Position on Managed Care

Managed care is a term that is often misunderstood and used incorrectly. Relative to dentistry, dental managed care plans are usually thought of as capitation programs (HMO’s or DHMO’s). However, they also include PPO’s. There has been a rapid proliferation of plans designed to organize and control health care costs since 1990.

For many African-Americans capitation programs, PPO’s and Medicaid are the only means by which dental care is affordable and accessible. For others, employers and the state, Medicaid agencies have disrupted patient-doctor relationships without consent or consideration.

In 1996, state requirements allowed Medicaid and Medicare to come under state regulated managed care plans. Medicaid waivers give states complete control over Medicaid funds with no federal regulation. The states’ growing reliance on managed care to provide health service to the nations poor, elderly and disabled populations will have a profound impact on African-American Medicaid beneficiaries.

In 1995, one out of three (11.6 million) Medicaid recipients was a member of a managed care plan. For Medicaid beneficiaries, 11% or 4.2 million were managed care enrollees in 1996. Currently, data on Medicaid enrollee satisfaction with managed care organizations, and the impact on the African-American health providers is being compiled. Access, quality and the efforts of essential community providers are critical issues.

• The NDA supports programs that will increase access to dental care and improve oral health in African-American communities

• The role of the NDA will be to educate consumers, policymakers and providers on the various types of managed care programs; quality assurance; and mechanisms for regulating, monitoring and oversight of these Managed care organizations

• We believe that patients deserve quality care and that providers deserve fair and equitable compensation

• We believe that optimum health care management is dependent on collaborative efforts, including consumers, plan administrators, providers and legislators

• The NDA believes that positive health outcomes are achieved when patients receive quality care from culturally competent providers in their own communities; and when patients can make informed choices. We endorse plans that adequately fund benefits and are designed to maximize member utilization, promote prevention, offer acceptable standards of care and scope of services, and monitor both patient and provider satisfaction

• The NDA upholds the right for any dentist to enter into managed care agreements, with the understanding that under no circumstances shall contract obligations justify compromised care or excuse them from their ethical duty to put the welfare of the patient first

• We believe that for profit managed care plans have an obligation to reinvest in the communities they serve; include traditional and essential community providers in their network; market the plan to target populations (traditionally underserved and vulnerable); encourage optimal utilization, and provide incentives/rewards for positive health outcomes and patient and provider satisfaction.