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In-office membership plans could build patient loyalty, revenue

June 22, 2018

By David Burger

Editor's note: This is the 15th story in the Decoding Dental Benefits series featuring answers and solutions for dentists when it comes to the world of dental benefits and plans. The series is intended to help untangle many of the issues that can potentially befuddle dentists and their teams so that they can focus on patient care.

Seatac, Wash. — Dr. Gregory Yen had a eureka moment nearly a decade ago, standing in line at his local Costco.

DDB LogoThe dentist surveyed the throngs of people jam-packed into the store. All of them, he thought, were paying for memberships just so they could buy products at a discount.

"What is keeping dentists from offering such programs?" he asked himself.

For eight years now, Dr. Yen has been offering in-office membership plans to his patients, reaping the benefits of avoiding "paperwork swimming pools" from traditional dental plans — while supporting patient loyalty and building revenue. Under this setup, there is no interference in the dentist-patient relationship, he said.

Although every in-office membership plan is different — that's the beauty, advocates say —  membership plans are dental care plans that practices offer directly to their patients. Patients pay a monthly or annual subscription directly to their practice for preventive care and discounts off other treatment. It is not an insurance plan, no claims are filed and no payments are made to any other health care providers. Once the annual fee is paid to the dentist directly, patients are entitled to the dental benefit membership program for 12 consecutive months.

Dentists other than Dr. Yen are interested in offering in-office membership plans. Staff from the ADA Center for Dental Benefits, Coding and Quality have heard the calls of dentists, and to help other dentists who are thinking about offering their own in-office membership plans, the ADA will post a toolkit on how dentists can set up in-office plans on the members-only ADA Center for Professional Success, Success.ADA.org.

The toolkit is also tied to a July 19 ADA webinar titled Increase Value In Your Practice! How? Start your own Dental Plan, where members can register online. After July 19, the webinar will be posted on Success.ADA.org, searchable by the name of the webinar.

Dr. Yen, who has taught many other practices how to install their own programs nationwide, provided his prevention-emphasized plan as an example. For the patient, it costs $412 annually, which includes two comprehensive exams, two cleanings and bite-wing x-rays. Patients receive 15 percent off all other services and a $55 annual treatment credit that is "bankable" if unused, so long as the patient renews the following year. He also partners up with specialists who have agreed to extend the 15 percent off discount — and sometimes even more — to the patient should they need specialty care.

Photo of Dr. Yen
Dr. Yen
Photo of Dr. Paumier
Dr. Paumier
"The ever-increasing insurance runaround and insurance policy blockades towards excellent patient care was the impetus for our program," said Dr. Yen, who is one of the speakers in the July 19 webinar. "As a second-generation dentist, our family realized that the third-party paying concept — especially with the prominence of the contract-based PPO-type arrangement with its treatment interference and never-increasing fee caps — was unsustainable in the long term for any business."

Another advantage, Dr. Yen said, is that before treatment, the patient knows the exact cost. "In-office plans are very transparent," Dr. Yen said. "We guarantee to our patients the cost of their treatment plan down to the penny. With these programs, they know what all their choices are and what the costs will be — with no outside influence or fine-print conditions. 'Will my plan cover this?' is no longer part of the narrative."

Dr. Yen said there are reasons dentists don't typically offer these programs, including "an addiction to the typical dental plan model and fear of change. Ironically, we manage fear on a regular basis for our patients. How about our own? Like we tell our anxious patients, there are times when we must be courageous about what we are facing. We are living in one of those times. Our profession as we know it is at stake."

Dr. Thomas M. Paumier, a dentist in Canton, Ohio, is former president of the Ohio Dental Association and now a chair of a state task force that is researching in-office membership plans and whether their association should endorse such plans. Although his practice doesn't offer a plan now, he plans to start an in-office dental plan within the next year, he said.

Dr. Paumier said he recognizes the need for these types of plans. "Nearly 50 percent of the population does not have an employer-provided dental plan," Dr. Paumier said. "Consumers desire a dental benefit and those with a dental plan seek dental care more often, have a higher treatment plan acceptance rate and generally have better oral health."

The success of subscription models such as Amazon and Netflix show that similar plans in dentistry could increase customer loyalty and provide recurring revenue for practices, Dr. Paumier said. "Every dollar paid by the consumer goes toward dental care and is paid directly to the dentist," he said. "There are no claim forms, no prior authorizations and no denials or limitations on services. This model is finally a dental benefit which is dentist- and consumer-friendly."

While dentists who offer in-office membership plans stress that the programs are easy to set up, outside vendors have stepped in to guide practices through the process. One is Kleer, a Pennsylvania-based company that has helped more than 500 practices in 38 states create their own customized membership plans since its launch in January.

Dave Monahan, CEO of Kleer, is another presenter in the July 19 webinar and said he researched the marketplace and saw a need for a cloud-based platform that enables dentists to create their own membership plan and offer it directly to patients. Kleer, he said, eliminates the cost and hassle of the dental plan middle man, making it easy for patients to get the dental care they want while enabling dentists to increase patient loyalty, visits and treatment acceptance.

"Patients don't trust dental plans," Mr. Monahan said. "They're expensive and complicated." Among dentists, he said, "The level of anger towards dental plans was beyond what I expected. It's sad."

The result, Mr. Monahan said, are plenty of uninsured people who would theoretically gravitate towards practices that offer in-office membership plans. Uninsured patients want more care, but feel like they can't afford it —until now, he added.

Dentists interested in these programs should exercise their due diligence first. Jennifer Stoll is chief commercial officer of DentalPlans.com, a member of the Consumer Health Alliance, a national trade association for discount healthcare programs. Ms. Stoll cautioned dentists seeking to create their own in-office membership plans to check with a lawyer to see if their states have regulations on such programs or make sure they are partnering with a vendor company that is fully compliant.

According to the Consumer Health Alliance, 34 states have discount health program laws, while 23 of those states require a license or registration for discount health programs including in-house dental plans. In addition, some states may consider these types of plans to be a form of prepaid insurance and, if so, require dentists to license or register with the state accordingly. While there are states that have enacted direct primary care agreement legislation which allow physicians to implement an in-office plan without having to register as an insurance company, few of these laws apply to dentists, said Allen Erenbaum, president of the Consumer Health Alliance.

The ADA has created an online landing page for dental benefits information that can help dentists address and resolve even their most vexing questions. Go to ADA.org/dentalbenefits, part of the ADA Center for Professional Success.

Staff from the Center for Dental Benefits, Coding and Quality can help dentists with dental benefits-related and coding problems, questions and concerns. Call the ADA's Third Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ada.org.

Previous installments in the Decoding Dental Benefits series are available at ADA.org/decoding.