Lobbyists from coordinated care organizations successfully derailed new transparency requirements last week and now the clout-heavy organizations are aiming to kill a bill in the Senate that would require them to share governance with dental care organizations.
CCOs have struggled at dental care, and utilization numbers have fallen since these groups were established to integrate dental care with physical care and mental health. House Bill 2882 would require a Medicaid dental provider to sit on the CCO governing boards, where they could help set priorities for the CCOs. Currently, only six CCOs have Medicaid dental providers on their boards.
“I don’t know how you’re going to transform healthcare if you don’t include those people who deliver most of the dental care in the state,” said Mike Shirtcliff, CEO of Advantage Dental, the state’s largest dental care organization.
The CCOs have resisted any attempt to increase regulation or force them to share the pie for providing Medicaid, and their opposition to HB 2882 is no different. CCOs are already statutorily required to keep a primary care provider and a mental health provider on their boards, but a dental provider is not spelled out explicitly -- even though Shirtcliff said that was the intention of former Rep. Tim Freeman, R-Roseburg, and former Sen. Alan Bates, D-Ashland, when they set up the CCOs in 2012.
Shirtcliff said the CCOs have had five years to comply with this intention, but most have just ignored it.
When HB 2882 passed the House unanimously last month, it allowed DCOs serving a CCO to nominate a person for the board, and the CCOs would have the freedom to select from among those nominees. This negotiated departure from the original language seemed to appease CCO concerns in the House, but now it appeared they may be try to defeat the bill outright.
The makeup of a CCO board can have tremendous influence on its priorities. The physician-led CCOs in the Coalition for a Healthy Oregon spend considerably more on primary care, which aligns their financial interest with their patients.
The hospital-led CCOs spend much less on primary care, and show higher claims at hospitals. The Oregon Health Authority has encouraged this apparent conflict of interest by paying the CCOs based on claims costs for some Medicaid members instead of actual risk.
Preventive dental care is also a form of primary care, but without a seat at the table, the dental care organizations backing HB 2882 -- Advantage Dental and Capital Dental -- argue that the voice for dental care is muted.
Under the old system, the Oregon Health Authority contracted with dental care organizations for oral care, managed care organizations for physical care and county and community mental health and addictions programs for behavioral health.
Starting in 2012, coordinated care organizations were formed to roll oral and mental healthcare under one roof, alongside physical care.
The Medicaid expansion not only added nearly 500,000 people to the system, it added dental care as a benefit for adults. Shirtcliff said his company has increased the number of clinics from 23 to 45, but the state’s dental networks are still trying to keep up with that expansion. Advantage is also trying to protect the investment it made when doubling its capacity in the state.
DCOs also recently got their rates cut, as the health authority set reimbursement based off 2015 claims, a year in which Shirtcliff said a lot of adults with bad teeth needed a lot of emergency work, impeding the dental care organizations’ ability to do more routine preventive work.
Utilization rates for children’s dental checkups have fallen from 45 percent in 2011 to 42 percent today -- well below the national Medicaid standard of 50 percent, and significantly worse than children get through private insurance, which showed utilization rates of about 70 percent in a recent survey from the American Dental Association.
Reach Chris Gray at [email protected].
Correction: A quote was misattributed to Deborah Loy, who is the executive director of government programs at Capitol Dental Care.
