Stevens Point-based Delta Dental of Wisconsin is rolling out an optional dental insurance plan upgrade that encourages more visits to the dentist for pregnant women and patients with diabetes or periodontal disease. Periodontal disease is an infection of the tissues that support the teeth.
The new enhancements take into account evidence-based research that shows the benefits of more frequent cleanings at the dentist office for such patients. Additionally, the upgraded plan calls for additional use of sealants for teenage patients.
Research indicates that patients who have diabetes or periodontal disease should have cleanings and examinations four times per year. Research also states that pregnant women should have one more cleaning and exam during their pregnancies than they normally would have.
“The relationship between diabetes and oral health, specifically periodontal disease, is well-accepted in the medical and dental communities,” a white paper on Delta Dental’s new evidence-based integrated care plan states. “Observational studies have consistently reported evidence of a greater prevalence, incidence, severity, extent or progression of periodontal disease in diabetics. These studies also show that diabetic patients experience periodontal destruction at an earlier age than non-diabetic individuals.”
Patients who already have periodontal disease should have additional dental exams and cleaning because it gives them an increased chance of keeping their own teeth, rather than needing dentures or implants, which are expensive to create and maintain, the report states.
Research has also shown a link between poor dental health and low birth weight in newborn babies. Babies with low birth weight generally have complications that result in high health care costs.
The increased attention to oral health in diabetic patients, those with periodontal disease and pregnant women is aimed at preventing higher health care costs in the future, said Dennis Peterson, executive vice president of Delta Dental of Wisconsin.
“It might seem like it holds the potential for usage concerns,” Peterson said. “But these have to be pre-qualified individuals. There’s no potential for folks to just say, ‘I think I’ll get some extra treatments done.’
“In fact, even though we are allowing for more cleanings, we’re being more aggressive in the treatments that are necessary and (the patients) should be doing anyway. What’s probably going to happen is that we’ll see some short-term increase in the number of visits, but we should see results on the other side at the same time,” he said.
The evidence-based plan enhancements have an anticipated 1 percent premium increase per year. Although the increased visits will result in initial higher usage of dental services, they are likely to prevent even more frequent and costlier treatments in the future, Peterson said.
“We’re not laying any claim to cost savings,” he said. “But look at it on the surface. (However) it’s difficult to make any guarantees.”
Because of the minimal impact on premiums and the inherent potential for long-term cost savings, Peterson and Delta Dental believe many employers will opt for the optional plan enhancements.
“With the minimal cost impacts and the upside to it, we’re hopeful that if the information is delivered in a good way, most will upgrade in 2007,” Peterson said. “This is a movement (evidence-based plan design) that is not going to go away.”
For decades, many dental plans have stayed largely the same, not implementing changes that incorporate evidence-based research, Peterson said. That trend is changing across the nation, and Delta Dental is changing with it, he said, by designing plan changes to deliver higher-value plans.
“Many of the structures have been in place for decades, and there’s been a resistance to change,” he said. “We’re at a point now that we’re beginning to see and take benefit dollars, restructure plans and deliver higher value. I believe evidence-based plans will roll out every year. Ultimately, group dental benefit plans will be customized to a whole variety of situations.”
Peterson declined to state how Delta Dental might next design an evidence-based plan. However, he said there is a growing body of evidence showing a link between heart and periodontal diseases, with five to seven years of research behind it.
The evidence-based plan enhancements were rolled out to customers for the first time in late August, Peterson said, and Delta Dental will be telling current customers and prospects about them in the fall, during the enrollment and renewal season. The company also will be enhancing its Web site (www.deltadental.com) to include information about the enhancements. The company’s Web site also will enable patients to self-report new conditions, which will update their coverage plans.
“There will be a real-time upgrade on the system,” Peterson said. “We think it’s important that people have to do it or their dentist has to do it. We have to make it as simple as possible. People won’t do it if it’s complicated.”
