California making strides in dental care measurement

By Ann Milar, CDA Sr. policy analyst

As the dental insurance marketplace continues to increase focus on improved quality of care, accountability and value, California's Health Benefit Exchange (Covered California) has taken the first steps in further ensuring Californians receive quality dental care. Specifically, it has announced that it will require all dental plans offering coverage through the Exchange to adopt the Dental Quality Alliance's (DQA) Pediatric Quality Measures Set.  

The DQA's 12 comprehensive, fully validated measures, titled "Prevention and Disease Management for Dental Caries in Children," will track utilization and cost by evaluating various dental procedures such as fluoride treatment and sealant use. The measures also look at continuity of care processes to improve monitoring and oversight of dental plans.

First released in 2013, the pediatric performance measures were developed by the DQA, an independent, unbiased organization established by the ADA that develops metrics to monitor and improve quality of dental services provided to patients and improve population health. Over the last two years, the DQA has been hard at work developing and testing additional measures and obtaining endorsement from the National Quality Forum (NQF), the gold standard for measuring health quality. The NQF selects measures to assess quality of care for federal programs such as Medicaid and the health benefit exchanges, including Covered California. The five NQF-endorsed measures are:  Prevention: Dental Sealants for 6-9-Year-Old Children at Elevated Caries Risk; Prevention: Dental Sealants for 10-14-Year-Old Children of Elevated Caries Risk; Utilization of Services, Dental Services; Prevention: Topical Fluoride for Children of Elevated Caries Risk, Dental Services; Oral Evaluation, Dental Services.

Covered California's recent announcement of its endorsement and adoption of the DQA's pediatric dental quality measures acknowledges an effort to improve the dental consumer experience. As the first health benefit exchange in the nation to adopt the measures, Covered California believes the measures will help consumers obtain high-quality dental care and, as a result, will include the measures in all of Covered California's Qualified Dental Plan contracts for plan year 2016. Covered California's rationale for adoption of the measures included the fact that they were developed collaboratively by multiple stakeholders from a variety of dental practice settings and geographic regions, and have been tested for reliability, validity, usability and feasibility.

DQA measures are now being used across other public programs, including California's Medicaid dental program, known as Denti-Cal. Earlier this year, CDA and other stakeholders participated in the process of updating the Department of Health Care Services' Denti-Cal Beneficiary Utilization Performance Measures, with CDA's advocacy focusing on encouraging those standards to be based on the DQA measures. The Centers for Medicare and Medicaid Services also incorporated the DQA dental sealant for 6-to-9-year-old measure into the 2015 core set of children's health care quality measures for the Children's Health Insurance Program. Use of the measures can assist programs to achieve better health outcomes for children through prevention and disease management by encouraging the use of the most effective, efficient, timely, equitable, patient-centered and safe health care.

Additional information regarding the use of the Dental Quality Alliance's measures will be forthcoming in the CDA Journal in 2016. In the interim, visit ada.org/dqa for more information.

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Covered California changes dental benefits
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As California approaches the second full year of implementation of the Affordable Care Act (ACA), California’s Health Benefit Exchange Board, responsible for Covered California, the state’s online insurance marketplace and for the overall implementation of the ACA in California, has announced some changes to how dental benefits will be offered in 2015.