care.

Project description:ObjectiveThe goal of this study was to use claims data linked with community-level measures to evaluate the impact of preventive services on the time to subsequent restorative, advanced restorative, and complex dental treatment among children enrolled in the Virginia Medicaid program.MethodsFour data sources were used (dental claims, eligibility files, American Community Survey, and Area Health Resource Files) for fiscal years 2011 to 2018. The outcomes of interest were time to first treatment services from birth. The treatment outcomes were basic restorative treatment, advanced restorative treatment, or complex treatment. The independent variable was a preventive service prior to a treatment service. Time-to-event curves were estimated and compared using a log-rank test. Propensity score-matched univariate and multivariate Cox proportional hazards frailty models with an inverse probability censoring weighting correction estimated hazard ratios (HRs) for treatment outcomes comparing use of preventive services while controlling for patient demographic, geospatial, and county-level socioeconomic status measures.ResultsThe analysis included 430,594 children (10,204,182 claims). A log-rank test showed significant differences (P < 0.001) between the times to treatment of those who had a preventive service and those who did not have a preventive service prior to a treatment service. Both Kaplan-Meier curves and the adjusted HR (1.88; 95% confidence interval [CI], 1.46-2.15) indicated that children without preventive services were more likely to have basic restorative treatment at an earlier age along with advanced restorative treatment (HR, 1.52; 95% CI, 1.28-1.80) and complex treatment (HR, 2.13; 95% CI, 1.68-2.61).ConclusionsIn a population of Medicaid-enrolled children, children who did not receive preventive services were significantly more likely to have treatment at an earlier age than those who did receive preventive services.Knowledge transfer statementThis study examines the impact of the utilization of preventive dental services since birth and the subsequent dental treatment for children enrolled in a dental Medicaid program. This study also examines the influence of preventive care on dental complexity of treatment for these children. Findings can inform federal and state policy planning of dental Medicaid programs as well as interventions to improve referral systems for the early use of preventive dental services and the establishment of a dental home.

Dataset Information

Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States.

Publications

Estimating the Cost Savings of Preventive Dental Services Delivered to Medicaid-Enrolled Children in Six Southeastern States.

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