G-2210-17633

Children Now, based in California, is a longtime partner and grantee of CareQuest Institute and is primarily a children’s policy advocacy organization. Between 2015 – 2020, through California’s Medicaid 1115 waiver, the state implemented the Dental Transformation Initiative, which included the implementation of multiple areas of policy and practice change. Through the Dental Transformation Initiative, Children Now partnered with a health IT company, Oral Health Solutions, to develop the Medical-Dental Referral and Action Network (MDRAN).

Over several years, MDRAN has been piloted and rolled out across Sacramento. Providers in the area have since been trained to use MDRAN and are now able to integrate MDRAN into Electronic Health Records (EHRs) or Electronic Dental Records (EDRs). The implementation of MDRAN made it possible for providers to make direct referrals to other Medi-Cal dental providers, as well as account for social determinants data that was shared with the dental provider. MDRAN also conducts monthly imports of updated Medi-Cal data, therefore, when a Medicaid member that has been referred receives services, MDRAN provides an update to both the medical and dental provider that the referral was successful. This information, along with a broad range of data sets, is also able to be aggregated and pulled to use for designing population health strategies.

Sacramento County is currently covered through managed care. The work that Children Now did last year, through CareQuest Institute funding, was to establish and roll out MDRAN in San Joaquin County, in which the dental part of Medicaid is fee-for-service. The vision for this project was to demonstrate the impact of effective care coordination through implementation of MDRAN in a fee-for-service (FFS) environment to build a case for payment and policy change in oral health care. Over the past year, Children Now successfully laid the groundwork for the implementation and the expansion of MDRAN, which included:

Expanding the MDRAN codebase to extend the capability and functionality of the system.

Training 14 San Joaquin Treatment + Education for Everyone on Teeth + Health (SJ TEETH) care coordinators.

Finalizing a patient satisfaction survey in partnership with the trained SJ TEETH care coordinators, who will also administer the survey.

Building a search function to allow medical providers to find dental providers.

Executing business agreements with two Medi-Cal managed care health plans to be able to upload live data from these plans to MDRAN when the FFS interface was launched in Q2 2023.

Supporting Kaiser Permanente's implementation of MDRAN within their Sacramento sites.

This proposal aims to build on last year's activities and success by launching MDRAN broadly among SJ TEETH care coordinator organizations, scaling MDRAN to interested counties, and identifying strategies to sustain care coordination supports.

First, Children Now, in partnership with First 5 San Joaquin, will continue its pursuit of a blanket data use and sharing agreement with San Joaquin County which would allow County programs serving Medi-Cal members, such as WIC, to use MDRAN and generate dental referrals. This access would introduce new data into MDRAN that could better inform patient barriers to care and responsive resources to share with them. Additionally, Children Now expects MDRAN to be well-established in San Joaquin County, generating dental referrals for children via SJ TEETH organizations (First 5 San Joaquin, San Joaquin Public Health Services, dentists, nonprofits, and other partners), county agencies, and other Medi-Cal serving partners, by 2024. As interest from the State Office of Oral Health grows around MDRAN, Children Now will leverage its relationships with partners in San Diego, Stanislaus, and Santa Clara counties to determine the feasibility of implementing MDRAN in those counties and execute blanket agreements where possible.

This request is for $150,000, which makes up less than 1% of the organization's overall budget. The grant funds will support staff time ($76,000) as well as travel for project activities, telecommunications, and a contract with Oral Health Solutions. This proposal was originally submitted in 2022 but was not approved as there was interest in having Children Now execute its blanket agreement with San Joaquin County prior to funding. Since then, expansion and utilization of MDRAN has continued and reviewers appreciated the organization's initiative and commitment to advancing MDRAN. The MDRAN pilot in San Joaquin County has created new and defined datasets that can be captured and updated in real time. This data will inform Children Now and its partners’ policy priorities for future years, specifically the case for the value of community-rooted care coordination paired with partnerships with community-based organizations, local government agencies, and health care industry partners.