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Anthem polls employers on integrated health care

ADA leaders discuss dental coverage as ancillary benefit

May 02, 2016

By Kelly Soderlund

A new study from Anthem Insurance shows employers recognize the benefits of integrated health care, but the ADA and other industry leaders are concerned that dental coverage remains a pre-defined ancillary benefit for patients.

Integrated health care connects pharmacy, dental, vision and disability data to the overall health data of the people on an employer’s health program to reduce costs and improve health outcomes, according to Anthem.

“Connecting ancillary and health data may lead to early detection and management of at-risk and chronic condition individuals,” according to Anthem’s 2016 Integrated Health Care Report.

Screening for chronic conditions in dental offices could reduce U.S. health care costs by up to $102.6 million per year or up to $32.72 per person screened, according to the report. Sharing health information between primary care physicians, ancillary providers, including dentists, insurance companies and other stakeholders would allow for evidence-based decision support, a holistic and collaborative approach to health care and safer diagnoses and treatment, the report states.

Photo of Dr. Riggins
Dr. Riggins
Dr. Ron Riggins, chair of the ADA Council on Dental Benefit Programs, said the Anthem study is informative but insurance companies need to do more to design dental plans that support the patients’ long-term oral and overall health.

“Council members met with representatives from the National Association of Dental Plans in April and discussed the state of the dental benefits market and employer attitudes,” Dr. Riggins said. “From the conversation, we understood that while oral health is valued among employers, dental benefits are still considered ancillary. Dental benefit plan designs have, for the most part, remained the same for decades. However, we are currently seeing some payers promote enhanced dental benefits for patients with medical conditions.”

The Anthem report stated that patients with chronic disease or pregnancy who have received treatment for periodontal disease have 6-74 percent lower medical costs and hospitalizations. It’s a statistic that Dr. Riggins believes is conditional, based on how much coverage a patient has and whether they’re willing to contribute any of their own money to their care, given the pre-defined 100 percent preventive/80 percent basic/50 percent major plan design for dental plans. Dr. Riggins further noted that a recent study by the ADA Health Policy Institute suggested that cost continues to be a significant barrier even for people with a dental plan.

“A lot of the medical costs savings depend on comprehensive periodontal care. However, a number of treatments for periodontal disease within an ancillary benefit are not fully funded by a plan and usually have a high out-of-pocket contribution,” Dr. Riggins said. “I wouldn’t yet consider dental plans as health focused, just a benefit that employees like. The ADA and the Council on Dental Benefit Programs is lobbying to change the perception that dental coverage is a secondary need.”

The administrative complexity of dental plans and the burden that complexity places on small dental offices is an important issue to the council, Dr. Riggins said.

“Council members and ADA staff work daily to champion the needs of member dentists,” Dr. Riggins said. “We hope studies like Anthem’s will prompt carriers and employers to look at the dental benefit plan design more carefully so it can support both oral and overall health.”