Medicaid Dental Programs in Seven States Could Save $550 Million Annually Through Adoption of Kool Smiles DSO Practice Model

The Benevis Foundation today announced the release of a multi-year, multi-state study by Dobson DaVanzo & Associates examining Medicaid dental utilization trends and expenditures in seven states, using publicly available Medicaid dental claims. The study, released during National Children’s Dental Health Month, found that providers from Kool Smiles – one of the largest dental service organizations (DSOs) serving pediatric Medicaid patients nationwide – performed more conservative, cost-effective care when compared to other Medicaid dental providers in Texas, Indiana, Virginia, Georgia, Mississippi, Louisiana, and South Carolina.

The analysis of Medicaid claims data supports recent research indicating that the DSO practice support model is effectively narrowing the gap in access to quality dental care for low-income children and families.

Using publicly available Medicaid data from 2011 to 2015, the study found:

  • Kool Smiles dental providers performed 15 percent fewer services overall, including 40 percent fewer extractions and 39 percent fewer pulpotomies.
  • As a result of lower utilization rates, Kool Smiles patients had an overall average monthly Medicaid expenditure that was 33 percent lower than non-Kool Smiles patients across all states and years analyzed.
  • If all Medicaid dental providers in these seven states adopted the same care protocol and utilization rates as Kool Smiles providers, the total savings to state Medicaid programs would be more than $550 million annually.
  • The annual Medicaid savings could fund the provision of dental care for up to 1.9 million more Medicaid children who currently do not receive care.

Existing literature suggests that the emergence of the DSO model in recent years has contributed to significant dental access gains among the Medicaid patient population,” said Alan Dobson of Dobson DaVanzo & Associates. “This analysis builds on those findings by showing that Kool Smiles, a DSO-affiliated dental provider, provides more conservative care to Medicaid dental patients and at lower cost to state Medicaid programs.”

“Oral health improves when children have access to regular, preventive dental care,” said Dr. D Ray Gifford, Managing Dental Director for Kool Smiles. “By providing a dental home to Medicaid children who have historically lacked access to a dentist and addressing needed preventative care early on, we are able to reduce the potential for more expensive, restorative procedures over time. If we can increase access, improve the oral health of these patients and lower Medicaid costs in the process, we best serve both our patients and taxpayers.”

The analysis represents utilization and Medicaid expenditures across 164 Kool Smiles providers and 8,077 non-Kool Smiles providers, which amounts to more than 490,000 unique Kool Smiles patients and 2,000,000 non-Kool Smiles patients.

The report also provides a solution to enable the Centers for Medicare and Medicaid Services (CMS) to reach its goal of increasing the number of Medicaid and CHIP eligible children aged 1-20 who receive preventive dental services by 10 percent.  The study suggests that the DSO practice model employed by Kool Smiles would be an effective way of addressing what the American Dental Association (ADA) has defined as the “Medicaid funding crisis,” by decreasing utilization and costs while improving access.

The research for this study was prepared by Audrey El-Gamil, Nikolay Manolov, Ph.D, Dorothy Chen, M.P.H., Joan DaVanzo, Ph.D., M.S.W. and Al Dobson, Ph.D. The study was funded by the Benevis Foundation.

For more information on the cost savings and quality of care provided by DSOs, you can read Dobson Davonzo & Associates’ full study here.

SOURCE Benevis Foundation,  PRNewswire