12/05/2012

Dental benefit experts speak at House of Delegates


As part of its continued efforts to keep members up-to-date on the changing landscape of the dental benefits industry, CDA invited three experts in the field to speak to the 2012 House of Delegates last month.

The two-hour presentation, which was coordinated as an extension of the research of the CDA Dental Benefits Task Force, informed the delegates about changes occurring in the dental benefits marketplace, health care reform trends and their potential to impact dentists, and the importance of doing the in-depth research necessary to understand how to best navigate these changes.

“We decided to pick three speakers who we felt would give the House of Delegates a broad focus on the overall trends we are seeing,” said Walt Weber, DDS, chair of the task force.

The speakers included Michael Sparer, PhD, JD, department chair, health policy and management, Mailman School of Public Health at Columbia University; Paul Manos, DDS, dental director for United Concordia Dental; and Al Guay, DMD, former chief policy advisor for the ADA and a consultant to the task force.

“The task force has heard a lot about market trends and medical/dental integration during our information-gathering phase, and we wanted to share some of this foundational information with the delegation,” Weber said.

During his presentation, Sparer discussed the top trends he is seeing in the health care system and how the results of those trends will not only impact the medical community, but will likely influence the financing and delivery of dental care as well. 

“The illusion of immunity from change in the dental community is false,” Sparer said. “The world is changing, the times are changing and that’s going to affect every one of you.”
Sparer identified the following trends:

  1. Moving toward an integrated health care delivery system. The breaking down of “practice silos” that separate health care disciplines.
  2. Creating leverage in the marketplace: e.g., consolidation due to hospitals buying insurance companies; insurance companies buying hospitals and provider groups. Entities becoming bigger through consolidation and integration of care.
  3. Debates over who does what. Trend toward changing scopes of practice.
  4. Growth of employer wellness programs.
  5. Care management programs.
  6. Comparative effectiveness of various treatment modalities; use of evidence-based treatment and measurable outcomes.
  7. Personalized medicine: treatment and therapies arising from genome mapping.

Sparer also addressed the Affordable Care Act.

“The Affordable Care Act itself contains provisions that seek to fundamentally change the way the health system is organized, and it contains provisions that seek to fundamentally change the way the health system is financed. Those provisions can and will affect the oral health and dental community,” Sparer said.

But changes are happening in the medical field regardless of the ACA, Sparer said.

“The health care world is changing and the ACA, while important to that conversation, is not nearly the whole story,” Sparer said. “The marketplace is changing in fundamental ways.”

The change is coming in many different areas. The way employers provide health coverage, for example, is a lot different today than it was 10 years ago when benefit packages accounted for approximately 2 percent of an employee’s compensation. Today, it represents between 18 and 25 percent. Employers also are increasingly relying on brokers to develop benefit packages and are influenced by their finance departments as much as their human resources departments. 

The number of stakeholders involved in the dental benefits industry is something dentists have to take into consideration, Manos said during his presentation.

“We tend to view dental insurance as something between the dentist, the patient and the insurance company … It’s a lot more than that,” Manos said.

Manos said the following stakeholders are part of the dental benefits marketplace:

  1. consumers/patients;
  2. employers/trusts/unions/TPAs/labor organizations;
  3. brokers/insurance consultants;
  4. dentists/staff;
  5. organized dentistry;
  6. regulators – federal/state;
  7. insurance companies/dental plans; and
  8. dental supply companies.

During his presentation, Guay added to the discussion of how many stakeholders are involved, and what that does to the system.

“Our dental system is complex … It used to be pretty simple; it was the doctor and the patient,” Guay said. “In my early days of practice, I would send a bill to patients that would say, ‘for professional services,’ and a number.”

But times have changed.

“There are now several other stakeholders that are between the doctor and the patient, and all of these stakeholders look at our system from a different perspective and with different aims,” Guay said. “As the distance increases between these stakeholders and the patient, the leverage the dentist has with the stakeholders decreases also.”

The speakers agreed that the fact CDA is conducting research on the dental benefits industry (based on a 2011 House of Delegates resolution) is a step in the right direction toward giving dentists a stronger voice in the process and promoting cooperation.

“I want to give special recognition to CDA for having this discussion and having discussions with other insurance companies,” said Manos, who also informed delegates about the anatomy of dental benefits, how benefits are determined and future plan challenges. “This is a huge push in the right direction for us to get together and work together.”

Sparer said the work of the task force is a positive, proactive step forward.

“No one knows exactly how these trends toward consolidation and integrated delivery systems are going to play out. But if you don’t manage change, change manages you,” Sparer said. “I think the California Dental Association, through the task force that’s begun and the work you are engaged in, is leading right now just by having this conversation.”

The task force is made up of a cross-section of 11 dentists from different stages of practice who are analyzing the health care environment, trends in dental care financing, dental plan coverage and payment policies. The task force met seven times in 2012 at the CDA headquarters in Sacramento where it heard presentations from more than 20 experts who discussed everything from the role of quality assurance and performance measures in benefit designs and reimbursement policies to health plan models that integrate medical and dental through reimbursement structure.

The project’s timeline includes an information-gathering phase that will continue into 2013, with findings and recommendations anticipated to come to the 2013 House of Delegates.

Read more information about the actions of the task force. For more information on other dental payment issues, contact the CDA Practice Support Center at 866.232.6362, or visit cda.org/compass.