Dental care differences among the behavioral health population in an accountable care organization: a retrospective cohort

Published:August 29, 2022DOI:



      To compare dental utilization and expenditures between children with and without behavioral health (BH) diagnoses in an accountable care organization.


      A retrospective cohort study using enrollment and claims data of Medicaid-enrolled children in Ohio. Children with 7 years of continuous enrollment from 2013-2019 were included. We calculated five dental utilization outcomes: 1) Diagnostic only visits; 2) Preventive visits; 3) Treatment visits; 4) Treatment visits under general anesthesia (GA); and 5) Orthodontic visits. Total 7-year cumulative expenditures were calculated for each outcome. Multivariable logistic regression models were run for each outcome adjusting for demographics and medical comorbidities.


      Among 77,962 children, 23% had ≥1 BH diagnosis. No utilization differences were noted between children with and without BH for diagnostic only visits, treatment visits, and orthodontic visits. BH status modified the likelihood of having a preventive visit and dental GA visits based on medical comorbidity. For example, children with BH diagnoses had significantly lower odds of a preventive visit (ex. Non-complex chronic comorbidity: OR=0.87, 95%CI: 0.85 to 0.89), and significantly higher odds of a dental treatment under general anesthesia visit (ex. Non-chronic comorbidity: OR=3.69, 95%CI: 3.26 to 4.18). The total cumulative dental expenditures were $10.5M greater for children with BH.

      Conclusion and Relevance

      Children with BH diagnoses were significantly less likely to have preventive visits and more likely to have dental GA visits, which was expensive. Early identification and intervention could alter treatment approaches, improve care, reduce risk of harm, and achieve cost-savings within a pediatric accountable care organization.

      What's new

      Children with behavioral health diagnoses have different dental care utilization patterns, which significantly alters expenditures. In the aftermath of the pandemic, these patterns of care warrant further exploration to promote interventions that improve cost-driving outcomes within an accountable care organization.


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