Dental Coverage An Essential Element to Assure Your Client’s Good Health

A CalBroker conversation with Humana’s Dr. Dean Fry, DDS and California Market VP Brian Sullivan

Linda Lalande, CalBroker (CB): What is Humana’s approach to health coverage?

Dr. Fry:
At Humana, we really provide a holistic package that helps move a member along their health journey. This includes medical, dental, vision and companion offerings to enable “lifelong wellbeing.” So, dental is critical — taking care of oral health affects your overall health and ensures wellbeing through a continuum of care.

What is the relationship between ORAL HEALTH and overall physical health? What are the different clues found in your mouth that might need intervention, or that can support a person to make sure that other health problems don’t develop?

Dr. Fry: On our chart, we show the relationship between Oral Health and Diabetes, Heart Disease, Stroke, Cancer, Pregnancy and Tobacco Use, etc.

Here are a few examples of how the dentist as gatekeeper is so important to our overall health.

Oftentimes people see their dentist more than their doctor. So, as a gatekeeper of care, dentists can see many health conditions that manifest first in the oral cavity. There may be a telltale sign that something is going on with the body that may not have been diagnosed before.

Periodontal disease and the inflammatory process is the real culprit here and can often be an indicator that something is going on that might need a physician’s attention.

With regard to expectant moms, there was a study done in Australia a number of years ago where they looked at periodontal disease — bone loss and inflammation in the mouth. They found that pregnant women who had untreated periodontal disease had a 15% increase in low birth weight and premature babies. That certainly seems to point to a direct correlation.

Things like oral cancer can also be seen in the tissues of the mouth. Oftentimes in a dental x-ray, a tumor or cancerous lesion might be detected, indicating there may be cancer somewhere else in the body. If caught early enough, it may be able to be successfully treated.

And, we really need to talk about COVID-19. It is certainly having an impact on oral health — we are seeing things like loss of taste, tissue lesions as indicators of infection, and
dry mouth. Dry mouth specifically can make someone more susceptible to periodontal disease and tooth decay. Of critical importance is that the mouth (oral cavity) is an important site for SARS-CoV-2 infection and implicates saliva as a potential route of SARS-CoV-2 transmission.

Interestingly, dentists are also reporting seeing more cases than ever before of chipped and cracked teeth due to grinding because of the stress of the pandemic. It affects mental, physical and oral health. Humana has a COVID-19 Long-Hauler team looking at health holistically so we can help members achieve our common goal of lifelong wellbeing.

CB: Are most dentists pretty well trained to recognize signs? Does Humana do something special to help educate them?

Dr. Fry: I would say yes, dentists are well trained overall.
The connection between oral health and overall health has grown closer and closer and it’s something that is being taught in dental, and even medical schools, today. That’s great because it really is bringing these younger dentists out of school with the mindset that ‘hey it’s more than just the mouth — it’s the total body.’ The younger dentist will often go into a clinical practice and have a mentorship with a more experienced dentist — and there is the opportunity for shared learning. It’s a very good thing. Things change, we learn new things, technology advances and looking at what’s going on in the industry is critical.

From a Humana perspective we look at what kind of initiatives can really support a more holistic view — things like social determinants of health in the dental practice. How do we do that within the standard dental practice so that we really are looking at everything that affects the patient?

We do have a provider portal that offers educational pieces on our website. We work very closely with many of our dental service organizations that include our dentists. Oftentimes we’ll do webinars and sit on panels to help with education. Our clinicians participate locally and nationally in CE learning events.

CB: Looking at the social determinants of health is definitely a trend of late. It seems like COVID-19 has revealed and emphasized how important that is — whether it’s a wealthy patient or a less advantaged one.

Dr. Fry: That’s exactly right. Social determinants of health really don’t have boundaries and limits on who it affects. Whether that’s food insecurity or loneliness — those types of things can really affect anyone regardless of who they are. It’s very important that when somebody touches the healthcare system, we are looking out for all of that. In dental, we need to make sure we’re not just focused on the mouth, looking for cavities, or periodontal disease. Yes, these things are very important to your physical health, but we need to be looking holistically at the whole person.

CB: What percentage of your members have dental coverage? And are you able to measure health improvements as a result?

Dr. Fry: Humana has 7.3 million members with dental coverage nationally. That gives us lots of ‘observational data’ to work with. So, how do we determine what certain outcomes mean? Our observational stats show us evidence, but we don’t have the scientific studies yet that show us WHY. Science is still working on causation and correlation. The dental industry is working diligently on how to measure better health outcomes scientifically, but we have a ways to go on true measures of health.

For example:

•  If we see that the overall costs for a member with diabetes is less if they go see the dentist, how does that correlate? Does that mean their A1C level remains stable because they are getting that more holistic care? Does it mean that because they are seeing their dentist as another touchpoint on their health care journey, they are more in tune with their health? We don’t know yet, but we’re watching and tracking.

•  One thing that we do see is a 27% lower medical spend from our members who see the dentist versus those that don’t.

•  For those who only see their doctor, inpatient admits are 1.8 times higher and ER visits are 1.4 times higher, versus those who also see their dentist. While this is strictly observational, those are significant differences and worth our attention to find out why.

Brian Sullivan: Studies show that 75% of heart attack victims suffer from periodontal disease. Is it causational or correlational? It doesn’t really matter.

The point is that it’s important to deal with periodontal disease, especially if it helps prevent heart attack or heart disease from occurring or worsening. Then it’s worth it to have good dental benefits particularly for employers that have larger populations where their claims have a direct correlation to the cost of their premiums.

Dr. Fry: Good point, Brian. Periodontal disease is really a driver behind the whole inflammatory process in the oral cavity. That’s really where problems begin. Some studies say people with untreated periodontal disease are twice as likely to have a heart attack, or stroke. Untreated expectant moms show low birthweight and/or premature birth. When you look at things like diabetes, inpatient admits and ER visits, heart conditions, etc. we know that the inflammatory process is really where the problem lies.

Diabetes is one of those conditions which make people more susceptible to periodontal disease, and periodontal disease makes diabetes harder to control, so it is a vicious cycle. There are some studies showing that following perio-dontal treatment we see the A1C level staying more static. I certainly hope we see more good studies and data coming out about this important correlation.

Osteoporosis can be also detected through dental x-rays and patients can be alerted to get treatment for this. We know that brittle bones can be a challenge as we age. Oftentimes the dentist is the first line of defense.

CB: This is great logic. This can help agents with some data points and conceptual thinking that can bridge the gap for clients about the importance of providing dental coverage with medical.

Brian: Yes, agents need to go beyond their common spreadsheets that list benefits like Perio/Endo lumped together as if they are the same thing. The reality is they are VERY different. Agents need to understand this to make sure the benefits reflect the reality of the treatment needed

Dr. Fry: Agreed. They are two very different categories that often get lumped together to the detriment of the patient.

>Endodontics, such as root canals, are episodic, not chronic.
>Periodontics is the diagnosis and treatment of diseases and disorders of the gums, like periodontal disease, which is chronic.

When you have healthy teeth and gums, the gums and bone are at a certain level. As the inflammatory process begins, bacteria begin to increase, this, in turn, burdens the immune system. Bone loss causes the gums to recede, creating pockets around the teeth that can get deeper and deeper. So, treatment with long term maintenance is critical. You want to eliminate the inflammation, arrest the bone loss, and lower the bacterial activity, and maintain that.

At Humana, we recommend four periodontal cleanings a year to keep your mouth healthy. Home care is critically important as well, in the maintenance of periodontal disease.

Visiting your dentist regularly is key to helping discover early signs of conditions like periodontal disease and maintaining good oral health.

It’s really true, an ounce of prevention is worth a pound of cure.

Understanding the difference will help agents recommend the right benefits.

Brian: Our standard plans offer 3 regular dental cleanings and 4 periodontal cleanings a year for those who have the disease. Only rare custom plans don’t offer this. The four deeper periodontal cleanings take the place of the three regular cleanings for those with the disease. That’s standard for Humana because we believe that it’s critically important — we don’t want to create any kind of barrier to people receiving the kind of care and treatment that they need.

Most plans from our competitors on the market offer at most two cleanings. Unfortunately, people just do what the insurance pays for. You go to the dentist, they see coverage for two cleanings and even if the patient needs more, they only do the two. Ultimately patients don’t get the care and treatment they need.

Dr. Fry: It’s not just access to care, it’s access to health. Because, it really is promoting and maintaining the good health of that member. That’s ever so important.

We have a protected, secure provider portal where there is a holistic view of patient records, where the physician, dentist, eye doctor and any other specialists can log in to see a member’s health summary. Health alerts are also generated, calling specific attention to certain conditions and treatment.

Humana also has great case manager nurses for members with chronic conditions. The nurses get alerts about conditions that develop and they in turn contact members to help remind the members to get dental or other care, helping them along their health journey. We have fantastic nurses — I have the utmost respect for these professionals.

CB: Any closing comments for our readers?

Dr. Fry: When you think about selling dental coverage, it’s more than just benefits — it really is about HEALTH. Oral health is part of and affects overall health. When we talk about holistic care and lifelong wellbeing, the dental benefit is part of that and really reflects our mindset and what we are trying to accomplish for the health of our members.

Brian: We sell individual dental plans, but more often it’s offered as part of employer sponsored programs. And we offer plans for groups of 2+. They can buy dental only, or a package with life and vision — it’s really their choice.

On the Medicare Advantage side, people can add on dental. And there are plans that have dental embedded in them. Humana puts on their Medicare card, “Did you know that you have DENTAL?” as a reminder.

The important consideration is not why Humana over the others, it’s WHY DENTAL?

As independent brokers and agents we have an obligation to make sure that we’re protecting the whole health of the people we serve. And including dental is part of that responsibility. It’s more than just fresh minty breath and pearly white teeth. It is a link and passageway for the entire whole-body health. That’s really the key consideration.

This is particularly true in the small business marketplace. Oftentimes because medical is such a huge expense, they don’t want to add dental, but it’s critical for them to understand it’s necessary to keep people healthy.

Agent communications are available online, along with in depth training and an annual Agent Experience in August that can be accessed in replay by request.
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