What’s the latest in the dental benefits industry? We’re here to fill you in on the five trends that are shaping dental plan design. From revenue strategies to improving access to care, these trends are hot topics you don’t want to miss. Let’s dive right in!
Trend 1: New Paths to Revenue and Profit
With rising costs and pinched premiums, dental plans are exploring other ways to increase revenue and profitability. They’re exploring strategies like virtual consultations and diagnostics, expanding dental provider networks, and prioritizing preventative care and early intervention. Moreover, they’re expanding coverage options and even delving into alternative payment models. It’s all about thinking outside the box and finding new ways to thrive in a changing landscape.
Trend 2: Managed Care and Value-Based Care
There is growing interest in including dental care in Managed Care plans and participating in value-based care. While Fee-For-Service remains prevalent, some dental provider compensation models are starting to incorporate value-based elements. Dentists and Dental Specialists are rewarded for data reporting and the quality of their performance.
Of course, it’s important to note that quality measures in dentistry are different from the ones for medical care. Quality measures in dentistry are measures of appropriate service provision. For example, whether sealants were applied when clinically appropriate or whether fluoride treatments and dental visits were provided according to guidelines. Quality measures are not focused on oral health outcomes or technical evaluations of procedures like in medical. Nevertheless, there is understanding and acceptance that payment models in medical will soon extend to dental, bringing about additional regulations.
The Focus on Provider Directory Accuracy
Eliza Hoffman, Vice President of the Regional Payer Segment at Quest Analytics, discusses the changing priorities for dental benefit providers.
Trend 3: Network Access Reports: Foundational and Crucial
Improving access to care is a top priority, especially in underutilized areas. Dental plans address this concern through the use of Network Access reports. These reports are no ordinary pieces of paper collecting dust; they’re foundational and crucial to ensuring that all members have access to care across all dental specialties.
Selling Dental Products and Meeting Regulatory Requirements
These Network Access reports have other important uses too. Dental plans use them for network submission to regulators and during sales presentations. They provide valuable insights into whether the network has adequate coverage for current and future members. By keeping a close eye on access to care and making necessary adjustments, dental plans can ensure their members are covered.
Trend 4: DSO & Payer Collaboration
Dental Service Organizations (DSOs) are collaborating with plans to build networks. When plans identify areas with limited coverage, they share this information with DSOs, who then work to recruit or acquire practices in those specific areas. This collaborative approach ensures network adequacy, filling gaps in coverage and improving patient access to dental care.
Trend 5: Prioritizing Provider Directory Verification
Lastly, let’s talk about provider directory accuracy. This is a top priority for dental plans and regulators. Federal and state regulators are implementing requirements to ensure dental plans maintain up-to-date and reliable provider directories.
Navigating these regulatory and compliance matters can feel like a maze. Quest Analytics is here to guide you through the process and help you stay review-ready and compliant confident year-round. Connect with our experts today to learn more.
The Ever-Evolving World of Dental Plans
There you have it—five trends that are the talk of the town in the dental benefits industry. Keep your eyes peeled for more news because the world of dental plans is always evolving. Until next time, may your smiles be bright, your paperwork be light, and your data be right.
Proven Solutions for Your Provider Network Management
Looking to simplify your workload? Let Quest Analytics take on the heavy lifting! Our solutions and dedicated team specialize in provider data accuracy and provider network adequacy for various lines of businesses, including Medicare Advantage, Medicaid and Commercial. Schedule a strategy session today and see how we can help you every step of the way.
