Economics expert speaks at CDA task force meeting

The CDA Dental Benefits Research Task Force heard from a dental economics expert with the ADA and learned about Oregon’s Coordinated Care Organizations at its January meeting.

The task force, which is identifying strategies to enhance the position of providers and patients in the dental benefits marketplace at the request of the 2011 House of Delegates, heard from Marko Vujicic, PhD, managing vice president of the ADA Health Policy Resources Center; Bill Ten Pas, DMD, senior vice president of Dental Services at Oregon Dental Service and president of the Dentists Benefits Corporation; and Al Guay, DMD, ADA Senior Policy Advisor and consultant to CDA’s task force.

Vujicic is an economist specializing in issues related to the health care sector and previously held the position of senior economist for the World Bank where he directed the World Bank Global Health Workforce Policy Program. Prior to that, he served as a labor economist with the World Health Organization.

Vujicic presented the task force with several key ADA findings related to the dental economy and utilization of services, including: dental spending per capita has been relatively flat since 2008; adult dental utilization has declined, especially among the young adult and middle-age groups; and dental coverage and utilization, largely the result of expanded public programs, is up for children.   

“I can tell you with confidence in the last decade, more of dental spending is coming from public services,” Vujicic said. “The public sector is still small, but it’s bigger than it was a decade ago because health care spending in the U.S. is becoming much more public as compared to out-of-pocket spending or private insurance financing.”

Vujicic said there are six key forces that are converging in the dental benefits marketplace: decline in dental utilization, especially by young adults, that began several years before  the recession; continued fiscal austerity within state budgets; a shift from financing procedures to financing outcomes; pressure on providers to become more efficient; increased integration of health care delivery and financing; and increased consumerism in health care.   

With regard to increased consumerism, Vujicic noted differences in health policy purchasing preferences by age groups. When consumers were asked if they would rather buy a dental-only policy, or a dental policy as part of their medical plan, young adults showed a preference for purchasing an integrated plan by 12 to 20 percentage points over every other age group, with adults, aged 45-54, most likely to prefer a dental-only policy. Vujicic explained that young adults show different shopping and purchasing preferences, not only for dental care, but for medical care as well as for many other goods and services, as reflected in these survey results.

Walt Weber, DDS, chair of the task force, said the presentation supplies further evidence that there are some factors that are out of the control of dentistry.

“It confirms that there is a macroeconomic factor that is at play here,” Weber said. “It confirms that some things are out of our control. At some point we have to accept what is out of our control and figure out what we can control – dentistry has choices, the economy is uncertain, the future of the Affordable Care Act and how it affects dentistry is uncertain, but even within the uncertainty we can make choices based on the knowledge we have.”

Weber said dentistry must be proactive to face these changes within the marketplace.

“I think we’re going to find that for some, corporate dentistry may be an answer; some will develop group practice relationships; maybe we develop strategies to improve practice efficiencies and reduce office overhead – there is not one an easy answer that is going to apply to everyone’s situation, but we’re continuing to study this to develop strategies,” Weber said.

A trend that began before enactment of the federal Affordable Care Act, but further encouraged by the Act’s creation of Accountable Care Organizations (ACO), is the integration of health care services. To give the task force a better understanding of the ACO-like Coordinated Care Organization network in Oregon, Bill Ten Pas and Al Guay spoke to the task force. According to oregon.gov, a CCO “is a network of all types of health care providers who have agreed to work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan (Medicaid).” These CCOs have begun integrating providers of physical health, mental and behavioral health, and in a few cases, dental health – with most CCOs waiting to integrate dental care last. 

There are 16 CCOs in Oregon, including All Care, Columbia Pacific, Eastern Oregon, Family Care and Willamette Valley. Ten Pas defined them as single organizations that accept responsibility for the cost of providing health care within a global budget.

“Each has their own boards that determine eligibility and how they will spend funds, and each must make decisions that maintain financial solvency and improve patient health,” Ten Pas said.  

Weber said there is still much to learn about these organizations.

“There is a lot to be determined in what the future holds with these accountable care organizations, and it is sort of a grand experiment – essentially 16 pilot programs – to see what works and what doesn’t work,” Weber said.

What’s Next

The CDA Dental Benefits Research Task Force is coming to the end of the information-gathering phase of its work and will be moving into the analysis and problem-solving phase when it meets again in March. 

Members interested in the dental benefits research project can visit cda.org and click on the dental benefits taskforce link under “Advocacy.” Additionally, further resources on dental benefits can be found on the Practice Support Center online at cda.org/compass.

For more information on this or other dental payment issues, contact the CDA Practice Support Center at 866.232.6362.