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DentaQuest Selected by Partners Health Plan to Administer Dental Benefits for Individuals with Intellectual and/or Developmental Disabilities in New York

DentaQuest, one of the nation’s largest and most experienced Medicaid dental benefits administrators, today announced its new engagement with Partners Health Plan (PHP) to increase access to oral health care and improve outcomes for individuals with intellectual and/or developmental disabilities (I/DD).

Partners Health Plan (PHP), a nonprofit managed care organization serving individuals with I/DD, selected DentaQuest to administer dental benefits and specialized services for its members. With the addition of PHP to its other government clients, DentaQuest now serves 63% of Medicaid enrollees in the state.

“We are honored to support Partners Health Plan in its commitment to serving adults with I/DD,” said Steven Pollock, president of DentaQuest. “We’ve long recognized the importance of increasing health equity for all, and health plans like PHP that focus on underserved populations are critical to making it happen. Oral health is often overlooked as more immediate medical needs take precedence, but as we know good oral health drives overall health and everyone can benefit from routine, preventive care. Innovative approaches, such as our industry-leading case management program, provide an extra level of support for individuals with I/DD and their caregivers to navigate a complex, imperfect health system to ultimately get the right treatment, at the right time.”

DentaQuest’s case management program helps identify appropriate resources needed to resolve a member’s issue – often unrelated to health care – and coordinates access to those resources with PHP care managers to ultimately achieve optimal oral health. Together, DentaQuest’s case management team and PHP care managers partner to secure transportation, medical clearance, sedation and anesthesia, hospital level care and other dental services.  The collaboration between PHP and DentaQuest has led to a substantial increase in member utilization and appears to be addressing long standing access challenges faced by the I/DD population.

Launched in 2016, PHP develops and coordinates personalized life plans that ensure participants receive the essential medical, behavioral, dental, habilitation, and other services and supports needed. Dental care is the primary unmet need for adults with I/DD. More than 30% of children with I/DD are likely to have their first dental visit delayed, and in general, individuals with I/DD are less likely to receive necessary restorative care. Addressing this disparity is a critical component in impacting overall health equity for individuals with I/DD, as poor oral health can result not only in dental caries and gum disease, but can impact overall health, potentially leading to heart disease, cancer, and diabetes.

“The work we are accomplishing with DentaQuest shines a light on what is possible across the nation – people with I/DD deserve and can achieve lifelong optimal oral health and wellness when we create the right partnerships and invest in the right programs,” said Kerry Delaney, CEO, PHP. “We look forward to continuing our partnership and the measurable results we are seeing in dental care for PHP members.”

In the future months, PHP will also be piloting teledentistry and mobile dentistry programs in partnership with DentaQuest to increase access to oral health care for members.

About DentaQuest

DentaQuest is a purpose-driven health care company dedicated to improving the oral health of all. We do this through Preventistry® — our inclusive approach to quality care and expanded access built on trusted partnerships between patients, providers and payors. As one of the nation’s largest and most experienced Medicaid dental benefits administrators, we manage dental and vision benefits for more than 33 million Americans through a nationwide network of providers in all 50 states. Our outcomes-based, cost-effective dental solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. At the same time, we are expanding our footprint of more than 70 oral health centers in six states to deliver direct patient care in rural and underserved populations. Learn more at www.DentaQuest.com and follow us on FacebookInstagramLinkedIn, and Twitter.

About Partners Health Plan

Partners Health Plan (PHP) is the first-in-the-nation, provider-led managed care organization that fully integrates Medicare and Medicaid for individuals 21 years and older with Intellectual and Developmental Disabilities (IDD), so they have the most complete care package. PHP provides person-centered care for whole-person wellness addressing the physical, behavioral, and social needs of individuals to assist them in living a quality life. The plan operates in 4 New York State regions (nine downstate counties): New York City, Long Island (Nassau and Suffolk counties), Rockland County, and Westchester County. For more information, visit www.phpcares.org.

Health Care Options Expanded for PHP Members: Stony Brook Medicine Joins PHP Provider Network

BRONX, NY, October 4, 2022— On September 1, 2022, Stony Brook Medicine joined the Partners Health Plan (PHP) provider network offering services to PHP members.
Kerry Delaney, PHP CEO stated, “We are very happy to welcome them back into our network. This will expand care options for PHP members. Stony Brook Medicine is an extensive health care system. It includes three acute care hospitals and many affiliated specialty groups and physicians with specialized services for individuals with Intellectual and Developmental Disabilities (IDD). This relationship will deepen the care choices that PHP members and their families have come to expect from us in providing state-of-the-art supports and services.”
For more information on the Stony Brook Medicine providers and locations that are now part of the PHP provider network, please contact: This email address is being protected from spambots. You need JavaScript enabled to view it..
About the facilities and services in the Stony Brook Medicine – PHP relationship
3 Acute Care Hospitals:
• Stony Brook University Hospital, Stony Brook, NY
• Stony Brook Eastern Long Island Hospital, Greenport, NY
• Stony Brook Southampton Hospital, Southampton, NY
Affiliated specialty groups and physicians that offer the following services:
• Ambulatory Health Centers
• Cardiovascular Disease
• Dialysis
• Family Medicine
• GI and Hepatology
• Inpatient/Outpatient Psychiatry
• Mammography
• Oncology
• Orthopedics
• Podiatry
• Radiology
• Sleep Disorders
• Urology

New Report Determines Partners Health Plan’s FIDA-IDD Demonstration Shows Positive Impact and Progress for Enrollees with Complex Care Needs

BRONX, NY, July 6, 2022— Partners Health Plan (PHP), a nonprofit managed care organization dedicated to serving individuals with Intellectual and Developmental Disabilities (IDD), is pleased to announce that the results of an independent evaluation funded by the Centers for Medicare & Medicaid Services (CMS) indicate positive returns for enrollees in the New York Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) demonstration.

The FIDA-IDD demonstration is a pilot program established to test the success of delivering services that address the whole person and promote community involvement and independence for people with IDD eligible for both Medicare and Medicaid benefits. According to the findings, PHP is well on its way toward meeting those objectives.

“This is an extremely positive report,” said Kerry Delaney, CEO of PHP, “but also acknowledges in a realistic way the challenges we have faced.” Those challenges stemmed from the newness of managed care for providers in the space, lack of plan coverage awareness for covered entities, and providers’ refusal to participate or offer services to the population just to name a few. Despite these challenges, key findings reflect that if implemented correctly, managed care can be a viable option to serve people with IDD.”

Key Findings:

  • Through the comprehensive “It’s All About Me” (I AM) assessment tool, PHP effectively elicited responses from the IDD population about health and wellness needs allowing enrollees to leverage control over benefit options impacting their everyday lives.
  • Innovative solutions like the pharmacy management program reduced errors, unnecessary emergency department visits, and length of hospital stays. Similarly, the telehealth program successfully resolved 90% of consultations virtually. The rewards incentive program “Choose Health” also received positive feedback for motivating members to achieve preventive health goals.
  • While the new rate payment method has been a challenge to cover certain member populations, like older and frailer members, programs like pharmacy management are viewed as innovative cost-savings strategies.
  • Regularly engaging stakeholders from the Participant Advisory Committee helped to address real-time needs, like improvements to transportation services and communications efforts.

One of the best measures of the impact Partners Health Plan has had on member health and experiences comes from the members themselves. PHP FIDA-IDD plan member, Jessica, stated, “Recently I needed special comprehension therapy for my legs and was able to get something to help me at home. This keeps me healthy and helps my ability to walk. I want to keep my independence. I also have support from my Care Manager and my Broker with my self-direction!”

As the agency responsible for the IDD program in New York State, the Office for People With Developmental Disabilities (OPWDD) was integral in the demonstration’s design and implementation. “OPWDD has been pleased to collaborate with Partners Health Plan on the FIDA-IDD program, which has offered people an opportunity to coordinate their health and long-term care services in a new and innovative way,” said OPWDD Commissioner Kerri Neifeld. “We look forward to continuing to work with Partners Health Plan and the larger provider community to ensure quality supports and services are available to NYers with intellectual and developmental disabilities.”
Read the full report here: https://innovation.cms.gov/data-and-reports/2022/fai-ny-fida-idd-prelim-firstsecondevalrpt.

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About Partners Health Plan: Partners Health Plan (PHP) is the first-in-the-nation, provider-led managed care organization that fully integrates Medicare and Medicaid for individuals 21 years and older with intellectual and/or developmental disabilities (I/DD), so they have the most complete care package. PHP provides person-centered care for whole-person wellness addressing the physical, behavioral, and social needs of individuals to assist them in living a quality life. The plan operates in 4 New York State regions (nine downstate counties): New York City, Long Island (Nassau and Suffolk counties), Rockland County, and Westchester County. For more information, visit www.phpcares.org.

About CMS Financial Alignment Initiative: The Centers for Medicare & Medicaid Services (CMS) created the Medicare-Medicaid Financial Alignment Initiatives (FAI) Demonstrations to test in partnership with States integrated care models for dually eligible beneficiaries with the goal to improve care for dually eligible beneficiaries and reduce program costs through an aligned financial and person-centered care coordination structure. A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. For more information, visit Financial Alignment Initiative (FAI) | CMS.

 

Unique Managed Care Model Improves Quality of Life for People with IDD

New Report Determines Partners Health Plan’s FIDA-IDD Demonstration Shows
Positive Impact and Progress for Enrollees with Complex Care Needs

BRONX, NY, July 6, 2022— Partners Health Plan (PHP), a nonprofit managed care organization dedicated to serving individuals with Intellectual and Developmental Disabilities (IDD), is pleased to announce that the results of an independent evaluation funded by the Centers for Medicare & Medicaid Services (CMS) indicate positive returns for enrollees in the New York Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) demonstration.

The FIDA-IDD demonstration is a pilot program established to test the success of delivering services that address the whole person and promote community involvement and independence for people with IDD eligible for both Medicare and Medicaid benefits. According to the findings, PHP is well on its way toward meeting those objectives.

“This is an extremely positive report,” said Kerry Delaney, CEO of PHP, “but also acknowledges in a realistic way the challenges we have faced.” Those challenges stemmed from the newness of managed care for providers in the space, lack of plan coverage awareness for covered entities, and providers’ refusal to participate or offer services to the population just to name a few. Despite these challenges, key findings reflect that if implemented correctly, managed care can be a viable option to serve people with IDD.”

Key Findings:

  • Through the comprehensive “It’s All About Me” (I AM) assessment tool, PHP effectively elicited responses from the IDD population about health and wellness needs allowing enrollees to leverage control over benefit options impacting their everyday lives.
  • Innovative solutions like the pharmacy management program reduced errors, unnecessary emergency department visits, and length of hospital stays. Similarly, the telehealth program successfully resolved 90% of consultations virtually. The rewards incentive program “Choose Health” also received positive feedback for motivating members to achieve preventive health goals.
  • While the new rate payment method has been a challenge to cover certain member populations, like older and frailer members, programs like pharmacy management are viewed as innovative cost-savings strategies.
  • Regularly engaging stakeholders from the Participant Advisory Committee helped to address real-time needs, like improvements to transportation services and communications efforts.

One of the best measures of the impact Partners Health Plan has had on member health and experiences comes from the members themselves. PHP FIDA-IDD plan member, Jessica, stated, “Recently I needed special comprehension therapy for my legs and was able to get something to help me at home. This keeps me healthy and helps my ability to walk. I want to keep my independence. I also have support from my Care Manager and my Broker with my self-direction!”

As the agency responsible for the IDD program in New York State, the Office for People With Developmental Disabilities (OPWDD) was integral in the demonstration’s design and implementation. “OPWDD has been pleased to collaborate with Partners Health Plan on the FIDA-IDD program, which has offered people an opportunity to coordinate their health and long-term care services in a new and innovative way,” said OPWDD Commissioner Kerri Neifeld. “We look forward to continuing to work with Partners Health Plan and the larger provider community to ensure quality supports and services are available to NYers with intellectual and developmental disabilities.”
Read the full report here: https://innovation.cms.gov/data-and-reports/2022/fai-ny-fida-idd-prelim-firstsecondevalrpt.


About Partners Health Plan: Partners Health Plan (PHP) is the first-in-the-nation, provider-led managed care organization that fully integrates Medicare and Medicaid for individuals 21 years and older with intellectual and/or developmental disabilities (I/DD), so they have the most complete care package. PHP provides person-centered care for whole-person wellness addressing the physical, behavioral, and social needs of individuals to assist them in living a quality life. The plan operates in 4 New York State regions (nine downstate counties): New York City, Long Island (Nassau and Suffolk counties), Rockland County, and Westchester County. For more information, visit www.phpcares.org.

About CMS Financial Alignment Initiative: The Centers for Medicare & Medicaid Services (CMS) created the Medicare-Medicaid Financial Alignment Initiatives (FAI) Demonstrations to test in partnership with States integrated care models for dually eligible beneficiaries with the goal to improve care for dually eligible beneficiaries and reduce program costs through an aligned financial and person-centered care coordination structure. A longstanding barrier to coordinating care for Medicare-Medicaid enrollees has been the financial misalignment between Medicare and Medicaid. For more information, visit Financial Alignment Initiative (FAI) | CMS.

Contact Us
  • Partners Health Plan
  • 2500 Halsey Street
    Bronx, NY 10461
  • (855) PHP-LIVE or (855) 747-5483
  • TTY:711
  • 8am-8pm, 7 days a week

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855-747-5483 | TTY/TDD:711
Partners Health Plan is a managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to provide benefits to Participants through the Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Demonstration.

H9869_PHPWeb_2022_Pending

The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide participants free, confidential assistance on any services offered by Partners Health Plan. ICAN may be reached toll-free at 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800) or online at icannys.org.