Expanding early childhood caries prevention from public program to provider-community partnership

Twenty-five percent of children aged 2 – 5 years are estimated to have preventable dental disease. A disproportionate amount of low-income children develop early childhood caries (ECC) severe enough to require restorative treatments under sedation/anesthesia (SECC), which involves pain, risks associated with surgery, and missed early childhood education opportunities; additional costs include their caregivers missing work. Treatment of SECC is a disproportionately large component of per capita pediatric Medicaid dental expenditures. The burden of this condition has spurred innovative public-sponsored ECC-prevention programs. The changing nature of health care reimbursements is giving private healthcare providers incentives to address health issues at a population level. Our large healthcare network (Network) in the northeast noted that same-day surgeries (SDS) for dental abscesses or caries account for 18.4% of the costs of its pediatric Medicaid SDS, and 48.2% of its cost for SDS among Medicaid children aged 2 - 5. Further, while each ECC SDS costs the Network more than $1700, Medicaid reimburses only $690, on average. Additional financial losses and human costs are incurred for ECC patients requiring inpatient admission to treat infections. Our Network's SECC patients are predominantly Medicaid-insured and have other risk factors for ECC. Consequently, in partnership with the local FQHC, hospital networks, dental and primary/prenatal care providers, and early childhood education providers, the Network is developing a comprehensive ECC-prevention program comprised of evidence-based interventions that targets socio-demographic groups at highest risk for ECC in our community. Preliminary cost-effectiveness calculations show this approach to be cost-effective from the provider's perspective.