The Changing Face Of Dental Insurance Prevention Is An Emerging Key To Improving Health While Lowering Costs

In uncertain economic times, is dental insurance a benefit for employers to sink their teeth into or an unnecessary cost that is better extracted?
It can actually be both, depending on the company, said Kathy O’Loughlin, president of Delta Dental of Massa-chusetts.

“Employees put great value on it, so I think it’s used by companies to retain workers,” she said. “There is a lot of desire on employees’ part to have a good dental plan.”

O’Loughlin admitted that, when businesses are looking to cut back on expenses in tight times, dental insurance premiums can be an attractive place to begin, as dentistry represents only about $53 billion of a $1.3 trillion medical marketplace in the United States. But more employers recognize that dental insurance is a valued benefit that comes at a relatively low premium, she added.

The statistics seem to back that up. According to the annual benefits survey conducted by Associated Industries of Massachusetts, 79{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Bay State businesses offer a dental benefit to their employees, and that figure rises to 83{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in Western Mass.

Dental insurers and employers alike benefit from the fact that dental costs have been rising at a 6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} annual rate — about half that of medical costs in general. As a result, even companies looking for cost savings have reason to hang onto the benefit, as the statistics bear out.

“What affects medical costs greatly affects us,” O’Loughlin said. “But we are often left out of draconian measures. It is an important benefit that doesn’t cost a lot of money, so employers leave it alone.”

Regardless of membership numbers, however, dental costs do continue to rise, and plans must constantly deal with emerging technologies and treatments. It’s a changing world in medical progress, and dentistry is no different.

A Growing Industry

In the 1960s, dental insurance became widespread in the United States, about 10 years behind medical insurance in development, O’Loughlin said. Since then, third parties have contracted primarily with employers to pay for dental work in return for premiums. Delta Dental, as one example, contracts with about 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the dentists in Massachusetts.

Most people with dental insurance get it through group plans simply because coverage for individuals is not commonly offered, according to the American Dental Association (ADA).

The reason for this is that dental needs, unlike medical needs, are highly predictable. Knowing what dental work will cost over the long haul, patients will not pay premiums they expect to be more expensive than the cost of the actual treatment needed. With this being the case, insurance companies would stand to lose money on every individual dental plan they write, spending more on benefits than they receive in premiums.

However, some companies offer a form of dental benefits for individuals. These plans are often known as ‘referral plans’ or ‘buyers’ clubs.’ Under these types of plans, an individual pays a monthly fee in return for access to a list of dentists who have agreed to a reduced fee schedule. Payment for treatment is made from the patient directly to the dentist, with the third party acting only to match the patient to the dentist. Meanwhile, the dentist receives no payment from the third party outside of a fee for referral of patients.

According to the ADA, there are several alternate options for setting up dental insurance. Direct reimbursement programs reimburse patients a percentage of the cost of dental care, regardless of the treatment category and generally with no restrictions on treatments or dentists.

Schedule-of-allowance programs det-ermine a list of covered services with an assigned dollar amount. That dollar amount represents how much the plan will pay for covered services, and the patient pays the difference.

Under Preferred Provider Organization (PPO) programs, contracting dentists agree to discount their fees as a financial incentive for patients to select their practices. If the patient’s dentist of choice does not participate in the plan, the patient will have a reduction or complete loss of benefits.

Finally, capitation programs pay contracted dentists a fixed amount per enrolled family or patient. In return, the dentists agree to provide specific types of treatment to the patients at no charge, although for some treatments there may be a patient co-payment.

As new dental technology emerges (see related story, page 21), plans of every type must undergo reassessment as to which procedures will be covered. O’Loughlin said there is typically a five- to 10-year gap between the emergence of new dental technology and decisions by insurers that those procedures are worth covering.

“We’d like to close that gap,” she added. “Cost-effective technology should be available quickly.” And that cost-effectiveness is a huge issue to insurers, she said, so much that promising new technology often doesn’t make it to the marketplace because of perceptions that third-party payers won’t cover it.

Prevention Is the Key

No matter what the plan format, however, the rising cost of dental care continues to be of concern. That’s partly why many dental insurers are starting to place more value on prevention in dentistry, recognizing that effective preventive efforts will lower costs for both patients and insurers.

“In dentistry, the emphasis has always been on surgically treating diseases,” O’Loughlin said. “But, just like in medicine, people are starting to see the value of prevention. Dentistry has always been in the forefront of prevention, and we would like to see that translated to lowering disease rates in the general population, rewarding providers more aggressively for preventing disease instead of just treating it.”

Dr. Robert Compton, Delta Dental’s Massachusetts director of disease management, explained how preventive, ‘evidence-based’ dentistry works with a real-life example. A woman noticed that her gums were occasionally swollen and sore, and when she saw her dentist, he not only cleaned her teeth but also discussed some of her eating habits, general health, and family medical history.

What he was doing was putting together a risk profile regarding cavities and periodontal disease. Using this evidence-based approach, he suggested the woman embark on a dental care program that included switching to a different over-the-counter allergy medication to reduce dry mouth (a decrease in saliva production that contributes to plaque buildup) and visiting the dentist for checkups every four months to monitor her gum health.

For the patient, this customized program focused on keeping her mild gum disease from progressing, while reducing her out-of-pocket expenses and time away from work due to oral health problems. For her employer and insurer, it meant saving money down the line by avoiding costly restorative procedures.

In fact, Compton said, the American Dental Hygienists’ Association estimates that for every $1 spent on oral health prevention, between $8 and $50 is saved on restorative and emergency procedures. Meanwhile, Public Health Reports pegs the annual savings due to preventive dental care at $4 billion annually.

“The technology exists for screenings, so dentists have the tools to do risk assessment and prevention,” O’Loughlin said. “And just like in the medical field, it does lower the cost of care.”

And cost savings could eventually be applied to uninsured populations who struggle to gain access to affordable health care, she added.

The issue is a crucial one not only in oral health but health care in general, as studies show that uninsured people have four times the disease burden as insured patients.

“In a $1.3 trillion marketplace, it’s inexcusable that some pockets of our cities have mortality rates like a third-world country,” she said. “I think the prevention piece will help in that issue.”

Biting into a Big Issue

Two years ago, the U.S. surgeon general’s office released a study determining that working Americans lose 164 million hours every year to dental disease and dental visits. Meanwhile, children lose an additional 51 million hours of school due to dental illness, leading to further lost work time as their parents tend to their needs.

Clearly, dental insurance is more than an incentive for employers — it’s a way to increase efficiency in the workplace and improve the overall health of Americans.

“In the end, the primary responsibility for good oral health falls on the patient,” Compton said. “However, companies can encourage employees to make smart choices about their oral health.”

Through dental insurance participation, more than ever before, they’re doing just that.