More on MDRAN: Answers to 11 Questions about a Successful Care Coordination System

Care coordination involves ensuring that all providers caring for a patient have access to the same information and can communicate seamlessly with one another. That coordination is critical to providing the right care, in the right place, at the right time.

That coordination is also difficult to achieve — especially in the oral health system.

One promising solution, the Medical Dental Referral and Navigation (MDRAN) system, was featured in the March 10 CareQuest Institute for Oral Health webinar, “Taking a Community-Based Approach to Care Coordination.” More than 300 dental and medical professionals joined the live call to learn more about the value of care coordination in oral health and the success of MDRAN, part of a pilot organized by Children Now, in improving dental care for children in California. The presenter and panelists — Katie Andrew, EdM, associate director, Health, Children Now; Matthew Crandall, vice president of technology, MDRAN, Oral Health Solutions; Roberto Garces, MPH, program director, MDRAN, Oral Health Solutions; Robyn Alongi, health program planner, Sacramento County Public Health; and Rebekah Fiehn, manager of care coordination and interoperability at CareQuest Institute — responded to several questions during the program, but participants wanted to learn more about the success of the system.

The panelists collaborated after the call to answer 11 questions about MDRAN and oral health care coordination efforts in Sacramento County.

1. What is MDRAN?

The MDRAN system was originally created to allow physicians to easily refer their Medicaid patients aged 0 - 20 years to a dentist. MDRAN is a HIPAA compliant, user-friendly, web-based system that uses claims/encounter data to make referral and tracking easy.

In 2021, the system was expanded to include all Medicaid members in Sacramento County regardless of age. (In Sacramento County, care coordination is provided by the three managed care dental plans.) MDRAN also expanded the type of users from strictly physicians to include any organization/program that interacts with the Medicaid population to create a “no wrong door” approach to connecting people to dental care. This includes school-based screening programs, school nurses, WIC, Nurse Family Partnership home visiting program, and more. MDRAN tracks the referral to completion and notifies the referring user when a dental visit associated with one of their referrals has occurred.

2. Can MDRAN be used in other states?

Yes. For MDRAN to operate in other locations, it is necessary to obtain dental Medicaid data from the state directly or the contracted managed care dental plans. Because care coordination is a key component to ensure that a referral is “successful,” stakeholders would need to lay out a potential care coordination strategy based on the resources available. In the case where dental services are provided through a dental managed care structure, for example, the team would need agreement from the managed care dental plans to provide care coordination supports.

3. Do the providers (both medical and dental) need to log in to this system? Has there been resistance to “another” log in? 

No. Only the referring user needs to log into the system. Once a referral is generated in the system, it is routed to the care coordination team embedded within the dental plan assigned to the Medicaid member so that they can initiate care coordination supports, such as assistance in scheduling a dental appointment, arranging for language services, and/or transportation assistance. The system then monitors new data uploads from the dental plans for a dental claim associated with that referral and alerts the referring user that a dental appointment happened, when it occurred, and what services were provided. The dentist who provided services does not have to log in to MDRAN or enter any information about the visit.

4. When MDRAN started, who engaged all the various organizations to participate?

Through the Medi-Cal Dental Advisory Committee, Sacramento County has had a robust group of oral health stakeholders who have been meeting for many years to provide oversight and guidance to improve Medi-Cal dental utilization rates and the delivery of dental care services in the county. During the Dental Transformation Initiative, this group was the basis for connections. Robyn Alongi (Sacramento County coordinator for the DTI) and Katie Andrew (Children Now, lead for the Medical-Dental Partnership pilot) were responsible for mapping out programs/organizations that provide services to the Medi-Cal community and then conducting outreach and recruitment. They connected with community clinics, OB/GYN providers, county programs, school nurses, the local dental society, the school-based screening program, and other stakeholders.

5. Was it necessary to incentivize medical providers to join MDRAN?

No incentives were provided to users. We have heard for many years that there was a huge unmet need and physicians did not have a reliable method to refer their patients to a dentist, nor were they informed of the outcomes of the referral if one was made. It took time and effort to recruit providers. Once we had data to support efficacy and primary care physicians understood how quick and easy the referral was, more providers began using the system.

6. Does MDRAN interact or connect data to health information exchanges? 

Not at this time. MDRAN engaged with two of the largest health information exchanges in California and explored the possibility but discovered HIE currently does not have a robust enough dental dataset for MDRAN to work. We will continue to monitor the progress of HIE and its inclusion of dental data.

7. Is MDRAN still dependent on grant funding?

While our work in San Joaquin Valley is currently grant funded (Children Now is a grantee of CareQuest Institute), the three managed care dental plans currently support MDRAN in Sacramento County. We are discussing future support and expansion into other counties with local oral health programs and the managed care health plans that deliver Medi-Cal benefits within each of those counties.

8. Are there hopes to integrate Medicare and a system of referrals for oral care?

Dental referrals and referral management for the Medicaid population is the focus of MDRAN for the time being, as we work to expand the userbase in Sacramento and into other counties. There is still a lot of work to be done in the Medicaid space, but we are always open to exploring how MDRAN can facilitate referrals for other populations as well.

9. What system-level changes are still needed to ensure sustainability and spread of the MDRAN program?

Due to policy changes at the state-level through a managed care procurement process and a reimagining of California’s Medicaid program (referred to as CalAIM), Medicaid managed care plans in California are becoming increasingly responsible for the oral health of their members and are exploring strategies for care integration and coordination. The implementation of CalAIM will require a significant lift by both the managed care health plans and the state. As integration and oral health becomes more of a focus of the managed care plans, they will need to ensure that their provider networks are considering both the physical and oral health of their patients. It will be critical for referrals from medical providers to be tracked and managed as these integration efforts are rolled out.

10. We see MDRAN as a system well-positioned to assist Medi-Cal managed care plans in helping to connect their members to dental care, monitor care coordination efforts, and track and manage referrals.  Care coordination takes more than just a referral. Often, there are other barriers to care which must be considered when building a network. Can you describe how your community is addressing social determinants of health and other barriers?

The care coordination teams that receive and coordinate MDRAN referrals have workflows that integrate some social determinants of health screens to determine if patients need assistance (e.g., transportation to get to their appointment, translation/language assistance, etc.). We are exploring the possibility of embedding additional SDOH screenings into MDRAN to be used at time of referral or at care coordination.

11. If a community wanted to get started with organizing around care coordination, what advice would you offer?

We have five pieces of advice:

• Determine a source of funding. Talk to the local health plan, search for grant funding, ask the county.
• Create a list of providers (who are accepting new patients) and the attributes of each office: what languages are spoken, what accommodations they make for patients with special needs (including wheelchair access to the exam rooms), their comfort with treating pregnant women, their office hours, etc. Keep this list up to date.
• Think about how to organize the care coordinators by using a central hub or a place within key organizations such as Federally Qualified Health Centers, hospitals, and community-based organizations. 
• List organizations in the community that could refer people with dental needs to your care coordination team, including physicians, food banks, county programs, shelters, special needs programs, schools, and the local dental society. Who in your network has a connection to an organization that could facilitate an introduction?
• Start reaching out to those organizations.  

Editor’s note: For more information about MDRAN, contact Katie Andrew at kandrew@ChildrenNow.org or Roberto Garces at rgarces@oralhs.com.