Government Healthcare Administration

Through our wholly owned subsidiary, Access Dental Plan, we have held Medicaid contracts with the State of California since 1994. For more than a quarter of a century, we have annually managed dental benefits for more than 250,000 people enrolled in the Sacramento-based Geographic Management Care (GMC) and the LA Prepaid Health Plan (LAPHP).

Our California programs are incubators for the development of innovative and culturally competent outreach strategies intended to connect with the diverse populations that make up our membership such as:

• Microtargeted, bilingual phone and text messaging that significantly increases appointment completion
• Virtual dental home programs implemented through school partnerships
• Value-based quality incentives that result in triple digit increases in preventive utilization

Each of the Medicaid managed care plans we serve in Kentucky trust us to manage both dental and eye care benefits for their members. With more than half of the Kentucky market on our integrated platform, we set the standards for Medicaid dental and eye care processing in the Commonwealth. Examples include:

• Writing the silver diamine fluoride guidelines and related processes now in use by most Kentucky Medicaid managed care plans
• Advising the Commonwealth on the implementation of telehealth regulations
• Introducing telehealth initiatives to help federal qualified community health centers expand their ancillary care capacities
• Introducing a dental opioid prescription monitoring program that reduced non-compliant prescription rates by 70 percent in six months
• Increasing annual diabetic retinopathy exam (DRE) completion rates through portable, home-based care

More than 1,500 Guardian employees live in Pennsylvania, making this an important market for our team. We currently manage dental benefits for more than one million Medicaid members, and more than 100,000 Medicare Advantage enrollees. Our accomplishments include:

• Helping one health plan achieve their HEDIS annual dental visit (ADV) goal using a dental home
• Ensuring access to care by maintaining a provider to member ratio of 1:114
• Increasing oral health literacy of 126,000 children in 5,000 K-3 Title I classrooms through our corporate partnership with the Children’s Health Fund and Scholastic

Through our wholly owned subsidiary Premier Access Insurance Company, we have held a contract with the State of Utah since 2010. Today we manage care for more than 150,000 Utahns who qualify for Medicaid or CHIP benefits across the state.

Our accomplishments include:

• Earning the NCQA HEDIS Compliance™ seal in 2019 and 2020
• Continuously achieving HEDIS annual dental visits above the state average  
• Assisting the Utah Department of Health with an expansion of dental managed care statewide without compromising access or operational efficiency
• Supporting Utah Oral Health Coalition’s efforts to assess and improve oral health literacy of Medicaid and CHIP members statewide

Ensuring that members get the right care at the right time in the right place is our priority. Our teams work together to emphasize the importance of prevention, provide follow-up reminders, and help remove barriers to care such as language and transportation. We keep members with special healthcare needs (SHCN) top of mind, including people with comorbid conditions such as pregnancy and diabetes.

One example is in the Medicaid dental contract we manage for the State of California.

In our California Medicaid dental market, we wanted to improve preventive visits among some of our members with special health care needs. We used automated bilingual calls to reach parents and guardians of Medicaid members who had not visited the dentist recently, according to our records. During this call, the parent or guardian was given the option to receive live, bilingual help with making an appointment. Our results showed that those who take advantage of the live appointment assistance were more likely to make—and keep— their child’s dental appointment within three months. This increase was seen for children of all ages—from newborn to age 20.

In order to help achieve your goals for member access, we need a stable and satisfied network. Our provider-centric, local network management model puts providers in the hands of our experienced clinical leaders. We also offer peer-to-peer consultation with trained, licensed clinicians and office support delivered by provider relations professionals with real-world clinical and office experience.

One example is in the Medicaid dental contract we manage for the State of Utah.

In 2017, an analysis of our Utah Medicaid/CHIP prior authorization data revealed that the scoring of the required orthodontic index was inconsistent among providers. We engaged in provider outreach with  several rounds of phone calls and emails, and  brought the Clinical Director of Utilization Management, to Utah for two in-person presentations  on index scoring and claims submissions. Providers were then encouraged to participate in the Q&A sessions that followed, allowing participants hands-on experience with the scoring process before the meeting ended. The result was an improvement in prior authorization submissions, which helped increase provider satisfaction and reduced delays in the onset of treatment.

Healthcare costs continue to rise, putting more pressure on our state and health plan clients to be good stewards of the taxpayer dollars that support Medicaid and Medicare. We’re here to help by emphasizing the value of preventive care; reducing fraud, waste, and abuse; and carefully managing high-cost services.

One example is in our Georgia Medicaid market.

Our IV Sedation program provides the option to move dental patients out of the hospital or ambulatory surgical center for surgical procedures and returns them to their communities for lower cost treatment through mobile sedation services arranged in a dental practice setting . In our Georgia Medicaid market, over a three-month period in 2019, 708 dental procedures were arranged out of the hospital and into a dental office setting , saving our health plan clients an average of $6,889 per visit or $4.9M in all.

Dental and eye care are important and only address a small part of the body. We help by integrating our clinical management programs with other disease management and health improvement efforts, like assisting our health plan partners in diagnosing and managing diabetes and reducing opioid prescription rates. 

One example is in our Kentucky Medicaid market.

In our Kentucky Medicaid dental market, where we manage dental benefits for 80 percent of the market, our prescribing program reduced the number of  dentists writing opioid prescriptions at rates that exceed the state’s recommended guidelines. In just six months, we reduced the number of high prescribers by 70 percent.

We connect network dentists and eye care providers to members who may need help getting access to care. Programs we can adapt to your market include:

• Dental Home
• Foster Children
• Siblings
• Expectant Mothers
• Children’s Dental Access
• Urgent Dental Services

We focus on early diagnosis and prevention to reduce costs and improve member health. Programs we can adapt to your market include:

• O2C2 (Oral and Ocular Coordinated Care)
• DRE Outreach
• ID Diabetes
• ADV Outreach

We focus on early diagnosis and prevention to reduce costs and improve member health. Programs we can adapt to your market include:

• Sensi-Dentistry
• MP2 (Modern Pain Management Program)
• Office-based IV Sedation