The Future of Dentistry: Where Dental Insurance Stands Today and Where It Will Be Tomorrow

By Bryan Carey, CEO, Benevis

Becker’s Healthcare Dental recently held the Future of Dentistry Roundtable event in Chicago, IL, to highlight the business of dental healthcare, the vast potential for dental innovation, and how it has the potential to  improve patient care. The roundtable sessions featuring key industry thought leaders were designed to elevate the most important aspects of oral healthcare services and how whole-person care and digital technology are improving patient outcomes.

As CEO of Benevis, I was pleased to join the high-level strategic discussions about the current landscape of dental insurance and its future potential. On Friday, October 27, I took part in the session, Where Dental Insurance Stands Today and Where it Will Be Tomorrow, alongside respected panelists Anushka Gaglani, DDS, Co-Chief Executive Officer, Areo Dental Group, Robert Trager, DDS, owner, Dentists for Airport Employees, and Sina S. Amiri, Vice President, Revenue, Zentist.

As an industry, we recognize that preventive care is critical to curbing the long-term consequences of neglected oral health. Yet, millions of Americans lack health insurance or the access to care for routine cleanings and check-ups. Enhancing the accessibility of exceptional healthcare begins with providing health insurance to diverse patient populations. Value-based care (VBC) initiatives play an important role as well. During the panel discussion, I shared that Benevis, for example, has developed VBC arrangements with insurers where we can demonstrate the quality of care provided and negotiate for better reimbursement based on adherence, outcomes and patient satisfaction. I have seen this strategy be effective in healthcare, and I’m optimistic about making it work for dental healthcare as well.

For over 20 years, Benevis’ role has been to accelerate the accessibility of oral healthcare to underserved patient populations. I feel privileged to be a part of Benevis, where we’ve provided exceptional care in 13 states and Washington, D.C. for 620,000 underserved children and families this year, with over 80% of our patients leveraging Medicaid or Children’s Health Insurance Program (CHIP) coverage. We know preventive dental care is essential in reducing the expenses associated with neglected oral health, and our team at Benevis is committed to making it happen. As CEO, I am committed to our efforts to construct a seamless care continuum, often in close collaboration with value-based care arrangements. My mission for the dental healthcare delivery organization is to ensure that quality healthcare – including dental healthcare – is readily available to those in need. I’ve been committed to realizing this vision throughout my career.

Here’s a closer look at takeaways from the Future of Dentistry Roundtable panel, including my specific insights working as CEO of Benevis.

Negotiating with Insurers

Collaborating with insurers can be a challenging task. What has held us all back is the lack of transparency to quality data. If a dental practice or dental service organization (DSO) does not have data to support its claims of high-quality patient outcomes, it can be a real challenge to develop alignment. Insurers often rely on data and evidence to make informed decisions. In my healthcare services experiences, there was more data availability than in the dental space. At Benevis, we have worked hard to show the difference our care makes to the community leveraging our proprietary medical records platform and strong data orientation.

An example is our recent Louisiana case study data that showed that nine of our Taylor Dental & Braces practices realized lower costs of care per patient for three years, on average over $78 per patient (compared to the state’s total provider network) leveraging a preventive care focus. Pulling this together was not easy and required Freedom of Information Act requests to access the Centers for Medicare and Medicaid Services (CMS) data. We hope to do more in the future to make it easier for our payer partners to understand our impact on community health through our focus on preventative care.

Additionally, a cost-only focus lens is a challenge. If negotiations focus solely on costs rather than the value and quality of services you provide, it can hinder the process. While cost considerations are important, they should be balanced with a commitment to quality and improved outcomes. It’s essential to maintain an open line of communication with your insurer partners and adapt your negotiation strategies as needed. Every negotiation is unique, and staying flexible and responsive to the insurer’s priorities can lead to more successful agreements.

Not to be discouraged, there are successful efforts when negotiating with insurers. Staying committed to access to high-quality care and excellent patient communications is critical. The payers Benevis works with really care about quality, and they are impressed with our patient outcomes. Using data to tell the story is also a critical element. The Taylor Dental & Braces practices case study highlighted the economic impact of Benevis’ care across Louisiana through its nine practices that provide over 100K patient visits annually. We were able to prove that investing in routine preventive care helped to decrease costly dental conditions.

My advice to those seeking negotiations is to highlight your commitment to providing high-quality dental services and showcasing impressive patient outcomes. Insurers will prioritize quality of care in their networks if the evidence of improved outcomes is available to them.

The Future of Dental Insurance

A lot is at stake for dental insurance. The federal Medicaid unwinding process, which began in the spring of 2023 after the end of the Covid Public Health Emergency, allows states to disenroll non-eligible patients (adults and children) from Medicaid. Most concerning is that many of these patients are being cut from coverage due to administrative or paperwork processes such as not updating contact information forms, not because they do not qualify. As of October 26, 2023, 9.5 million people have been disenrolled, and this year, it is estimated that as many as 15 million people will be impacted. In 19 states that reported age breakouts, children accounted for 40% of disenrollments. We are grateful to CMS’ Chief Dental Officer Dr. Natalia Chalmers and the organization for helping to pause the unwinding in many states in order to avoid further errors and for adding a level of federal support through national TV commercial advertising. Benevis is also actively working to help people get and stay enrolled through community connections in each of our offices.

Another concern is the staffing shortage. Dentists, hygienists, and dental assistants deserve to be paid well, as we value their dedication and care. For practices to pay teams correctly, we need to ensure we are operating effectively and also need reimbursement rates to be fair and reflect these increased costs of care delivery

What is working and will continue to drive success in the future is preventative care. Benevis’ payer partners are excited to see our offices expand the dental services offered. We are truly a dental home for our patients and reach approximately five million underserved patients. With more focus on preventative care and integration of oral health into traditional healthcare, we are supporting our payers’ vision for better patient care. In tandem, improving quality data, including dental diagnostic codes, allows dentists to access information on the types and range of conditions they encounter in their offices, enhance patient communication, track clinical outcomes, and monitor best practices. Many payers have discussed expanding the use of diagnosis codes, and when they do, our technology platform is prepared.

What I am focused on, specifically for the 120-plus practice locations in Benevis’ network, is establishing valuable relationships that can simplify the process for multi-state payers and enhance their ability to appreciate the value we bring. Many of our payers, whether they follow a VBC or pay-for-performance model, prioritize improved patient access. Our programs are specifically crafted to expand access, and we’re witnessing this positive impact in numerous markets.

Building a Financial Foundation for the Future

Allow your mission to be your beacon. For Benevis, it helps us stay focused on enabling access and availability to excellent dental care for everyone who would benefit. Our focus on patient access and availability to care – especially for Medicaid and CHIP beneficiaries – aligns with our payer’s goals of building a dental home or integrating oral health into total health.

Through our proprietary technology, we have improved our ability to address reimbursement challenges, improve outcomes, and manage operational costs more effectively. We have invested in technology and training to support communication with our payer partners. These investments have resulted in more timely payments in many cases. Our investments in data analytics and patient communication have also empowered us to adapt to a demanding market environment, ensuring that we can consistently deliver excellent clinical care and support the care delivery aspect of our business.

I am excited for the future of dental insurance and its evolution to better support diverse patient populations, encourage access to care and preventative oral health services, and improve overall health outcomes for patients.