Dental Care Organizations Express Concern About Transformation

Because dental organizations aren't required to participate in the coordinated care model until 2014, some feel left out of the discussions

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.

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I have been a supporter of the CCO process from the beginning. The language of HB 3650 says "on or before 1 July, 2014 a CCO must have a contract with any DCO in the region that it serves." It is going to take time to sort out the delivery system transformation. With hospitals, counties and their public and mental health authority, medical plans both commercial and Fully Capitated Health Plans, quasi public, public, and private medical providers, mental health providers, dental health providers,reserves and risk sharing, the needs of the consumers of the system as well as the public at large all have to be considered. Being the only statewide MCO, I have been in many conversations and as noted, involved with one that looks like it may get off the ground and am very impressed with the dicussion. The first question that has to be asked is will this transformation happen? I have found no one who does not feel change is needed. Secondly, then the question is in a particular region who should be at the table and involved in the discussion, then comes the discussion about how do we do this where we do not lose the system we have while we move to the new system. Mike Shirtcliff

Just because DCO's have been given some time does not mean they should not be part of the dicussion. Remember some hospitals have been given some time also. The bill says "on or before" not never. Advantage has been active in being part of the discussion as have other DCO's. With the complexity of physical health, hospitals, county mental health and public health, and the difficulty that DCO's had in developing a dental network, it was felt time was needed. With the acception of one DCO, we told the Governor that we were in support of the transformation process and plan to honor that commitment. Mike Shirtcliff

My understanding is that the DCOs wanted out of the CCO process (at least for a few years) from the outset so now why all the consternation about not being at the table. And be careful about pointing out dental pain in emergency rooms because as a medical provider I hear an awful lot of those people talk about not being able to get an appointment or they are treated disrespectfully or they don't even know who their dental group is which tells me somebody is getting the money to care for them whether they get the outreach and care or not.