Demonstration of payer readiness for value-based care in a fee-for-service environment: Measuring provider performance on sealant delivery.

OBJECTIVES: Previously published sealant measures are not useful when applied to Medicaid claims data in states where dental services are carved out of managed care. A novel sealant measure was developed to assess the degree to which dental providers seal eligible teeth during preventive dental visits (PDVs) in an effort to ascertain if such a measure can be used to valuate provider performance, as condition of potential value-based care model implementation. METHODS: A single-county feasibility study was conducted using Medicaid claims. A study cohort included children aged 8 years and enrolled 12 months during 2018. Prospective analysis was used to determine whether dental sealants were applied by the same dentists during PDVs or up to 9 months thereafter. Eligible teeth included first permanent molars. Teeth previously restored, sealed or missing were excluded. PDV was defined as any encounter with prophylaxis, fluoride treatment, or EPSDT. Claims were compared to public health surveillance for measurement validation. RESULTS: Single-county results showed 11 percent of eligible teeth were sealed. Only 9 percent of dentists applied sealants to at least 40 percent of eligible teeth. Face validation of sealant rate was 23 percent Medicaid versus 36 percent Public Health. The former measures incidence and the latter prevalence with greater heterogeneity that included partially retained sealants. CONCLUSIONS: A sealant measure that assesses provider adherence to sealant standards of care was produced. It has potential application for assessing performance of pediatric preventive services and informing value-based performance expectations.

Patterns and trends of fish mercury in New York State.

In the mid-2000s a survey was conducted to evaluate fish mercury in lakes across New York State. Approximately 10 years later a second survey examining adult sportfish from 103 lakes and reservoirs was conducted to evaluate the response of fish mercury to recent declines in US mercury emissions. Of those lakes, 43 were part of the earlier survey and were examined to determine if mercury concentrations in four popular sport species, Yellow Perch, Walleye, and Small- and Largemouth Bass, declined in response to decreasing emissions. Water samples were also collected at 35 of these lakes and analyzed for mercury, methylmercury and other analytes. The Adirondack and Catskill regions remain biological mercury hotspots with elevated concentrations in fish. The most widely sampled species, Yellow Perch, showed significant increases in mercury in the Northeast and West regions of New York State over the past decade. The increases in Yellow Perch mercury is not consistent with significant reductions in water concentrations of both total and methylmercury observed corresponding in lake water samples. This discrepancy suggests watershed and in-lake processes beyond mercury emissions, such as recovery from acid deposition, impacts from climate change, or changes in food web structure may be controlling fish mercury concentrations. These results demonstrate a need for a consistent, long-term program to monitor fish mercury to inform the status of mercury contamination in New York State.

Conformance to evidence-based treatment recommendations in schizophrenia treatment services.

OBJECTIVE: To assess quality of health care provided in a representative Canadian mental health service using conformance to evidence-based treatment recommendations, and to examine differences from published US results. METHOD: We used a cross-sectional cohort design involving a randomly selected sample of patients diagnosed with schizophrenia attending 1 of 3 mental health clinics in 1 Canadian regional health system. The sample size was calculated to detect differences with the US sample. Conformance criteria were based on a published protocol. Data were collected using patient interviews and a structured review of health records. Conformance to 9 key Schizophrenia Patient Outcomes Research Team recommendations was assessed. RESULTS: Conformance ranged between 58% and 90% for pharmacological recommendations, and 0% to 81% for psychosocial recommendations. No patients who met criteria for assertive case management had been referred to an assertive case management team. Significant differences in conformance rates to some treatment recommendations were found between Canadian and published US results. CONCLUSIONS: It proved possible to assess health care quality using process measures of conformance to treatment recommendations. Conformance to clinical recommendations for pharmacotherapy is higher than for psychosocial therapies. The absence of barriers to access for pharmacological therapies likely enhances the higher conformance to these recommendations. Limited or variable access to psychosocial services, specifically assertive community treatment, likely negatively affects conformance to psychosocial treatment recommendations. Methodological limitations preclude drawing conclusions on comparisons between Canadian and US services.