Medical Loss Ratios For California's Dental Insurance Plans: Assessing Consumer Value And Policy Solutions.

As a consumer protection, the Affordable Care Act (ACA) requires that large-group health plans spend at least 85 percent of all premium dollars on health services and quality improvement activities-thus giving the plans a medical loss ratio (MLR) of 85 percent. Small-group and individual plans must have an MLR of at least 80 percent. The ACA did not set minimum MLRs for dental plans. California passed a law in 2014 requiring dental plans to report MLRs but stopped short of setting minimum thresholds. We analyzed dental plans' MLRs reported in California for 2014 and 2015. The average MLR, weighted by covered lives, was 76 percent, with wide variation across product types and sizes. Few products sold by dental plans met the MLR thresholds set by the ACA, but many did meet or exceed other proposed thresholds. While millions of Californians were in large-group plans that achieved high MLRs, millions more were in other plans with relatively low MLRs. A legislatively mandated MLR would provide a standardized financial tool and potentially ensure value for dental insurance products. Given the multiplicity of dental products and the varying numbers of covered lives in those products, setting MLR thresholds poses a challenge for stakeholders.

Improving oral healthcare delivery systems through workforce innovations: an introduction.

The objective of this paper is to describe the purpose, rationale and key elements of the special issue, Improving Oral Healthcare Delivery Systems through Workforce Innovations. The purpose of the special issue is to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, Sufficiency of the U.S. Oral Health Workforce in the Coming Decade. Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific populations' needs and explore the roles that the workforce can play in improving the care delivery model. The contributing articles provide a broad framework for stimulating and evaluating innovation and change in the oral health care delivery system. The articles in this special issue point to many deficits in the current oral health care delivery system and provide compelling arguments and proposals for improvements. The issues presented and solutions recommended are not entirely new, but add to a growing body of work that is of critical importance given the context of wider health care reform.

Racial and ethnic disparities in dental care for publicly insured children.

Poor oral health has important implications for the healthy development of children. Children in Medicaid, especially Latinos and African Americans, experience high rates of tooth decay, yet they visit dentists less often than privately insured children. Even Latino and African American children with private insurance are less likely than white children to visit dentists and have longer intervals between dental visits. Furthermore, Latino and African American children in Medicaid are more likely than white children in Medicaid to have longer intervals between visits. These findings raise concerns about Medicaid's ability to address disparities in dental care access and, more broadly, in health care.

How much public health in public health nursing practice?

Public health nursing (PHN) practice is defined by an emphasis on population health issues rather than individually focused clinical interventions, but the actual scope and focus of PHN practice have not been well documented. The purpose of this survey was to investigate the practice activities, priorities, and education of public health nurses in California. Public health nurses in five counties were surveyed about interventions targeted at individual-family, community, and system levels. Summary scales (range: 1-4) were created to measure self-rated PHN activity, importance, and education at each level. Staff were most likely to perform individual-family level interventions (mean score, m=2.55), followed by community (m=1.86) and system-level interventions (m=1.46). Managers rated individual-family level interventions as most important (m=2.91) and community-level interventions (m=2.42) as more important than those at the system level (m=1.99). Individually focused case management was the most frequently performed and highly valued intervention. Staff and manager-directors deemed individual-family interventions as the area in which public health nurses were best educated, followed by community and then system interventions. Results indicate that the population health focus of public health nursing is not reflected in the practice activities, management priorities, or educational preparation of public health nurses.