G-2309-19846

The Missouri Coalition for Oral Health (MCOH) is a state coalition that is a returning partner and grantee to CareQuest Institute. The organization's work has historically been focused on the reinstatement and protection of Medicaid adult dental benefits, however, the organization received support in 2021 to partner with Enable Dental to begin the design of a responsive, value-based payment system for oral health care in Missouri.

With this proposal, MCOH is requesting funds to build on this previous work as well as increase support for the implementation of oral health value-based health metric payments to widen the use of teledentistry. In the most recent grant period, MCOH worked with Enable Dental to create a data dashboard and warehouse of metrics to support data collection and exchange data, support care coordination in and out of the practice, and monitor and generate reports on targeted metrics, such as patients served. The two organizations are completing a custom coding effort to support more robust data analysis as well as refine the measures that impact value and quality. As this project advances into its next phase, this dashboard will serve as the system for measuring the impact of the APM that MCOH and its partners will implement in the coming year.

During the proposed grant period, the organization will work with three project partners in Enable Dental, Southeast Missouri Health (SEMO) Network (a rural FQHC), and Elks Mobile Dental Unit to test virtual care through teledentistry, which MCOH sees as a disruptive tool for systems change that brings care to people where they can access it. The organization will also build, test, and implement a dental alternative payment methodology (APM) pilot for people with intellectual and/or developmental disabilities (I/DD) in collaboration with the three project dental providers and will adjust as needed. This work will include building IT and staff capacity, integrating new workflows within the partner clinics, and capturing and reporting data. Enable Dental, the initial project partner that support work in phase one during 2022, will serve as the primary technical assistance and training provider for the two additional pilot sites this year and will also be responsible for maintaining and updating the data dashboard, which lives with the organization.

The metrics that have been initially identified for the project were selected using Dental Quality Alliance (DQA), National Committee for Quality Assurance (NCQA) and Agency for Healthcare Research and Quality (AHRQ) measures, however, adjustments may be a result of this work. MCOH shares that, at the end of the proposed project period, the organization will have achieved the following outcomes:

A dental APM to increase the focus on quality oral health care and increased capacity among dental teams to provide preventive care and treatment for people with I/DD

Updated data dashboard that can support the case for value-based care and payment through analysis

Clear project processes and resources to support future policy change toward person-centered care in Missouri and beyond

Increased number of underserved individuals with I/DD receiving quality dental care that lead to improved outcomes

Improved patient care integration, experience, engagement, and satisfaction that can be mapped to metrics captured in the data dashboard.

The information captured through this project will not only build awareness and support for cost-effective, efficient, and equitable oral health that is supported by public infrastructure, it will shed light on the benefits and challenges of such a model for oral health advocates to leverage in discussion with policymakers. Through this project, MCOH will be better able to address the various challenges that arise in designing, monitoring, and evaluating an APM, which will be pursued longer term in Missouri.

This proposal is focused on value-based care in oral health and the requested funding amount is $220,488. Funding is being recommended in the amount requested, $220,488, and will support salaries for project personnel (across four roles), contracts with three clinical partners ($50,000 each), and a relatively minor allocation to support benefits/payroll taxes for project staff. During the review process, there was a concerned raised about a potential conflict of interest involving Enable Dental. That concern was brought to CareQuest Institute's Legal team and, because the organization did not influence MCOH's proposal design in any way, deemed permissible to recommend for funding. The project is responding to interest in the state to identify and pursue viable APM options and, given the data collection and baseline that MCOH and Enable Dental established in 2022-23, expansion and project impact data over time could be valuable for advocates, community members/patients, and providers alike.