As American as apple pie, dental benefits continue to be a valued staple among workplace offerings. And while it's tough to improve on the simple perfection that is apple pie, benefit plans can and should be regularly revisited to ensure they are effectively serving the needs of their employee participants.
Among these regular status checks should be strength of an employer's dental plan network, according to MetLife. While the value proposition of a dental provider network is partially hidden from benefits professionals, its strength encompasses much more than the notion of contracting with as many dentists as possible. To help benefit pros and their advisers, MetLife, which administers dental plans for nearly 20 million Americans, has published a guide to help employers evaluate and benchmark a full range of criteria that include many intangible components that inform carrier selection.
The guide, "Check the Label: To Find the Dental Network That's Right for Your Company" identifies four key components that drive the value of dental benefits: plan design, claims management, service efficiencies and network. It also suggests that, like the myriad goods and services sold on store shelves, not all dental benefit plans are created equal, nor does size matter to a point where it should be seen by producers as the overwhelming reason for choosing a carrier.
"While a large network is important because of the access and potential savings it provides to employees, you should look beyond these numbers," according to Alan Hirschberg, vice president of MetLife Dental Products.
Driving forces
Hirschberg says it's important for employers to align the needs and behaviors of employees with how dental carriers balance network size, negotiated fees and utilization of services. Other factors include whether each dentist has significant patient volume or capacity for growth, as well as the extent to which network size and negotiated fees are driving savings, value and employee satisfaction.
It's also vital to know what fees are based on, how frequently discounts are used and whether network comparisons are based on the same denominator (ideally, it would be the actual average eligible area charges). Considering both historic and anticipated fees will help project future increases in network provider discounts.
As for network sizes, they cannot be adequately compared without the same provider counting methodology, which can be a problem since there's no standard of measurement for this area. Also, network growth may not necessarily produce savings or generate greater in- network utilization. But be that as it may, there are several other notable metrics that more easily evaluate the merits of each dental plan carrier.
Series of reports
The MetLife guide suggests that it's critical to have realistic expectations about the use and value of standard measurement tools such as accessibility, disruption and discounts reports. For example, an accessibility report that matches employee locations to the network does not indicate whether network dentists are able to absorb new patients. Disruption reports used to determine the level of "disruption" caused by employees seeing dentists who are in the current network, but not in a new network identify overlap and high-volume providers. However, they do not show emerging network trends like dentists who may consider dropping out of the network for various reasons or dental practices that are in a growth stage.
Also, a discount report that compares a carrier's "standard" fee schedules against an area's average charge does not show the level of custom contracting, future dental inflation and network fee increases.
To derive more value from these reports, employer can request the turnover rates of general dentists and specialists in a carrier's network, as well as analyze their reasons for leaving, such as poor service or negotiated fees, to gain more insight into how the network operates. By the same token, benefits professionals are urged to examine network recruitment plans, including whether the practice patterns of prospective dentists are compared against a database of normative practice patterns, as well as appropriate performance guarantees for network activity.
Data integrity
One significant caveat to consider is that carrier data isn't always comparable and some systems may not be able to process requests for certain information. Data elements among various carriers must be consistently provided. Also, analyzing average charges for a specific three-digit ZIP code will differ from charge data for a broader area, which doesn't allow for an apples-to-apples comparison.
With regard to the quality or integrity of data supplied by the current carrier and any prospective carriers as a basis of comparison during the request-for-information process, it's important to keep in mind that incomplete, inconsistent or outdated data can serve to diminish the validity of an employer's analysis and undermine decision making.
As for dental plan contract provisions or guidelines, the MetLife guide recommends that they stipulate reimbursement for necessary and appropriate care, as well as address the latest market trends, clinical research and practice protocols. It also promotes the importance of transparency.
Dental provider shortage looms
However, if current provider trends continue, dental plan networks - no matter how strong - likely will shrink. According to a survey sponsored by Delta Dental Plans Association, the dentist population could begin to contract as early as 2012.
Researchers looked at current dentist retirement rates and at survey responses from dentists who expressed a desire to make a career change within the next five to 10 years and compared those numbers with the current dentist school graduation rate.
Projecting these trends into the future, the study found that the 2009 dentist population of approximately 179,600 will increase through 2011 but retirement and career changes could outpace dentist school graduation beginning in 2012. By 2019, the dentist population could be smaller by nearly 7,000, assuming consistent dental school graduates of 4,500 annually.
"As more people acquire dental coverage through an employer, an individual policy or through some form of government-assisted program, it is crucial that dentists are available to actually see and treat them," says DDPA president and CEO Kim E. Volk. "With more than 132,000 dentists participating in our network, we're interested in helping affect, not just monitoring, these trends."
Groups such as Delta Dental and others are having success attracting dentists to underserved areas and are providing prospective dentists with loan repayment or loan forgiveness programs.
For example, programs like the Fulfilling Iowa's Need for Dentists program, funded jointly by Delta Dental of Iowa and local business, government, health and civic organizations, help to wipe out a large portion of student dentist debt within three to five years if they set up their practice in an underserved area.
"These types of programs are proving to be a win-win-win," Volk says. They're a win for the dentist who needs to pay down debt, a win for the local economy and a win for the residents in need of care."
