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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Child.

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Strategy. Medicaid Reforms. (13.2)

Approach. Increase the number of dental providers who accept Medicaid through activities such as provider training, increased reimbursements, and other incentives

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Overview. Implementing Medicaid reform (e.g., increasing reimbursements paid to oral health providers, recruiting dentists to participate in Medicaid, making administrative changes, adding health plan incentives) can increase preventive oral health care utilization.[1]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of dental providers receiving training on Medicaid policies, billing, and administrative process. (Measures workforce engagement in capacity building)
  • Number of incentives for support resources offered to dental providers to encourage Medicaid participation. (Quantifies strategies to reduce barriers)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of dental providers trained on Medicaid who report increased knowledge and willingness to participate. (Assesses effectiveness of training)
  • Percent of newly enrolled Medicaid dental providers who receive ongoing support and technical assistance. (Measures retention efforts)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of partnerships established between Medicaid and professional dental organizations to support provider recruitment and training. (Measures collaborative effort)
  • Number of policy changes implemented by Medicaid to streamline provider enrollment and reduce administrative burden. (Assesses systems improvement)

OUTCOME MEASURES:

  • Number of children and youth who establish a dental home with a regular Medicaid provider and receive continuity of care. (Measures patient-provider relationships)
  • Number of Medicaid policies for initiatives implemented to sustain dental provider participation and support ongoing network adequacy. (Evaluates long-term systems change)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of Medicaid dental provider recruitment and training resources tailored to areas with greatest access needs. (Measures focus of efforts)
  • Percent of incentives and support strategies tailored to the needs and priorities of dental providers serving communities with lower incomes. (Assesses responsiveness to provider context)

OUTCOME MEASURES:

  • Percent of Medicaid-enrolled children and youth who receive a preventive dental visit from a participating provider. (Measures utilization of expanded access)
  • Percent of Medicaid dental providers who remain enrolled and actively serving Medicaid beneficiaries over time. (Measures long-term engagement)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Nasseh K, Vujicic M. 2015. The impact of Medicaid reform on children’s dental care utilization in Connecticut, Maryland, and Texas. Health Services Research 50(4):1236–1249. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4545356

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.