October 3, 2013 -- Behind closed doors, coordinated care organizations are negotiating with dentists to reach agreement on Oregon’s most vulnerable population – people on the Oregon Health Plan. Next January, thousands of low-income Oregonians start flocking onto Medicaid once income eligibility jumps up to 138 percent of the federal poverty level.
The Legislature made a clear-cut decision to coincide with Gov. Kitzhaber’s efforts to transform the publicly-funded health system. And dental care represents the grand finale. Starting July 1, at the very latest, people on Medicaid will receive dental care from their coordinated care organizations.
No longer will they have to scramble into an emergency room, shrieking in pain with an abscess tooth; children and adults will all have access to dental care.
Some coordinated care organizations, such as Trillium Community Health Plan in Lane County, are preparing to move at a quickened pace, and intend to introduce dental care starting Jan., 1. To accomplish this, they must submit binding letters of intent to the Oregon Health Authority by Nov. 1.
Trillium appears to be halfway there, after reaching agreement with two dental plans -- Advantage Dental and Willamette in the last few days
“We worked out a compromise that was good for everyone – patients and dentists who provide the care,” said Mike Shirtcliff, president of Advantage Dental. “”And, the dental care organizations purposely decided not to talk to each other because we didn’t want people pointing fingers at us and saying we colluded.”
But Trillium still remains at odds with Capitol Dental and ODS Dental.
“Unless something changes by October 1st, we won’t be in Lane County in January,” Bill Ten Pas, president of ODS Dental, told The Lund Report last week. “That doesn’t mean we aren’t interested in participating.”
Ten Pas was reluctant to discuss why contract negotiations had broken down, but another dental plan executive had no problem sharing some of the details. Under the proposed contract, Trillium is requiring dental plans to agree to a risk withhold – meaning that a certain amount of their reimbursement would be held back until Trillium knows how much care is actually being delivered.
When asked why negotiations hadn’t produced a favorable outcome for ODS or Capitol Dental, Debi Farr, Trillium’s public relations specialist, was reluctant to discuss details but did say, “We’re disappointed not to have a binding letter of intent with all four dental care organizations, but the negotiation process is complex, and we’d rather do it right than do it fast. We’re encouraged to have two letters of intent and are looking forward to the integration of dental care into our coordinated care organization in January.”
Despite his success with Trilllium, Shirtcliff admitted that wasn’t true of three other coordinated care organizations – AllCare Health Plan, Health Share of Oregon and WVP Health Authority. But he hs worked out terms of agreement with five other CCOs -- FamilyCare, Western Oregon Advanced Health, Intercommunity Health Plan, Primary Health of Josephine County and Jackson Care Connect.
Nevertheless, Shirtcliff hasn’t given up hope with AllCare and Health Share. “As of yet, we haven’t been able to have friendly discussions with them.”
For its part, AllCare has held several joint meetings to work out “the critical non-financial terms of cooperative agreements” with the four dental organizations in its area, Curry, Jackson and Josephine counties, said its spokesperson Freddy Sennhauser.
AllCare was able to reach agreement with Willamette Dental Group, and ODS with contract start date of Oct. 1. 2013, Capitol Dental has been on board since July 1, 2013, But, two days ago, negotiations reached an impasse with Advantage.
“The other three dental care organizations had accepted the key terms,” said Sennhauser, but not Advantage. “It is our desire to treat all DCOs in a similar and equitable fashion as was our agreement with them at the onset of the process. We plan to continue to work with Advantage Dental to reach agreement on this important issue.”
Health Share had a similar response, telling The Lund Report that it anticipates finalizing the contract process with all eight dental care organizations in its area by Nov, 1. “Anytime you are entering into a contract with a new entity, there are always discussions around the contract language – this is a routine part of doing business,” said Beth Sorensen, communications manager.
Diane Lund-Muzikant can be reached at [email protected].
