Community Dental Services health plan, plagued with financial troubles and quality-of-care problems, has shut down its managed care dental plan in Sacramento and Los Angeles counties.
On Friday, the state announced that all 16,000 Medi-Cal beneficiaries at CDS, the bulk of them in Sacramento County, would switch to Liberty Dental Plan of California. Also making the change will be 4,000 non-Medi-Cal patients. State officials said beneficiaries' providers would remain the same in almost every case.
The failure of CDS may be good news for the state and the beneficiaries in the plan, since that company had the lowest utilization rate among the five health plans providing dental coverage in Sacramento County. The state has been under fire recently because of low utilization rates in the pilot "geographic managed care" system. In the 2010-2011 fiscal year, fewer than one-third of Sacramento County Medi-Cal children went to a dentist, compared with a utilization rate of nearly 50% for the rest of the state.
"We had financial and quality issues with them. A lot of financial and quality issues," said Marta Bortner, deputy director of communications and planning at the Department of Managed Health Care. As for the CDS beneficiaries, she said, "They will receive better care at another plan, I know that. We are supporting the move to Liberty, we think it's a really good thing for them."
Bortner said the CDS quality issues included inappropriate company policies, failure to follow up on appeals, or even to maintain a reliable grievance system at all, and the inability to pay claims accurately and on time.
"They certainly have been under pressure to resolve financial and quality issues," Bortner said. "They've been under increased scrutiny for some time."
Those issues extend to access to providers, according to Norman Williams, deputy director of public affairs for the Department of Health Care Services. "Access issues have been raised at CDS," Williams said. "Certainly this will be an improvement. We anticipate increasing level of access, because Liberty is one of the better-performing plans, and CDS was the worst."
However, the 16,000 Medi-Cal patients served by Community Dental Services is just a small fraction of the overall population -- about 5% of the Sacramento County beneficiaries. The utilization issue is broader than that, said Assembly member Richard Pan (D-Sacramento).
"This is an improvement in the sense that this is the worst performer," Pan said. "But this is not a reform fundamentally."
Pan said he's pleased that DHCS is minimizing disruption of care for beneficiaries, and the focus on utilization has certainly increased. "But monitoring is going to continue to be needed," Pan said.
One of the issues with this dental managed care program, Pan said, is that providers are already paid on a capitated, per-patient basis, so there is little incentive to encourage patient visits.
"Hopefully that [state attention] translates into different behavior among providers," he said, "so they will follow through to ensure these patients get the care they need."
Pan is pushing for DHCS to allow an opt-out for beneficiaries who don't want to be in the managed care system, to allow them to choose fee-for-service, if they want.
"People need a choice, an option for fee-for-service, if they're unable to get care through their managed care plan," Pan said.