Oregon’s Largest CCO Prepares for Integrating Dental Care

Oregon’s coordinated care organizations have until next summer to integrate dental care, and Health Share of Oregon, which serves the Portland metropolitan area and the largest number of patients (approximately 165,000), is expecting to have dental care integrated by January 1.

JanetMeyerHealth Share is working with all eight of Oregon’s dental care organizations (DCOs), which currently provide dental care to Medicaid patients. The logistics of integrating eight separate health plans into one CCO has been challenging, says Janet Meyer, Health Share’s CEO.

“I don’t think any of us knows what it fully means yet,” she says. “Right now, we have no interactions with them on a meaningful or regular basis. It is very much a silo.”

There are a variety of technical logistics to sort out, and Meyer says one of the most challenging is that Oregon’s DCOs don’t use the same diagnostic codes that physical and mental health providers use. Those codes are used to identify someone as having congestive heart failure, or asthma, or diabetes, and Meyer says those codes are how Health Share identifies and tracks its population. While dental care’s codes are expected to change this summer, the situation illustrated to Meyer how different the dental system is.

But she thinks the biggest challenge in the months ahead will be determining how dental care is integrated into the rest of the healthcare services Health Share provides, especially in terms of budgeting for particular services and types of care. “We haven’t sit down with our dental partners yet to discuss it,” she says. “They bring a rich base of knowledge to the table. It will come.”

Meyer thinks Health Share should target providing dental care to a few sub-populations, including people with severe mental illness, and ensure that those people get regular screenings and cleanings. “The drugs they take to manage their mental illness are very hard on their body,” Meyer says, making it necessary for them to have good medical care.

Providing preventive dental care to children, particularly giving fluoride varnishes and sealants, will be another priority. Pregnant women are another population Meyer envisions targeting, because calcium and other minerals can leech from their teeth while pregnant.

Many CCOs, including Health Share, are changing how particular types of care are delivered—for instance, having a mental health practitioner work in a doctor’s office, to better coordinate with a patient’s physical healthcare provider and make intake for new patients easier.

Meyer thinks a similar approach can be taken with dental care. In the case of mentally ill patients, she thinks it’s possible to have dental hygienists. Similarly, dentists could work in a pediatrician’s office to make it easier for children to get dental checkups. “Parents wouldn’t have to make a separate appointment,” she says.

Such changes in how care is delivered is designed to create, she says, “a system of care about meeting the patient where they’re at.”