Dental Evaluation Now Part of MRMIB Effort

The Managed Risk Medical Insurance Board has about 875,000 subscribers — so when it evaluates which health plans show the highest quality improvements, that information is important for quite a number of Californians.

This year, it chose six organizations that showed overall superior performance in the quality of care for children in Healthy Families, California’s version of the federal State Children’s Health Insurance Program administered by MRMIB:

  • San Francisco Health Plan;
  • CalOptima (Orange County);
  • Contra Costa Health Plan;
  • Health Plan of San Mateo;
  • Northern California Kaiser Foundation Health Plan; and
  • Southern California Kaiser Foundation Health Plans.

MRMIB cited Southern California Kaiser and the Community Health Group in San Diego for making significant improvements in quality of children’s care, as well as the Community Health Plan in Los Angeles County for its quality improvements in treating adolescents.

Twenty-six plans participate in California’s Healthy Families program. The federal government requires states to evaluate and report on the quality of care provided through SCHIPs.

This year, MRMIB did something new — it released a review of dental care in the Healthy Families program.

Overall performance by the six plans providing Healthy Families dental coverage continues to rise, according to the report.

“It’s coming out as the leading edge of a dental initiative we’re starting,” according to Jeanie Esajian, deputy director of legislative and external affairs at MRMIB. “We’re going to do a lot more work on dental quality. It’s a front-burner item here.”

Delta Dental and Premier Access Dental provide coverage as exclusive provider organizations — or EPOs — on a fee-for-service basis. Access Dental, SafeGuard Dental, Western Dental and Health Net Dental provide coverage as dental HMOs, paying a flat amount per month to provide care for members.

Dental EPOs outperformed dental HMOs but MRMIB hopes to change that.

The agency has only added dental as a mandated benefit for a year, Esajian said. “So we’re developing a more robust quality infrastructure,” she said. In particular, the agency is concerned about the quality gap between higher-performing EPOs and lower-performing dental HMOs, Esajian said.

“This is a way we recognize improvement in performance,” Esajian said of the medical and dental evaluations. “We do this because we want to acknowledge and recognize quality performance and to encourage it.”

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