The effect of an accountable care organization on dental care for children with disabilities.

Objectives: Accountable care organizations (ACOs) are a new model of health-care delivery that aim to improve care through increased provider collaboration and financial rewards for meeting cost and quality targets for a defined patient population. In this study, we examined a state policy change that effectively moved some children with disabilities into a Medicaid-serving pediatric ACO on dental service use. We hypothesize that ACOs' emphasis on prevention, care coordination, and reduction in emergency department use will extend to dental services.

Study Design/methods: We used Ohio Medicaid administrative claims data for year 2011-2016 to examine changes in patterns of dental service use by Medicaid-eligible children with disabilities before and after enrolling in an ACO compared with similar children enrolled in non-ACO managed care plans.

Results: Dental utilization is relatively low among Medicaid-eligible children with disabilities. We find that preventive dental visits increased 3.1% points (P < 0.05) from a baseline in the control group of 33.9 percent among ACO-enrolled children, especially among adolescent children, compared to similar children that were not in the ACO, representing an 11 percent increase in the rate of preventive dental visits relative to the comparison group. However, overall dental utilization did not increase for children with disabilities who were part of the ACO compared to similar children who were not in the ACO.

Conclusions: Access to dental care is a continuing challenge for children covered by Medicaid. ACOs that serve Medicaid children are well positioned to include dental services and could play an important role in improving access to dental care and increasing dental utilization.