Dental Close-Up
Growing Consumerism in the Dental Industry
by Brian Watts

   Like so many medical industry trends, healthcare consumerism is spreading to the dental benefits industry. Several forces are fueling dental consumerism, such as higher dental costs, shrinking funds for ancillary benefits, and growing evidence linking oral health to overall health. Today’s dental consumerism offers a significant opportunity for the entire industry to create new plans that provide more affordable dental care.
   Thanks to the advent of many new “pain-free” procedures and better awareness about oral hygiene, pain is no longer the number one reason people avoid the dentist. Today, high cost is our greatest obstacle.
   My three-year-old son’s first trip to the dentist included an exam, cleaning and x-rays, and a bill of more than $300 from our local children’s specialist. That’s a lot of money for a check-up and cleaning. An industry associate recently told me that her out-of-pocket co-insurance for a crown was $700 with a good group insurance plan. With the high cost of dentistry along with medical inflation, people are having a harder time continuing their dental coverage and the uninsured are grasping for ways to afford even a routine visit. The National Institutes of Health (NIH) reports that people are 50% more likely to go the dentist if they have benefits. NIH also reports that every $1 spent on preventive dentistry saves $4 in restorative costs.

Dental Consumerism

   For decades, the dental industry has adopted medical trends, such as HMOs, PPOs, EPOs, and POS plans. Today, the medical industry is using consumerism to reduce medical plan premiums by holding members more financially accountable for their care. Consumer-directed concepts can also help the dental industry achieve lower rates; address the needs of the uninsured; and expand the value of dental care.
   The first tenet of consumerism is to get people to spend their healthcare dollars as if it were their own money. Have you ever split a dinner bill with friends and wondered how your $10 salad ended up costing $20? Those ordering the least expensive food invariably pay more for their food while those ordering the most expensive food pay less.
This dinner bill analogy describes one of the ways employers inflate their dental premiums unintentionally. It also reveals how introducing consumerism can lower dental bills. When reimbursement levels for PPO dental plans are the same for everyone, employees who go to in-network providers subsidize the premiums of employees who go to more expensive non-network providers. A simple and effective way to reduce premium costs without taking away an employee’s freedom of choice is to follow the medical benefit industry’s differentiation between in-network and out-of-network benefits for all dental services.
   Employers with PPO plans should allow their employees to go to the provider of their choice. But, they should have to pay higher co-insurance on all services if they go to a more expensive out-of-network provider. This single change in plan design would reduce the premium for employees and employers and foster more cost effective spending habits among employees.
Most employers require some premium contribution from employees and there is a trend to transfer even more of that premium to the employee. This should be ample incentive to take reasonable steps toward modifying plan designs to reduce premium costs.

Information Is Power

   Providing information to help consumers make better-informed decisions is another key to dental consumerism. Whether insured or uninsured, consumers who have to pay more for their dental care demand more information. The medical industry has no standard system to track prices. But, in the dental industry, several national organizations have collected fee information for dentists across the country and have developed average usual, customary, and reasonable (UCR) fees. Access to this fee information allows insured and uninsured dental consumers to make better financial decisions.
   Insurers are beginning to offer online benefit calculators to help members understand what procedures cost and how much their plan pays before they go in for an appointment. Coupled with the network incentives, this calculator helps employers educate their employees and promote more cost effective behavior.
   The growth of discount dental plans is another important trend for uninsured and insured consumers. These discount plans generally save consumers 20% to 50% off of the retail fee for most common dental procedures. With most discount plan Websites, consumers can compare the plan’s discounted fees with the UCR fees in their area. Dental discount plans can be an excellent supplement for services that an insurance plan does not cover. Insurance plans always include limitations including annual maximums and exclusions, such as teeth whitening, dental implants, and orthodontics.

Evidence-Based Dentistry

   Perhaps the most compelling reason to make dental more affordable is the growing evidence linking oral health to overall health. Evidence-based dentistry is driving product innovations to educate consumers and create plans that meet their needs. Evidence-based dentistry can even reduce medical costs. A routine dental exam can detect dental conditions linked to low birth weight babies, heart disease, diabetes, and more than 120 medical symptoms.
   Studies are leading to integrated medical-dental products for high-risk consumers. Aetna recently published some exciting results from a study it conducted with Columbia University’s College of Dental Medicine – earlier periodontal treatment results in lower medical costs for members with diabetes, coronary artery disease, and cerebrovascular disease. Plans are expanding sealant coverage for children and adults – a benefit that has been limited in traditional plan designs.
   Research reported by Washington Dental Service (WDS) shows that sealants can reduce cavities by 93% when coupled with fluoride varnish. Another WDS evidence-based dental plan option offers anti-microbial mouth rinse to improve oral hygiene for pregnant women. This option is based on research, reported by WDS, showing that premature births decline by as much as 84% among women who receive treatment for gum disease before their 35th week of pregnancy.
   Dental spending in this country continues to grow steadily every year. But, the number of uninsured remains constant. Industry studies show that employer contributions to dental plans will continue to decline in favor of consumer based-choices. This trend underlines the importance of offering affordable consumer-directed plan designs. It also serves as a wake up call for employees to accept more responsibility for their spending decisions if they want affordable dentistry in the future.
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Brian Watts is vice president of sales for First Dental Health (FDH). Recently, Brian helped guide FDH through the nation’s most stringent licensing process to make the company’s discount dental plan New Dental Choice the first and only licensed discount healthcare plan of any kind in California. Brian is also responsible for the company’s new online consumer initiatives as well as building new third-party relationships within highly regulated industries that. Previously, Brian was the director of national HMO sales at Protective Life/United Dental Care. He has served as the vice-chair of the Regulatory Committee of the California Association of Dental Maintenance Organizations and as a board member and treasurer of the San Diego Employee Benefit Council. He holds an M.A. in organizational communications and a B.S. in organizational management. Brian can be reached at bwatts@ firstdentalhealth.com or 800-334-7244, ext. 2606.