Dental practices are increasingly being asked to screen for high blood pressure, diabetes and other chronic conditions, but the reimbursement system hasn’t fully caught up to that expanded role.
Dental and medical benefits still largely operate separately, and payers are still working out whether and how to pay dentists for screenings and referrals. Some leaders say the return is already showing up in other ways, through higher case acceptance, new revenue streams and added value from network participation.
Four dental leaders discussed whether reimbursement is keeping pace with integrated medical and dental care at Becker’s 5th Annual Future of Dentistry Roundtable in Chicago.
Note: Responses were lightly edited for clarity and length.
Question: If integrated medical and dental care produces better overall health outcomes, is our current reimbursement system adequately reimbursing the dental providers who are helping create those outcomes?
Jamie Clarke. Senior Vice President, Provider Strategy of Delta Dental of California and affiliates (San Francisco): The first thing that providers ask is if they are getting paid. What we like to do is really elevate the conversation to create value. How do we create value and incentivize the right behaviors that we’re looking for? That can come in the form of compensation, but it also can come in the way of creating capacity in our dental clinics. Can we create a capacity so teams aren’t spending time with us and actually can spend more time chairside? How do we think differently about how we’re working and looking at their costs? Our provider directory is a top marketing tool. One of the most common questions from our dentists is, ‘How do I get higher in the directory?’ What if practices committed to dental-medical integration got badges that moved them higher in search? That’s a whole lot cheaper than trying to pay for leads yourself. There is also the trust factor. Patients trust their dentist. They want these services. So, yes, compensation is a piece of the discussion, but I think there are a lot of ways that we can work more closely with our providers to create value in network participation.
Joe Feldsien. Senior Vice President, Integrated Care of PDS Health (Henderson, Nev.): There are a couple of metrics we can see right away. We look at case acceptance, and we can measure it at scale. In our dental practices, anywhere from 31% to 35% of the dentistry that is diagnosed gets done. In our integrated dental-medical practices, it’s 55% to 60%. That happens because the physician supports the dentist’s diagnosis and tells the patient, ‘This is important, not just for a nice smile. It’s affecting your blood pressure and your A1C.’ Meanwhile, the number of our medical patients who are now also dental patients is growing fast. It’s just too convenient, and it makes too much sense to them. At the end of the day, it comes down to value, and data will demonstrate that value to the payer and the employer. If we can show that integrating these two professions reduces overall costs, that’s value.
Sathya Kallur, DDS. Chief Specialty Officer of ProSmile (Woodbridge, N.J.): At the DSO level, we’ve found the best way to increase EBITDA and enterprise value is to add airway and TMJ services, two things that both dental and medical insurance pay for. Patients spend more time in our dental chair than they do with their physicians, so we have more opportunity to ask questions and address those problems. We’re now introducing airway, TMJ and salivary diagnostics. The opportunity is huge. We’ve found that airway health can add close to $4,000 to $5,000 per patient.
Rawle Philbert, DDS. Division Chief of Oral and Maxillofacial Surgery of UT Southwestern Medical School (Dallas): In our practice, we also manage oncology patients. When I started at UT Southwestern five years ago, we had a smaller pool of patients. Now we have a much larger pool, and those patients don’t come for just one thing. They come for the follow-up, the skin graft and other procedures. The number of cases continues to increase significantly, and because we treat both the medical and dental sides, revenue has skyrocketed.
At the Becker's 5th Annual Future of Dentistry Roundtable, taking place September 14-15 in Chicago, dental leaders and executives will gain insights into emerging technologies, practice growth strategies and the evolving landscape of dental care delivery, with a focus on innovation, patient experience and operational excellence. Apply for complimentary registration now.
