DentaQuest is proud to serve Tennessee and we look forward to improving the oral health of children statewide. We welcome public discussion about efforts to improve oral health, as well as constructive analysis of industry and professional practices. It’s our belief that public discussion and news stories can help start meaningful conversations about a topic that’s very important to DentaQuest: improving the oral health of all. The following information and associated web pages are meant to provide some context around DentaQuest’s role in Tennessee, the steps taken to build our new provider network, and our process toward ensuring members have access to care.
Increasing Access and Quality While Providing Cost-Effective Care
- Just as the U.S. health care system is undergoing monumental changes, so too is the field of dental care. Concerted efforts to improve quality, focus on value over volume, and ensure greater accountability from both providers and patients, are becoming more commonplace and expected. These shifts have come about for one reason – we have to address the fact that our total health care spending has gone up while outcomes have not improved. This trend applies in dental care, too.
- In fall 2013, the American Dental Association (ADA) announced its first set of dental performance measures under the Dental Quality Alliance. This effort, initiated by the ADA at the request of the Centers for Medicare and Medicaid Services (CMS), is designed to prepare the dental field to participation in national efforts underway to improve the delivery of health care services, patient health outcomes and population health.
Managing the TennCare Dental Program
- Through a competitive RFP bid process in spring 2013, TennCare selected DentaQuest to administer the TennCare Medicaid dental benefits program. Our administration of the program began on October 1, 2013.
- DentaQuest has extensive experience successfully managing Medicaid dental networks. We are the largest administrator of government sponsored dental programs in the United States, serving more than 18 million recipients in 27 states and managing 10 of the 13 state Medicaid dental carve out programs. This wide breadth of experience allows us to consistently fine tune best practices and incorporate them into our management of dental programs for our clients, such as TennCare.
- For the first time with dental benefits, the State of Tennessee has shifted the TennCare program from an administrative services-only contract to a partial risk-sharing contract. TennCare’s contract is designed so any cost savings come from more efficient, more streamlined management of the program – not from a reduction in the number of enrollees receiving services
- The partial risk-sharing contract brings about greater accountability to the dental benefits manager. Managing dental care for TennCare beneficiaries now goes beyond processing claims by ensuring children have access to needed preventive and treatment services, while striving for high quality and efficiency in dental care. It is important to note that in partial risk-sharing contracts, there is both positive and negative risk in sharing in potential savings or in financial loss. Shared savings are contingent upon DentaQuest meeting all benchmarks for member access, utilization and outreach and program quality and efficiency. At the same time if unsuccessful, DentaQuest must share in any program cost overruns.
Developing A High Value Dental Network
In line with our agreement with TennCare, DentaQuest was tasked with developing a completely new provider network. DentaQuest built the new network from the ground up to meet the state’s requirements for access and maximum quality and efficiency in how TennCare members receive, and providers, deliver dental care.
- TennCare certified the network in December 2013 as exceeding every TennCare-established benchmark for network composition, access and geographic outreach.
- The network has one dentist for every 857 patients, which exceeds the CMS recommendation of one provider for every 1,500 patients.
- DentaQuest invited providers into the new network who 1) completed re-validation with TennCare; 2) satisfied peer-reviewed criteria, including care quality and efficiency performance criteria; and 3) met geographic access requirements to ensure care is provided close to home.
- Our criteria align with Dental Quality Alliance recommended dental performance measures initiated by the ADA at the request of CMS to create benchmarks for dentistry. Our evaluation criteria take the following into consideration:
- Meeting patients’ needs consistently with best practices for preventive and acute dental care, with close attention to appropriate costs of care. For example, some of the quality measures include percent of patients ages 6-9 and 10-14 receiving sealants on permanent molars, percent of patients receiving fluoride and percent of patients receiving exams
- Coding and delivery of procedures typically provided to Medicaid populations. This information helps us to understand each provider’s approach to dental care
- Evaluating providers with higher-than-average claims denials and analyze whether that’s an indicator of performing unnecessary procedures
- Review of claims data to analyze providers’ TennCare treatment and billing practices
- The benchmarks for all our quality and efficiency measures are calculated based on the performance of similar dentists in each geographic region to determine the “norm” for that region
- We continually evaluate the network and providers to ensure appropriate access and effectiveness.
Meeting TennCare Contract Benchmarks*
Communication with Dentists & TennCare Members
DentaQuest has communicated regularly since July 2013 with dentists, specifically participating providers, and professional dental associations – prior to our administration, during the network launch and today, while managing the program.
- We are here to help TennCare members with their dental health care needs. TennCare members can contact us toll-free at 1-855-418-1622 or online at www.dentaquest.com.
Improving Oral Health
*Last updated June 2014.