February 1, 2012—Dental care organizations are growing increasingly vocal about the future relationship they’ll have with the coordinated care organizations (CCOs) that are expected to provide healthcare to Oregon Health Plan members in July.  

House Bill 3650, which set in motion the overhaul of the Oregon Health Plan, doesn’t require dental organizations to participate in these CCOs until July 2014. Because of that, “some of the CCO organizational folks haven’t invited oral health folks to the table,” said Mike Shirtcliff, CEO of Advantage Dental

“You have to remember that oral health is always a poor step child,” Shirtcliff said. “We’re all trying to be cautious and figuring out how we can participate in the new game so we can survive as an organization.”

Dental care needs to be integrated into the overall healthcare system, according to Deborah Loy, executive director of Capitol Dental, who spoke before the Oregon Health Policy Board recently.  Oral pain is the number one cause of why people go to the emergency room. “When [the mouth] is sick, the body is too,” Loy said. “How can overall [healthcare] costs be lowered without having oral health?”

Making matters even more complicated is the question of how many dental organizations can actually contract with a CCO. Currently the implementation plan requires “each CCO to have a formal contractual relationship with any dental care organization that serves members of the CCO in the area where they reside.”

Depending on the interpretation, it’s unclear whether a CCO can only contract with only one  entity in a geographical area.  

Shirtcliff says the implementation plan is clear. “You’re going to have to contract with all four or five” dental care organizations in a particular region. .  

Not necessarily, according to Steve Petruzulli, the former CEO of Willamette Dental.
“ ‘Any does not mean all,’” he told the Senate Health Care Committee during a hearing last week. “Maybe we’re paranoid.”

Petruzulli urged the Senate to clarify that CCOs must work with “all [dental care organizations] in their service area.” Otherwise, some organizations could end up going out of business and that could reduce the number of available dentists.

“Medicaid patients [should] continue to have choice and continue to see the providers they’ve become adjusted to,” he told lawmakers.

Sen. Jeff Kruse (R-Roseburg) told Petruzulli that legislators may clarify the language about dental care organizations, requiring them to be part of a CCO.   

“I think anybody with risk should have a voice, and not just a contractual relationship,” Kruse said.

Shirtcliff hasn’t experienced any problems being a part of the conversations on the formation of CCOs. A group of nine healthcare providers in Douglas County, including Advantage Dental, have announced they’re prepared to form such an entity. And, Shirtcliff’s been participating in discussions with other provider groups around the state interested in forming CCOs.   

He believes the transition to CCOs on July 1 won’t have an impact on dental care organizations or people on the Oregon Health Plan seeking care. “We’re still going to be taking care of them,” he said. “The state is still going to give us the money. We won’t have as good coordinated, integrated care.”

CCOs are expected to integrate physical, mental and dental services for people on the Oregon pending the Legislature’s approval of an “implementation proposal” during its special session this month.