House Votes to Enshrine Dental Care Organizations into CCO Boards for Oregon Health Plan

The Oregon House unanimously took up House Bill 2882 on Monday, requiring that each coordinated care organization put a dentist from a dental care organization on its governing board.

“House Bill 2882 finally allows the dental care organizations to have a voice in the coordinated care system,” said Rep. Cedric Hayden, R-Cottage Grove, a dentist who once led a dental care organization in Lane County. “It’s been three or four years coming.”

Coordinated care organizations were built on the concept of integrating physical, oral and mental health, rather than offering these services through separate managed care organizations.

But only six of the state’s 16 CCOs have a member of a dental care organization on their boards -- others have no dentists at all, while some have dental providers who are not involved with Medicaid.

“They haven’t done as well as they could because they don’t have the [dental] people who serve their members on the board,” said Mike Shirtcliff, CEO of Advantage Dental, who sits on the board of the PacificSource CCO in Central Oregon.

Advantage also has a seat on the Western Oregon Advanced Health board in Coos Bay. It is the only DCO that serves patients in all 16 CCOs. In 2009, Advantage bought out Hayden Family Dentistry.

Under HB 2882, each DCO that serves a CCO’s members will nominate a candidate for the board, and then the CCO board will select from those options. Each CCO contracts with an average of four of these dental groups; both CCOs in the Portland Metro contract with all eight DCOs.

Dental care organizations have worked with Oregon’s Medicaid system for over two decades and have provided one of the only means for which Oregon Health Plan patients can get access to a dentist, particularly for comprehensive care.

DCOs take on large pools of patients and assume the risk for the oral health needs of the population. They are paid upfront on a per-member basis, regardless if the member actually receives care. This allows DCOs to spread the risk for patients who need care across their clientele.

Without this managed care approach, Medicaid patients are largely shut out of dental care, as few dentists are willing to accept Medicaid patients at the very low fee-for-service rates set by the government.

“I could spend a lot of time discussing the difference between transformation and reorganization, but it is impossible for me to see how integration and transformation are going to occur unless each CCO has a DCO representative on their respective boards,” said Shirtcliff. “I work with all of the CCOs and those that have a DCO Board Member seem to be making the most progress.”

Currently, Capital Dental Care and Willamette Dental Services each serve on two different CCO boards.

Dental care organizations were supposed to be dissolved into the operations of the CCOs but because of the slow pace of integration, they continue to operate as partners with CCOs rather than subsidiaries.

The Coalition for a Healthy Oregon and 12 CCOs all signed a letter of modest opposition to HB 2882, but indicated they would not oppose the bill if it was amended from its original version, which had a more complicated formula for appointing a DCO representative to their boards. Hayden amended the bill to allow DCOs to nominate and CCOs to appoint, a workable compromise.

Moda Health, which operates the Eastern Oregon CCO, also opposed the bill, arguing that putting a specific DCO representative on its board could hinder it from expanding relationships with other dental care providers. Moda currently contracts with Advantage and Capital, as well as ODS, which it owns.

Reach Chris Gray at [email protected].