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Carol Tobias, BUSPH APHA 2012

Planning for oral health services: Utilization and cost of dental care for people living with HIV/AIDS . Carol Tobias, BUSPH APHA 2012. Presenter Disclosures. Carol Tobias. No relationship to disclose.

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Carol Tobias, BUSPH APHA 2012

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  1. Planning for oral health services: Utilization and cost of dental care for people living with HIV/AIDS Carol Tobias, BUSPH APHA 2012

  2. Presenter Disclosures Carol Tobias No relationship to disclose (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

  3. The SPNS Oral Health Initiative (2006-2011) • 15 programs funded to expand access to HIV oral health care • 8 rural programs, 7 urban programs • Service models • 4 mobile vans • 7 co-located medical and dental services • 1 program in a dental hygiene school • 3 Satellite clinics

  4. SPNS Sites

  5. Eligibility Criteria • At least 18 years of age • HIV positive • Out of oral health care for prior 12 months, except for emergency care to relieve pain or infection

  6. Services Provided Over the course of the study: • Patients made over 15,000 clinic visits • They received over 37,000 services • 917 (42%) completed a Phase 1 treatment plan *Phase 1 Treatment Plan = Prevent and treat active disease

  7. The ones that got away… 375 (17%) patients had only one visit

  8. What does it cost to provide this care? It depends on ……. • The services covered • The price paid for a service, or the cost • How many patients are new to dental care vs. already engaged • What other resources are available? (Medicaid, private insurance, foundation funds)

  9. Pricing Methods • Used utilization data from the SPNS initiative • Grouped sites according to services provided (basic, intermediate, comprehensive) • Used 3 different fee schedules (FL Medicaid, Delta Dental, ADA usual and customary) • Applied fee schedules to services provided during the first 12 months of care (at different levels of coverage) • Did the same thing for the second 12 months of care

  10. Definitions

  11. Average Cost/Person in First 12 months of Treatment Low cost = Miami/Dade County fee schedule; Medium cost = Delta Dental; High cost = ADA usual & customary

  12. Average Cost/Person for First 12 Months of Treatment

  13. Change in Costs – Year 2* *Using the medium cost schedule

  14. Difference in cost – Years 1 and 2* * Using intermediate level of care and medium cost schedule

  15. Things to think about • Who are your dental providers – CHCs, university clinics, private practices, HIV clinics? • What will they accept for payment rates? • What is the trade off between depth of coverage and numbers served? • Other payers? • Geographic considerations

  16. Other Results To access the Public Health Reports journal supplement on Innovations in Oral Health Care for People Living with HIV/AIDS, go to: http://www.publichealthreports.org/issuecontents.cfm?Volume=127&Issue=8

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