Dental Care Organizations Want to Get a Jump Start on Transformation

April 25, 2012—Although dental care organizations aren’t required to become a part of the transformation process until 2014, two groups are getting a jump start.

Mike Shirtcliff, the CEO and president of Advantage Dental, doesn’t see any reason to wait. His company, based in Redmond, provides dental care to about 187,000 people on the Oregon Health Plan, and was listed in six letters of intent sent to the Oregon Health Authority from coordinated care organizations interested in integrating mental, physical and dental healthcare for people on the Oregon Health Plan.

“I believe in the concept of coordinated care, and believe that’s the future,” he said. “I want to come in a reasonable way, and in a way that we can help.”

Advantage Dental expects to join the Community Health Alliance based in Douglas County. Dr. Bob Dannenhoffer, the CEO of Douglas County Independent Practice Association who’s among those spearheading the Alliance, always assumed dental care would be part of that coordinated
care organization.

“We have to work together, and dental care is critical to overall health,” he said.

But Shirtcliff has also unexpectedly experienced a great deal of frustration working with other organizations interested in becoming coordinated care organizations, including hospitals, counties, doctors and mental health groups.

All of those groups, Shirtcliff said, are in a “battle” over which organizations will be part of a coordinating care organization’s governance board—which will determine how the organization works and delivers integrated care.

“It’s ferocious,” Shirtcliff said. “It’s created a situation where the little players hardly even get a chance to have a voice.”

Shirtcliff has approached other potential coordinated care organizations, which he wouldn’t name, that have turned him down, saying they don’t want to “futz” with dental care.

“That sends up a bit of a red flag,” said Dr. Kurt Ferre, executive director of the Creston Children’s Dental Clinic. “Dentistry always kind of takes a back seat. A lot of people don’t understand [that] you have to have good oral health.”

Dannenhoffer, who agreed with Ferre, said “We all have a lot on our plate. [But] think of the ways that dental health and physical health cross over. A lot of dental patients wind up in the emergency room [because of dental pain]. Similarly, we have kids who have really rotten teeth. They should have better coordination between pediatricians and dentists to prevent some of that decay.”

Shirtcliff points to the language in Senate Bill 1580 as one reason behind this problem. That bill, which passed the Legislature in February gave the Oregon Health Authority the ability to move forward and create coordinated care organizations but didn’t require dental organizations to serve on their governing boards.

The fast timeline to create coordinated care organizations has also caused tension among providers, he said. The applications are due by April 30 with the intent of certifying these new organizations by June.

One could argue that providers have had plenty of time to think about becoming coordinated care organizations. House Bill 3650, which created the new organizations, laid the blueprint for what’s happening now, was approved by the Legislature in June 2011.

But according to Shirtcliff, many organizations waited until passage of Senate Bill 1580 in February to get a better idea of what, exactly, would be expected of them.

“We really didn’t know until January what the business plan was going to look like,” he said, referring to when the Oregon Health Policy Board approved the final version of the business plan. “And Senate Bill 1580 just barely got out of the Senate. Who do you sit down and talk to
when you don’t even know who’s interested in being a coordinated care organization?”

Since dental and mental care often “end up on the chopping block” when it comes to budgeting, Ferre thinks that dental organizations should wait to join coordinated care organizations until the dust settles.

“[Providers are] all trying to find out where their niche is going to be in this new format,” he said. “Let’s let them duke it out and find out where dental is going to fit in. I imagine there are arguments both ways. I would just hate to see dentistry get buried right off the bat.”