Putting money where the patient's mouth is: Increasing benefits to save money

May 6, 2008
Insurance companies are taking action in addressing the benefits of preventive dental care.

by Teresa Duncan

Insurance benefit providers are realizing that patients who take care of their oral health tend to be healthier overall. Studies show that periodontal disease is not just a concern for dentists. The Journal of the American Dental Association (JADA) has published findings that show a high correlation between periodontal disease and vascular disease.

The American Academy of Periodontology (AAP) presented a study in their March 2007 journal that shows periodontal disease to be a risk factor for pre-diabetes. Another AAP study showed that organ transplant failure could be linked to periodontal inflammation.

Periodontal disease is the most common chronic infection in the human body. Fortunately, it is preventable and treatable. While the patient's age, sex and genetic history are unalterable, the treatment and prevention of gum disease is modifiable. With early diagnosis the patient can avoid medical complications resulting from periodontal disease. The outcome to a diagnosis of diabetes or heart disease may well be altered by proper oral care.

Insurance companies are taking commendable action in addressing the benefits of preventive dental care. By increasing coverage for these services and including oral care in disease management, the insurance industry stands to realize significant cost savings. The American Dental Hygienists' Association estimates that for every $1 spent on preventive measures, $8 to $50 is saved in dental treatment costs.

As a pilot program last year, Blue Cross Blue Shield of Michigan (BCBSM) distributed coupons for free dental cleanings to OB/GYN offices to distribute to pregnant patients. Motivated by studies suggesting a link between poor periodontal health and premature birth, the carrier hoped to avoid the steep costs associated with high-risk births. The coupons were so popular that the program has continued this year. Another coupon program was initiated for patients diagnosed with diabetes and heart disease.

Aetna launched a Dental/Medical Integration program this year to monitor members who are pregnant or who have diabetes, coronary artery disease, or cardiovascular disease. Their results showed that members in the outreach program visited their dentist for preventive care 50 percent more than members that were not in the program. This means more opportunity to identify and treat patients with chronic disease risk factors before the disease reaches late stages.

Spending more preventive dollars to avoid future treatment costs is relatively new to dental benefit plans. Compared to the design of medical benefit plans, dental benefits are usually paid on a non-comprehensive basis. With a typical annual maximum of $1,000 to $1,500, dental benefits are less comprehensive than supplemental. By contrast, disease management has been an integral part of the medical insurance field since the early 1990s. By evaluating patients on a systemic basis, specialty physicians are able to collaboratively provide care. Proven cost containment using this approach suggests possible savings in the dental field. Successful programs such as BCBSM have paved the way for employers to purchase more preventive benefits at more reasonable rates for their employees, such as sealants and periodontal maintenance procedures.

Some plans are now providing benefits for sealants up to age 16 instead of 14. Delta Dental of Massachusetts (DDMA) now offers sealant coverage to age 19. Covered fluoride treatments for adults are increasing. Periodontal maintenance procedures (D4910) are traditionally paid at a restorative rate after a deductible. More plans are allowing benefits up to four times per year, rather than the traditional two prophylaxes per benefit year. DDMA now offers coverage for chlorhexidine rinse and prescription-strength fluoride toothpaste following periodontal therapy. Coverage for diagnostic oral cancer screening tools is increasing. The use of ViziLite©Plus is now a covered benefit for certain Guardian Dental and Cigna Dental plans.

The cost savings associated with early disease detection will factor into designing future benefit plans. With patients presenting at the dental office on a regular basis for preventive care and other dental treatments, it is not a stretch to view the dental office as a primary provider. Recorded blood pressure readings at each visit provide us with a baseline health statistic. Evaluation of bone levels on radiographs can be used to evaluate possible bone loss associated with osteoporosis. Imagine the savings health plans would realize by identifying members at risk for cardiovascular disease, high blood pressure, and higher rates of bone fractures before these conditions present themselves at a trauma center.

The high price of health care coverage is a limiting consideration for employers purchasing benefit plans. It is in the best interest of the insurance carrier to provide plan structures that offer more comprehensive care for little price increase. By touting the perks of increased preventive coverage, the carrier provides the employer with a more attractive plan to present to employees. Spending a small amount in this area may ultimately reduce insurance carrier expenses in the costly medical arena.

The trend of increasing preventive benefits is a positive one. Consumers will look to their dental providers for advice on how to best use their benefits. They will be more receptive to covered services such as screening and diagnostic procedures. Using these procedures, we can illustrate to patients the impact of their oral health status on their overall health. For many patients, this connection will be new information. Such an educational opportunity is significant and should not be missed.

References available upon request.

Teresa Duncan has a master's degree in Health Care Management from Marymount University. With more than 19 years of health-care team experience, she has developed a passion for educating and motivating dental team members. She is an educator for the Association of Dental Implant Auxiliaries. You can read her blog, The Dental Implant Blog, at The Dental Implant Blog.

Teresa can also be contacted by e-mail at Teresa Duncan or through her Web site at Odyssey Management.