NEW Study: Texas Medicaid Dental Program Could Save $235 Million Annually Through Adoption of Kool Smiles Practice Model

Multi-Year Analysis of Texas Medicaid Claims Data Shows Kool Smiles Dental Providers Performed More Conservative Care at Lower Costs than Other Medicaid Providers in State

Feb 01, 2016, 15:03 ET from Benevis Foundation

AUSTIN, Feb. 1, 2016 /PRNewswire-USNewswire/ -- The Benevis Foundation today announced the release of a study by Dobson DaVanzo & Associates examining Medicaid dental utilization trends and expenditures in Texas over a four-year period, using publicly available Medicaid dental claims data. The study, released on February 1 to mark the beginning of National Children's Dental Health Month, found that Kool Smiles – a national dental practice serving pediatric Medicaid patients in Texas – performed more conservative, cost-effective care when compared to other Medicaid dental providers in the state.

The analysis of Medicaid claims data supports recent research indicating that the dental service organization (DSO) practice support model is effectively narrowing the gap in access to quality dental care for low-income children and families, a population that has historically faced obstacles accessing quality dental care since a majority of dentists in the U.S. do not accept Medicaid patients due to inadequate reimbursement.

Using publicly available Medicaid data from 2011 to 2014, the study found:

  • Kool Smiles dental providers performed 24 percent fewer services per patient than non-Kool Smiles providers operating within the same geographic area.
  • As a result of lower utilization rates, Kool Smiles patients had an average annual Medicaid expenditure that was 38 percent lower than non-Kool Smiles patients across all years analyzed.
  • If all Medicaid dental providers in Texas adopted the same care protocol and utilization rates as Kool Smiles providers, the total savings to the Texas Medicaid program would amount to $235.5 million annually.  
  • The annual Medicaid savings could fund the provision of dental care to 688,000 additional Texas children who do not currently receive dental care.

"Existing literature suggests that the emergence of the DSO model in recent years has contributed to significant dental access gains among the Medicaid patient population," said Dr. Alan Dobson of Dobson DaVanzo & Associates. "This analysis builds on those findings by showing that Kool Smiles, a DSO-affiliated dental provider, provides more conservative care to Medicaid dental patients and at lower cost to the Texas Medicaid program."

"Oral health improves when children have access to regular, preventive dental care," said Dr. D Ray Gifford, Managing Dental Director for Kool Smiles. "By providing a Medicaid dental home to Texas children who have historically lacked access to a dentist, we are able to reduce the potential for more expensive procedures over time. If we can increase access, improve the oral health of these patients and lower Medicaid costs in the process, we best serve both our patients and taxpayers."

The report also provides a solution to enable the Centers for Medicare & Medicaid Services (CMS) to reach its goal of increasing the number of Medicaid and Children's Health Insurance Program (CHIP) eligible children and young people aged 1-20 who receive preventive dental services by 10 percent.  The study suggests that the DSO practice model employed by Kool Smiles would be an effective way of addressing what the American Dental Association (ADA) has defined as the "Medicaid funding crisis," by decreasing utilization and costs while improving access.

The analysis represents utilization and Medicaid expenditures across 36 Kool Smiles providers and 1,262 non-Kool Smiles providers in the state, which amounts to approximately 170,300 unique Kool Smiles patients and 353,443 non-Kool Smiles patients in Texas.

The research for this study was prepared by Audrey El-Gamil; Nikolay Manolov, Ph.D; Dorothy Chen, M.P.H.; Joan DaVanzo, Ph.D., M.S.W.; and Al Dobson, Ph.D. The study was funded by the Benevis Foundation.

For more information on the cost savings and quality of care provided by DSOs, you can read Dobson DaVanzo & Associates' full study here.

About Kool Smiles

As a leading children's dental health provider, Kool Smiles' mission is to improve lives by providing high quality dental care in a fun, compassionate environment. Founded in 2002, Kool Smiles has more than 120 affiliated dental practices across 15 states and the District of Columbia, primarily in underserved communities that have historically lacked access to dental care. Kool Smiles dentists are proud to offer care to children and adults with almost any insurance plan, including State Children's Health Insurance Programs (SCHIP), Medicaid and Tricare. Kool Smiles also provides oral health education programs through partnerships with community schools and organizations. For more information, please visit

About the Benevis Foundation

The Benevis Foundation is committed to improving dental care access and outcomes for underserved communities in the United States through research, education and outreach. The foundation sponsors ongoing research on the role of Medicaid dental providers in improving access to preventative care, early intervention, and dental health education among traditionally underserved pediatric populations, as well as research on the cost savings associated with improving access to dental care among these patient populations in both federal and state healthcare systems. Through these research efforts, the Benevis Foundation hopes to provide data that informs and strengthens public policy related to dental access and affordability. For more information, visit


SOURCE Benevis Foundation