Dental Integration into CCOs Expected to Jumpstart Evolution

Dental care has always been regarded as the ugly duckling of medical care: no one likes going to the dentist, and dental programs that are part of state Medicaid programs often lag behind physical and mental health programs when it comes to funding. The billing codes for dental care are also completely different, relying on procedures instead of diagnoses.

But a sea change is underway in Oregon—starting this month, dental care organizations (DCOs) begin contracting with Oregon’s coordinated care organizations, and they have until July 1 to become fully integrated into CCOs, which are responsible for coordinating and integrating the physical, mental and dental healthcare of the state’s Medicaid patients.

Leaders of the state’s DCOs say integration will propel the most substantive changes to the delivery of dental care and how the quality of that care is measured, an evolution they say is sorely needed.

“It’s an opportunity to really get the ball moving in the direction that the dental industry, whether it likes it or not, needs to go,” says Matthew Sinnott, Willamette Dental Group’s director of government relations.

“The biggest challenge doesn’t even really lie in the integration, it lies in where we want to go with it…our big goal to integrate dental care into a ‘whole person’ model of care. What we are embarking on is unprecedented,” he says.

CCOs are embarking on a variety of pilot projects and small demonstration projects to test innovative ways to provide care. It will be no different for dental—CCOs and dental organizations are already talking about funding mobile vans to provide dental care in rural areas and having dental hygienists visit schools and provide cleanings and education.

Populations to target for providing preventative care have already been identified, including children, pregnant women, and people with mental illness. Collaboration and data sharing between health providers is expected to increase the likelihood that a patient is getting the care they need.

“Many of the DCOs have been doing some of these things, but in small pockets,” says Erin Fair Taylor, CareOregon’s director of CCO partnership and development. “The opportunity that exists with CCOs is to be able to really test what’s working, and what isn’t. All of this should be about meeting people where they are and making it easy to make good choices about healthcare.”

But integrating dental into CCOs has not been without challenges. The legislation creating coordinated care organizations allowed dental organizations to slowly transition into becoming part of CCOs, partially because from an operation point of view, dental and physical are very different types of care.

“We’re not speaking apples to apples with physical health,” Sinnott says, especially when it comes to different billing codes, which are changing this summer. “It’s been a challenge for everybody involved. It’s a complicated thing to do, to break down the silos and get everyone speaking the same language.”

The legislation also requires CCOs to contract with every dental organization in its geographic area. “The legislation, in some ways, is very prescriptive,” Taylor says. “It forces everyone to the table.”

Willamette Dental Group’s patients, for example, are served by 12 CCOs; so far, Sinnott says Willamette has finalized contracts with eight, and hopes to have the other four completed by July.

The legislative requirement is proving especially tricky for the Portland metro area, where all nine dental organizations operate. That means Health Share of Oregon and FamilyCare must work with nine different dental organizations, and get them each to adopt a standardized contract, adhere to the same quality metrics, and other administrative and procedures.

“It adds a layer of complexity that you don’t find in the other service areas where there are only two or four DCOs,” Taylor says.

By 2017, CCOs will no longer have to work with every dental organization in their area—meaning a CCO could simply choose to contract with one. “There is a lot of pressure on the dental organizations to really ensure high quality, cost effective, patient centered care,” Taylor says.

Taylor points out that because a particular organization’s outcome and metrics data will be available to other members of the CCO, it will quickly become evident which dental organizations are providing the best care.

“Are we going to bolster the ones falling short, or are we going to leave them behind?” Taylor asks. “That’s really the key question.”