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Coordinated Care Organizations - How might it affect you in your practice?

August 29, 2013 - 12:30pm

"Oregon has tried to tackle rising costs by focusing on Medicaid which serves 550.000 people in the state and is expected to grow by 200.000 under the Affordable Care Act’s Medicaid expansion that starts next year.  Governor John Kitzhaber last year spearheaded a new model of delivering services under Medicaid.  His initiative led to a state law that created ‘coordinated care organizations,’ which attempt to integrate mental, physical and dental care  as they improve the way chronic conditions are managed.  These organizations are required to manage their costs within a fixed rate of growth.”  AP-RTD, 8-29-13
I mention this because I see it becoming more prevalent in the future- that is, the CCO model.  We are seeing it already in medicine and now we are beginning to see the beginnings of it in dentistry.  How might it affect you in your practices?  It may not, depending on where you practice and whether you see Medicaid patients or not.  This is a global way to manage the financial side of taking care of large groups of patients.  In short, a CCO would be given a certain amount of money to take care of a certain group of patients over a length of time- say a year.  That finite amount of money is to be used to take care of the medical, mental and dental needs of that particular group of patients over that time period.  If there is money left over at the end of the year, it is proportioned out to the provider base as a ‘bonus’.  On the other hand, If you run out of money during the year, it is on your dime- not the funders.  The goal is to use the model to create healthier populations in an effort to control/decrease the cost of health care.  So, you are ‘incentivized’ to create healthier populations and punished if you don’t.  I will follow this model in Oregon closely to see how the dental fares over the first year or two.  Another disruptive ‘innovation’ for us to think about!