What dental plan?

Jan. 1, 2004
What will tomorrow bring? Will the economy continue to grow? Is the disposable income of our patients going to remain unchanged? Are we in for another stock market correction?

Tom Limoli Jr.

What will tomorrow bring? Will the economy continue to grow? Is the disposable income of our patients going to remain unchanged? Are we in for another stock market correction? When all is said and done, prosperity in the future will go to those who have learned the lessons of the past.

To examine this issue, let's look at three critical sub components. First, what is the future of dental benefit plans? Who are the plan purchasers and what are these purchasers demanding? How will these changes impact the delivery of dental care?

The future of dental benefit plans can best be summarized with one word — change! Gone are the days of the indemnified benefit product. An indemnity product is one in which the payer (insurance company) is assuming the risk-reimbursement loss in exchange for a premium paid by a purchaser. In other words, it is the funds of the insurance company that pay out the benefit claims. Your homeowners and/or automobile insurance are probably indemnity products. You pay a small amount of premium into a risk pool so that in the event of a loss, you are indemnified (restored to your original position) prior to the loss.

Today's health-benefit plans are designed along the ASO (Administrative Services Only) and/or MSO (Management Services Only) format. With this design, the plan purchaser assumes the risk and maintains control of the money via a self-funded plan. In today's reality, claims are not paid with insurance company money. This trend will continue while both the banking and insurance industries move to consolidate their respective market shares.

Now let's look at the plan purchaser. In the past, the customer has always been labor and management. The employer purchased and/or supervised the design of the benefit plan on behalf of its employees. Tomorrow's plan purchaser will very likely be the same customer that we treat in the dental office. The patient will continue to have a more active role in choosing, as well as paying, for his or her own dental benefit plan.

Will dental insurance be a thing of the past? Will the patient simply pay out-of-pocket without some form of benefit plan? I think not. Income tax reforms will continually foster the growth and development of newer and more cost-effective tax credits and benefit plan designs. The benefit plan of the future will be designed with the patient and family in mind, rather than the needs of the employer group.

As far as individual plan structure goes, this will be a direct reflection of dentistry's changing practice composition. Group practices, as well as individual practice associations, will continue to embrace and develop dental-delivery models geared toward the overall health of the patient, rather than the performance of individual procedures. Evidence-based utilization review will be largely ignored by the individual solo practitioners as they continue to focus their efforts on patient emotions, rather than overall wellness outcomes. Plan purchasers will continue to drive the benefit industry and dental profession to qualify, as well as quantify, the value of the delivered treatment.

Medicine embraced the role of the physician's assistant, and dentistry will continue to acknowledge the hygienist in the theater of data-gathering, prevention, and primary care. As trends continue to mature, innovations in dental hygiene education and its health-care delivery options will propel the profession of dental hygiene beyond the simple task of removing plaque, calculus, and stain from teeth.

I laugh in utter amazement at the number of useless legislative proposals that intend to place treatment blame on anyone other than the doctor-of-record. Both political forces are looking to do nothing more than please their constituents by redirecting the wayward finger of blame. How is it that legal documents are now rendering care? Let's face it, they aren't! Dental professionals are rendering treatments. Corporate entities and benefit plans are nothing more than money managers and benefit administrators.

Traditionally, the dental market has followed the medical model by a separation of seven to nine years. Technological advancements in the delivery of dental care have now reduced this time lapse to a period of less than three years. Medical- and dental-utilization review and outcomes-assessment criteria will soon be singing from the same song book, no matter how loudly we scream the battle cry, "Dental is different!"

Tom Limoli Jr. is the president of Atlanta Dental Consultants and the editor of Dental Insurance Today, a bimonthly publication that addresses third-party reimbursement in the dental office. He also is the author of Dental Insurance and Reimbursement Coding and Claim Submission. He can be contacted by phone at (404) 252-7808. Visit his Web site at www.LIMOLI.com.

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