Association for Public Policy Analysis & Management

Context: Debates about how to improve oral health for children covered by Medicaid rightly focus on beneficiaries. However, the preferences of dental providers should also be considered to ensure the success of a public program.  In 2006, Rhode Island initiated RIte Smiles, a dental managed care program that aims to improve access, utilization, quality, and long-term cost of dental services for children with Medicaid benefits born on or after May 1, 2000. RIte Smiles improved the reimbursement rate, and claims processes and payment schedule. We aim to elicit dentists’ preferences for additional program modification that might encourage providers to actively see and treat at least 100 Medicaid children a year.

Methods: We selected four attributes that might encourage dentists to actively participate in RIte Smiles. These attributes included the reimbursement rate for treatment services, two system improvement mechanisms, and providers’ incentives that might reduce claim denials. We used orthogonal main effects design to build 9 scenarios into a conjoint analysis survey, using a rating method. We mailed the survey to a sample of 320 active dentists practicing in Rhode Island in January 2016. We used the maximum utility model to compute the probability of choosing a scenario as the most preferred.

Results: Of the 75 surveys received we included 60 in the analysis after checking for data consistency. We found that the highest overall utility score of 94.6 is associated with a scenario where dentists would be reimbursed 100% of UCRF rate, obtain eligibility information in real time, receive special financial incentives to submit claims on a daily basis, and get a daily update on service frequencies. The probability of choosing this scenario as the most preferred was 71.9%. The lowest overall utility score of 33.2 is for a scenario with 71% reimbursement rate, eligibility obtained within a week, financial and non-financial incentives offered to submit claims on a daily basis, and daily update on service frequencies. The probability of choosing this scenario as the most preferred was 0.0%. This means that among the 9 scenarios, dentists prefer higher reimbursement rate and are willing to trade-off other changes for this benefit. For the attributes and levels tested, the relative importance was 44.2% for reimbursement rate, 21.3% for eligibility, 20.2% for service frequency, and 14.3% for providers’ incentives.

Discussion: The general premise for low reimbursement rate paid for dentists to service Medicaid patients is presumably that dentists might be willing to donate their time and overheads to serve a small number of Medicaid patients, or they may shift the cost to other patients. If evidence from the medical sector applies to dentists, then dentists are not shifting cost to other patients. With an increasing number of Medicaid patients and a shrinking pool of dentists willing to treat Medicaid patients, Medicaid and dental managed care programs should consider dentists’ needs and preferences for a fair reimbursement rate to ensure the supply of dental providers to meet the needs of increasing numbers of Medicaid beneficiaries.