Oral health quality measurement and improvement in Medicaid and Children’s Health Insurance Programs

Abstract

Background

Performance measurement and improvement are increasingly critical for enhancing the quality and accountability of the US oral health care delivery system, especially for Medicaid beneficiaries. States and their managed care plans conduct performance improvement projects (PIPs) annually to measure the oral health care being delivered to beneficiaries and test new interventions that may lead to improvements in those measures. The authors reviewed these PIPs to identify themes and trends in performance indicators being measured and interventions being implemented to promote quality improvement in oral health.

Methods

The authors identified oral health–related PIPs by means of analyzing existing external quality review reports for the contract year ending 2021. The authors categorized performance indicators and interventions using frameworks, such as those from the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services Core Sets, adding novel categories when necessary.

Results

Sixty-seven oral health–related PIPs were conducted across 19 states. Most reported performance indicators tracked use of different oral health services by beneficiaries. Most PIPs implemented interventions focused on improving beneficiary use of services. Provider-focused interventions aimed to provide education and training, care-gap or benchmark reports, and incentive payments for rendering evidence-based care.

Conclusions

The findings suggested that states and managed care plans are actively implementing PIPs to improve oral health care delivery, which may lead to more standardized, evidence-based, and accountable care practices.

Practical Implications

Collaboration among relevant stakeholders, including state Medicaid agencies, managed care plans, and providers will be key to creating sustainable quality measurement and improvement initiatives that deliver improved outcomes.