Dental Managed Care Takes a New Tack


Dental Managed Care Takes a New Tack

by David Gorn--(California Health Line)--Under a new financial model of dental managed care in Sacramento County, utilization rates have risen by more than 10% and providers are being paid significantly more than the state's fee-for-service Medi-Cal rate, according to Amir Neshat, president and CEO of Liberty Dental Plan.

Neshat said the new financial and administrative model has resulted in better access to care for children who need general anesthesia for their dental care. That issue has been a big concern for children's and dental care advocates for years, as providers said Medi-Cal rates were too low to accept patients in that population and so those patients were often unable to access care.

"Everybody bashes Denti-Cal but no one ever does anything about it," Neshat said. "We did something."

Liberty is paid by the state on a capitated, per-member-per-month basis, but the insurer reimburses dental providers on a fee-for-service basis at a rate about 20% higher than fee-for-service dentists were getting from Medi-Cal last year around the state.

The state's low reimbursement rate for fee-for-service Medi-Cal dental services were such a concern that legislators in last week's budget agreement included funding for restoration of a 10% cut in rates that had been imposed by the state in 2011.

Even with that rate reduction restored across the state, Liberty officials said their reimbursement rate for Sacramento County dentists still will be 10% higher than the rest of the state.

They can afford to do that, Neshat said, because of the addition of some accountable care measures.     

"We collect a lot of data, we make sure we understand what providers are doing, so there is an accountable care component," Neshat said. "We don't have the hospital component [of an accountable care organization structure].  What we do that is similar is we establish a dental home and we give providers an incentive to get as many kids in [to see the dentist] as possible."

The state's pilot program for dental managed care in Sacramento and part of Los Angeles posted poor results as recently as 2011, when children's dental utilization rates dipped below 30% in the managed care dental system, meaning fewer than 30% of Sacramento County Medi-Cal children saw a dental provider during that year.

Neshat said utilization rates at Liberty now are between 40% and 45%, an increase of more than 10% in the past four years.

James Musser, a dentist in Fair Oaks about 20 miles outside of Sacramento, said he was skeptical of the dental managed care pilot program, but he has seen big changes in the past few years.

"Personally, I've dealt with Liberty, and they're just very efficient with the management of the program," Musser said. "Being able to contact them whenever I need to, being able to get preauthorization the same day, those make a big difference."

Enough of a difference, along with the higher reimbursement rate, he said, that Musser is able to take on young patients who need general anesthesia.

"To me, geographic managed care has improved greatly over time," Musser said. "[Administrative efficiency] allows providers to do their job, allows the treatment of children."