Dental care is now part of the equation for the coordinated care organization serving people in Jackson and Josephine counties on the Oregon Health Plan.
AllCare, the coordinated care organization that serves roughly 30,000 people in the two counties, plus southern Douglas County, has signed an agreement with a dental contractor named Capitol Dental Care Inc., and the CCO will welcome three other dental groups in January — ODS, Advantage Dental and Willamette Dental.
While most Oregon Health Plan members are unlikely to notice much of a change initially, because many of the changes will be administrative and take place behind the scenes, the development "is a big deal," says Dr. Lyle Jackson, chief medical officer for AllCare.
As part of health reform in Oregon, CCOs have been set up to coordinate medical care for people on the Oregon Health Plan. A 2012 state law required health care providers to become CCOs and provide all three types of care — dental, mental and medical — under one umbrella.
AllCare is one of 15 CCOs in the state, and one of three that have now gone live with a dental coordination organization, Jackson says.
Dental benefits under the Oregon Health Plan are meager, offering little to no preventive coverage except for children and pregnant women, Jackson says. Adults, especially adult men, are covered for tooth extractions but little else, including fillings for cavities. And the addition of dental contractors to the CCO structure won't expand the number of benefits offered under the Oregon Health Plan.
But the new dental contractors will increase efficiency for dentists in their networks and will help "make sure people who need dental care, mainly pregnant ladies and children, get it," Jackson says.
"What we're hoping is that by putting them under the CCO banner, care will be better ... so people will not be running to the emergency room because they can't get in to see a dentist," Jackson says.
The reasoning is that, "instead of having 30 contracts with 30 dentists, we will work with contractors like Capitol Dental that have numerous dentists in their network," making it easier for dentists to get reimbursed and increasing overall efficiency in the delivery of care.
Improvements in efficiency will become even more important in January, when the Oregon Health Plan expands and as many as 20,000 more people in Southern Oregon will become eligible for coverage.
Most of the people covered by the Oregon Health Plan are "the working poor," says Jackson, and the agency is taking steps to increase the number of homeless people who will be eligible for coverage.
"The problem is that they are transient, and it will be hard for many people without an address or ID to establish residency.
"They can't get on the Oregon Health Plan because they don't have an ID. (In Josephine County), we're working with the Gospel Mission and we're paying for a part-time social worker, one day a week, to help people get an ID. We'd like to do that in Jackson County, too."
Reach Mail Tribune features editor David Smigelski at 541-776-8784 or firstname.lastname@example.org.