- Increased taxes
- Minimum loss ratio
- Increased competition
- Greater price transparency
- Standard benefit requirements
Tuesday, January 20, 2015
In a recent post, we examined some of the key drivers of margin compression in this new era of health care reform:
These factors, combined with the substantial costs associated with member churn, are driving a business truism within the health care industry: to effectively battle margin compression, health plans must strive to be present in multiple markets, and they should consider how ancillary benefits can be used to maintain and grow their business.
Of course, our industry is not the first to face game-changing legislation similar to the ACA. Following the attacks of September 11, 2001, airlines grappled both with stricter regulations that were costly to implement and shrinking demand as travelers responded to the tragedy.
Around the same time, websites like Expedia and Orbitz emerged as one of the primary sources to purchase airline tickets. These sites facilitated greater price comparison and increased price transparency, much like we are seeing today within the health care marketplace. Clearly, this kind of comparative shopping can significantly impact consumer behavior and choice.
The airlines that most successfully navigated these challenges attracted consumers with competitive base pricing and used optional amenity costs - such as added leg room, luggage fees, and food upcharges- to bring in additional revenue. Following a similar model, health plans can use ancillary benefits that appeal to consumers who are interested in purchasing supplemental care, thus preserving a significant portion of their customer base and the associated revenue stream.
Expanding into multiple markets to offset the effects of member churn can be similarly powerful in the fight against margin compression. Offloading members is costly and the movement of members between Medicaid and health exchanges can threaten the overall stability of a health plan by compromising its ability to predict its financial risk. Health plans that have a presence in multiple markets can preempt the negative impact of member churn and better preserve and protect their bottom line.
As is often the case with landmark legislation that impacts such a fundamental part of our daily lives, the Affordable Care Act has brought vast improvements and interesting challenges to the healthcare industry. Health plans have a unique opportunity during this watershed time to explore how ancillary benefits and market expansion can grow and protect their business and membership base.
Friday, January 9, 2015
By Steve Pollock, Chief Operating Officer, DentaQuest
There is increasing evidence demonstrating the relationship between oral and overall health, yet many in the industry don’t realize that in addition to improved health for members, medical and dental collaboration also allows for better care management and thus reduced costs.
On Wednesday, January 28, 2015 at 1:30 PM CT, I am hosting a webinar to discuss how health plans can use ancillary benefits like dental to grow their market share and control medical costs. I will be joined by Dr. John Luther, Chief Dental Officer for DentaQuest, who will speak about the scientific evidence to illustrate the centrality of good dental health to overall health and Dr. Justin Cramer, Chief Medical Officer at MissouriCare, who will speak about MissouriCare’s first-hand experience with medical dental integration.
The webinar will explore the unique opportunities that exist for health plans seeking to grow their market share by integrating dental benefits into health plan offerings and the healthcare insurance industry’s changing market dynamics. Through this first-hand account of the challenges and benefits of medical dental integration, attendees will learn strategies to successfully implement the concept.
I encourage you to join us to gain more insight into what I consider to be one of the most important areas of growth for our industry. You can also learn about the benefits of medical dental integration by following this blog series on Oral Health Matters, “Why This Matters to Me.”
Please click the following link to register at no charge: www.dentaquest.com/medical-dental-integration/webinar.
Tuesday, December 23, 2014
As 2014 comes to an end and we start making our New Year’s resolutions, once again getting healthy seems to be at the top of everyone’s list. But being healthy isn’t just about working out and eating a nutritious diet; good oral health is imperative to one’s overall health.
The New Year is the perfect time to start practicing good oral habits that will last a lifetime. Prevention helps you maintain a healthy mouth, and the single most important thing that you can do to protect your teeth is to brush for two minutes, twice a day, every day. And don’t forget to floss too. It’s equally as important to add this to your child’s daily routine..
Here are some brushing tips for all ages:
Infants, 3 months to 1 year and children, 1 year to 2 years: Gently wipe the baby’s teeth with a clean damp washcloth. For kids under age 2, use a soft toothbrush and a little water with a very small dabble of fluoridated toothpaste. Once teeth are cleaned at bedtime, they should drink only plain water.
Children, 2 years to 6 years: Help your children brush their teeth; hold the toothbrush with them and guide them. Demonstrate how to clean every tooth surface and to gently brush their tongue to remove germs and freshen breath. Use a pea-sized dab of fluoride toothpaste and teach your child to spit out the toothpaste when they’re done. Today there are numerous fun apps that you can download that will make brushing their teeth fun! Check out this video to for more tips on teaching children how to brush their teeth.
Tweens and pre-tweens, 6 years to thirteen: Once your child knows how to brush, let them do so on their own with your supervision. The goal is to spend 2 minutes to ensure they brush every tooth evenly– the front, back, top, and sides. Teach your children how to floss between teeth and instill this as part of their morning and nighttime routine.
Teens and Adults: We are all busy with work, school, sports, and family. However research is showing that poor oral health can exacerbate chronic health problems that people might have once thought were unrelated – such as diabetes and heart disease. Maintaining good oral health can aid in the management of these diseases. Teens and adults should clean they teeth gently but thoroughly for a full 2 minutes before they head out for the day. Finish the day by brushing to remove any leftover food in your mouth and floss between your teeth.
And remember this: Simple, repetitive tasks will become habit in just 21 days. Start on January 1 and make it your goal to brush your teeth for 2 minutes, twice a day, every day. You will have fulfilled one of your resolutions before the second month of 2015! You can do this!
Finally, think about when you last saw an oral health professional. If you haven’t done so in the last six to 12 months, now is a good time to schedule your next visit!
Friday, December 12, 2014
This week we discuss why some believe the Affordable Care Act isn’t doing enough for dental plans, learn what South Carolina is doing to improve the oral health of all its citizens, and discover that good healthcare for kids depends on where you live. Don’t forget to check out our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.
1. Shortchanged in ACA, dentists hope exchanges can boost coverage: The Affordable Care Act impacts health care providers of all types, but dentists were largely disappointed by its shortcomings in expanding dental coverage. While the ACA deemed dental benefits "essential," requiring insurers to offer dental plans to children up to age 18, the law did not mandate that those plans be purchased, and insurers don't have to offer the same plans for adults. But on the positive side, Dr. Anthony Giamberardino, president of the Massachusetts Dental Society, believes state and federal health care exchanges, the marketplaces where consumers can shop for health and dental insurance, have made people more aware of available dental plans, which could prompt more people to buy coverage.
2. Dental gap: Coverage slips through reform's cracks: Dental care is a peculiar niche of the U.S. healthcare system. Even though teeth and gums are just as much part of the human body as kidneys or elbows, they are insured differently—a lot differently. The question becomes how much the law has done to advance dental care. Not enough, some advocates argue. The Affordable Care Act mandated pediatric dental services as one of the 10 essential health benefits for health plans, but adult dental services were excluded.
3. SC's Healthy Connections program supports oral health: South Carolina's new Medicaid adult dental program emphasizes prevention. That's important because dental problems -- cavities and gum disease – are largely preventable if caught early. We salute the state of South Carolina for the bold steps it has taken to ensure eligible adults have the opportunity for good oral health.
4. How Good Is Healthcare for Kids? Depends on Your ZIP Code: The Department of Health and Human Services has allowed states to choose from a menu of benchmark plans, instead of establishing a federal gold standard for children's health (a decision that runs contrary to the recommendations from the Institute of Medicine). For example, a child with autism or a stuttering problem might fare better or worse depending on where he or she lives. The only way to remedy these problems is for HHS to revise the current essential benefits plan and bar treatment limits and exclusions for children, especially those related to disability or other developmental health conditions.
5. What your teeth are trying to tell you: Statistics show periodontal disease affects over 85 percent of the population. But there's more to your mouth than tooth decay and gum disease. There are some secrets your teeth could be trying to tell you.
Wednesday, December 10, 2014
DentaQuest is marking the one year anniversary of our management of Tennessee’s Medicaid Dental Program, TennCare. We are very pleased to announce that during this first year, we reached or exceeded all benchmarks required by the state of Tennessee.
Our goal with the TennCare dental program was to make it easy for members to visit the dentist and keep their smiles healthy. The importance of establishing good oral health early in life often goes overlooked despite the fact that it is a foundation for lifelong overall health and wellness.
Upon winning the TennCare contract, our first task was to create and manage a dental program that satisfied the needs of members, the state and dentists. We are honored to have the opportunity to work with TennCare Dental Director Dr. James Gillcrist and the dedicated staff of Tennessee’s Medicaid Dental Program in delivering a program that has increased member participation, while significantly reducing program costs. Most importantly, we’re making sure members receive the right care at the right time and in the right amount.
Since October 1, 2014, DentaQuest worked to develop a high-value network from the ground up with a focus on access, quality and efficiency.
- The current network of 869 dentists ensures that 750,000 Tennessee children eligible for dental benefits receive the highest possible quality of care.
- Today, there is 1 dentist for every 857 members. This ratio exceeds Centers for Medicare and Medicaid Services recommended ratio of 1 provider for every 1,500 patients.
- Members are located 3.4 miles from the closest DentaQuest dentist.
- The trending dental screening percentage is 90% – surpassing the requirement of 80%.
11 days, 21 hours and 10 hours – That’s the amount of time, on average between the scheduling of an appointment and a member being seen by a provider for routine, urgent care and emergency appointments, respectively.
- Routine appointments are being scheduled within 11 days. [The benchmark is 21-days]
- Urgent care appointments are scheduled within 21-hours. [The benchmark is 48 hours]
- Emergency care appointments are scheduled within 10-hours. [The benchmark is 24 hours]
We are very proud to note that in every instance, we surpassed the required benchmark.
DentaQuest is dedicated to remaining transparent and accountable in our oversight of the program and has released a Report for the Community including findings from TennCare’s November 2014 analysis of the network. Please visit http://www.dentaquest.com/tn/ to download a digital version of the full report.
Monday, December 8, 2014
The Affordable Care Act is making great strides in improving America’s access to health insurance; however, this is also creating new challenges for health plans. Below, I’ve outlined some of the pressing challenges health plans are facing and will identify potential solutions in an upcoming post.
Management of the health care of formerly uninsured patients who may have more complicated care needs
The influx of new consumers with difficult to manage conditions is requiring plans to implement population management and look at unique ways to manage the health – and cost – of these patients. It is also important for these patients to have plans that cover preventive oral health care on an ongoing basis, as chronic disease correlates strongly with dental hygiene. The role of dentists in managing chronic disease is explained in my recent blog post here.
On-going costs associated with sustaining and continuously improving new systems
Whether considering introducing a new ancillary line, expanding capacities in a new market, or finding administrative efficiencies, it is important for health plans to evaluate the time, scope and money required. This analysis leads to three potential solutions: build, buy or partner. We’ll dive into the benefits of partnering in my next blog post.
Regulatory pressure is increasing and medical loss ratio (MLR) requirements are placing additional burdens on margins
The Medical Loss Ratio requires insurance companies to spend at least 80% or 85% of premium dollars on medical care and new provisions are imposing tighter limits on health insurance rate increases. Failure to meet these standards triggers a requirement that insurance companies provide a rebate to their customers. As a result, health plans need to find a way to grow their market share without significantly increasing their administrative costs.
The costs associated with the need for investments in advertising and marketing, customer service, and IT and enrollment systems to prepare for the surge in consumer demand.
To capture and manage the influx of new consumers entering the market as a result of the Affordable Care Act, insurance companies are investing in marketing, advertising and IT, and will have to continue to develop more comprehensive outreach programs.
In addition, the growth is requiring the industry to explore new ways to communicate, interpret and store information, requiring the dedication of resources to test, acquire, and implement the latest technological innovations which likely includes mobile technologies to reach patients wherever they are.
As members’ financial situations change, the channels by which they access insurance will change as well.
Churn is a term often used to describe people moving back and forth between health insurance plans. For example, people often move between eligibility for Medicaid and eligibility for federal subsidies for private insurance bought on the ACA’s exchanges. Churn in the market increases costs, making it imperative to create products that can be easily managed regardless of how the member accesses benefits. The process puts pressure on already strained health plan administrative resources.
Healthcare has made significant advancements under the ACA; however, we need our systems, regulations and business models to evolve to ensure we can remain as productive and effective as possible.
Interested in learning more about ancillary benefits? Read more here.
Friday, December 5, 2014
This week we learned that kids from lower income families are getting preventive dental care but less treatment, we discussed the importance of South Carolina’s decision to expand its Medicaid adult dental plan, and found out that 100 percent fruit juice does not promote cavities in infant teeth. Don’t forget to check out our new blog series, Why it Matters to Me. Join the conversation on Twitter using #FridayDentalDL.
1. HHS report: Poor kids getting more preventive dental care, less treatment: According to a new report by the Department of Health and Human Services (HHS), poor children received more preventive dental care but less overall treatment in 2013. All children enrolled in Medicaid and CHIP (about 45 million children in 2013) have coverage for dental and oral health services. Despite considerable progress in pediatric oral healthcare in recent years, tooth decay remains one of the most common chronic diseases among children. The rate for preventive dental services increased from 45 percent to 48 percent, compared with 2011, but the rate for dental treatment services decreased slightly from 24 percent to 23 percent in the same period.
2. New study: Pure fruit juice does not promote caries in infant teeth: It is widely believed that unrestricted consumption of acidic beverages, such as juices and soft drinks, can cause dental caries (tooth decay). However, a new study conducted by dental researchers at the University of Maryland, Baltimore, has suggested that consumption of 100 percent fruit juice is not associated with early childhood caries in preschool-age children.
3. APHA 2014: Educating parents about dental care improved kids’ toothbrushing rates: Preventing tooth decay requires more than just regular dental care – it requires active management at home. Researchers from the Louisiana State University Health Sciences Center and Louisiana State University Shreveport studied the effectiveness of in-depth parental dental education and its influence on their knowledge and dental health practices of their children. The study found that educating parents about oral hygiene does have a positive effect on their children's oral hygiene practices.
4. Matthews: Medicaid’s new dental plan will improve overall health: DentaQuest South Carolina’s dental director, Rebekah Mathews wrote an editorial that was featured in The State. This week South Carolina began its expanded Medicaid adult dental plan. Mathews explains, “South Carolina’s Medicaid adult dental program now emphasizes prevention. That’s important because dental problems — cavities and gum disease — are largely preventable if caught early. Eligible adults can receive up to $750 per fiscal year in dental services to get the restorative care they need and the prevention services they previously lacked. Having dental benefits is a key factor in an individual’s ability to live a healthy, successful life.”