 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Oscar Arevalo, DDS, ScD, MBA, MS, Temple University School of Dentistry, Director, Outreach Programs and Dental Public Health, 3223 N. Broad Dr., Philadelphia, PA 19140, 215 707-5865, oaaf@dental.temple.edu, Richard C. Weiss, DMD, MScD, Associate Dean for Administration and Finacial Affairs, Temple University School of Dentistry, 3223 North Broad St., Philadelphia, PA 19140, R. Ivan Lugo, DMD, MBA, Temple University School of Dentistry, Associate Dean for Institutional Relations and Community Affairs, 3223 North Broad St., Philadelphia, PA 19140, and Lisa P. Deem, DMD, JD, Temple University School of Dentistry, Assistant Dean for Admissions and Student Affairs, 3223 North Broad St., Philadelphia, PA 19140.
Methodologies to determine a monthly capitation rate and to evaluate financial viability of a capitated contract are presented. Information for a one-year period from a community health center dental program (CHCDP) on variables such as demographics, mix of services, utilization levels, and costs (direct, indirect, fixed, variable) was utilized. A contract proposal from a managed care organization (MCO) was used to determine the monthly cost per enrollee for services included in the benefit package. Relative value units (RVU) were used to convert mix of services into a common scale and to estimate average cost per value unit. Net cost per individual service was calculated by projecting annual services for the enrollees and subtracting value of cost sharing. We obtained a rate of $ 9.76 excluding indirect costs and $ 13.08 when these were included. A sensitivity analysis at different utilization levels and patient visits was done to determine contribution margin of this contract. The contract yielded a positive contribution margin at the historical utilization rate for enrollees of the MCO (54%) and average number of visits per individual patient (3.4) at the CHCDP. Monthly benefit cost per individual and group was adjusted for demographic characteristics such as age and gender. The most expensive group ($ 11.40) was women (19 - 40 years) whereas the least expensive group ($ 8.43) was children (less than 19 years). The methodologies presented enable dental providers to make a rational decision about the financial viability of a dental capitation plan.
Learning Objectives:
Keywords: Access, Financing
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.