Research article Topical Sections

Evaluating network adequacy of oral health services for children on Medicaid in Arizona

  • Received: 13 September 2021 Accepted: 02 November 2021 Published: 16 November 2021
  • Purpose

    Inadequate networks can prevent patients from being able to see the providers that they trust and depend upon, especially for children insured through Medicaid. To improve our understanding of poor oral health care outcomes, we conducted a test of network adequacy among Medicaid pediatric dental providers in Arizona through a “secret shopper” phone survey.

    Methods

    This study tested multiple components of children's access to oral health care, including reliability of provider directory information, appointment availability at the practice level for children covered under Medicaid versus commercial insurance, and compliance with regulatory standards. We contacted individual providers, following a standardized script to schedule a routine appointment on behalf of a 5-year-old patient enrolled in either a Medicaid or commercial plan. We documented the time until the next available appointment, if the practice was reached, and if the practice accepted the specified insurance plan.

    Results

    We identified, catalogued, and attempted to call a total of 185 unique practices across Arizona. In four counties, we were unable to identify a single pediatric oral health provider through health plan directories. We observed minimal differences in appointment wait times between callers with commercial insurance and those insured through Medicaid.

    Conclusions

    Our findings underscore the need to improve the accessibility of pediatric health services, especially in rural regions. Facilitating access to routine and recommended oral health screenings for children enrolled in Medicaid is imperative to appropriate stewardship and fulfilling our commitment to provide this vital public health resource.

    Citation: Swapna Reddy, Matthew Speer, Mary Saxon, Madison Ziegler, Zaida Dedolph, Siman Qaasim. Evaluating network adequacy of oral health services for children on Medicaid in Arizona[J]. AIMS Public Health, 2022, 9(1): 53-61. doi: 10.3934/publichealth.2022005

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  • Purpose

    Inadequate networks can prevent patients from being able to see the providers that they trust and depend upon, especially for children insured through Medicaid. To improve our understanding of poor oral health care outcomes, we conducted a test of network adequacy among Medicaid pediatric dental providers in Arizona through a “secret shopper” phone survey.

    Methods

    This study tested multiple components of children's access to oral health care, including reliability of provider directory information, appointment availability at the practice level for children covered under Medicaid versus commercial insurance, and compliance with regulatory standards. We contacted individual providers, following a standardized script to schedule a routine appointment on behalf of a 5-year-old patient enrolled in either a Medicaid or commercial plan. We documented the time until the next available appointment, if the practice was reached, and if the practice accepted the specified insurance plan.

    Results

    We identified, catalogued, and attempted to call a total of 185 unique practices across Arizona. In four counties, we were unable to identify a single pediatric oral health provider through health plan directories. We observed minimal differences in appointment wait times between callers with commercial insurance and those insured through Medicaid.

    Conclusions

    Our findings underscore the need to improve the accessibility of pediatric health services, especially in rural regions. Facilitating access to routine and recommended oral health screenings for children enrolled in Medicaid is imperative to appropriate stewardship and fulfilling our commitment to provide this vital public health resource.



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    Limitations



    Our effort to evaluate pediatric oral health network adequacy was subject to limitations. First, calls placed to 44 unique practices between March 12 and March 27 were conducted against the backdrop of the ongoing pandemic caused by coronavirus disease 2019 (COVID-19). For these practices, appointment availability was severely limited following guidance issued by the American Dental Association to postpone all non-emergent visits. At the time, the magnitude of the COVID-19 pandemic was unforeseeable, and the decision was made not to postpone further data collection but rather to proceed with calling the practices. For the purposes of this study, only providers with a “pediatric” designation were included. It is possible that some providers without this designation and catalogued elsewhere in MCO directories could actively be treating patients under 18, but this would not be immediately distinguishable for parents or dependents attempting to navigate the directories. Additionally, our approach involved placing a direct phone call to every practice. If a practice was unreachable, researchers did not leave a voicemail to follow up at a later time or date. This was a deliberate attempt to reduce the time between the two “secret shopper” calls (one on behalf of a Medicaid-enrolled child, one on behalf of a commercially-insured child). While forgoing leaving a voicemail is a limitation of this study, it may also strengthen the generalizability of our findings to households without access to voicemail or for whom online appointment scheduling is not possible.
    Finally, all calls were performed in English due to constraints of our research team; thus, language accessibility could not be assessed within the context of appointment availability.

    Conflict of interest



    The authors have no conflict of interest to declare.

    [1] Department of Health and Human Services Promoting and Enhancing the Oral Health of the Public (2010) .Available from: https://www.hrsa.gov/sites/default/files/oralhealth/hhsinitiative.pdf.
    [2]  Dental Care Available from: https://www.medicaid.gov/medicaid/benefits/dental-care/index.html.
    [3] Arizona Health Care Cost Containment System (AHCCCS) AHCCCS Population Demographics (2021) .Available from: https://www.azahcccs.gov/Resources/Downloads/PopulationStatistics/2021/Jan/AHCCCS_Demographics.pdf.
    [4]  U.S. Department of Agriculture Economic Research Service Available from: https://www.ers.usda.gov/topics/rural-economy-population/rural-classifications.aspx.
    [5] Arizona Indian Gaming Association Tribal Land & Casinos Available from: https://www.azindiangaming.org/member-tribes/tribal-land-casinos/#:~:text=Arizona%20is%20home%20to%2022,covers%20just%20over%2085%20acres.
    [6] Griffin SO, Wei L, Gooch BF, et al. (2016) Vital Signs: Dental Sealant Use and Untreated Tooth Decay Among U.S. School-Aged Children. Morb Mortal Wkly Rep 65: 1141-1145. doi: 10.15585/mmwr.mm6541e1
    [7] Jackson SL, Vann WF, Kotch JB, et al. (2011) Impact of poor oral health on children's school attendance and performance. Am J Public Health 101: 1900-1906. doi: 10.2105/AJPH.2010.200915
    [8] Centers for Disease Control and Prevention (2019)  Oral Health Surveillance Report: Trends in Dental Caries and Sealants, Tooth Retention, and Edentulism, United States, 1999–2004 to 2011–2016 Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services.
    [9] Dye BA, Xianfen L, Beltrán-Aguilar ED (2012)  Selected Oral Health Indicators in the United States 2005–2008 Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention.
    [10] Arizona Department of Health Services Healthy Smiles Healthy Bodies Survey 2015 (2017) .Available from: https://azdhs.gov/documents/prevention/womens-childrens-health/reports-fact-sheets/oral-health/healthy-smiles-healthy-bodies-data-brief-2015.pdf.
    [11] Centers for Medicare & Medicaid Services Network Adequacy Standards Available from: https://www.govinfo.gov/content/pkg/CFR-2017-title42-vol4/pdf/CFR-2017-title42-vol4-sec438-68.pdf.
    [12]  Murrin S: State standards for access to care in Medicaid managed care. Department of Health and Human Services Available from: https://oig.hhs.gov/oei/reports/oei-02-11-00320.pdf.
    [13] Hsiang WR, Lukasiewicz A, Gentry M, et al. (2019) Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis. Inquiry 56: 0046958019838118.
    [14] Haeder SF, Weimer DL, Mukamel DB (2016) Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans. Health Aff 35: 1160-1166. doi: 10.1377/hlthaff.2015.1554
    [15] Tipirneni R, Rhodes KV, Hayward RA, et al. (2015) Primary care appointment availability for new Medicaid patients increased after Medicaid expansion in Michigan. Health Aff (Millwood) 34: 1399-1406. doi: 10.1377/hlthaff.2014.1425
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