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Insurers integrate dental, medical benefits

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The recently found connection between oral health and medical health has led some insurers to revamp their dental benefits offerings to include integrated dental and medical products--a step that may convince some self-insured employers to consolidate coverage behind one insurer.

Last year, insurers, including Hartford, Conn.-based Aetna Inc. and Philadelphia-based CIGNA Corp., began programs that address the link between dental and medical health that has emerged from scientific studies.

In a number of studies in recent years, researchers have linked periodontal disease--a gum infection that can lead to loss of teeth--to health problems for three groups: pregnant women, diabetics, and those at risk of heart attacks or stroke. Research has found that bacteria from the mouth travel through the bloodstream and affect other parts of the body.

The dental insurance offerings are limited to plan members in the three risk groups highlighted in the research. At no cost to the member or to fully-insured employers, some insurers now cover services such as scaling and root planing, an in-depth cleaning; periodontal maintenance, which is follow-up care to make sure problems do not recur; and up to three dental cleanings per year (see box, page 20).

Some insurers offering the enhanced dental coverage require that plan members have both health and dental insurance with the insurer. That is the case with Aetna, CIGNA and Detroit-based Blue Cross Blue Shield of Michigan.

"Insurers see this as an opportunity to increase their sales by providing multiple products to one client," said Eric Sanner, a senior vp for health and benefits at Aon Consulting in Washington.

For example, roughly one-quarter of Aetna's 35.9 million members have dental and medical coverage. BCBSM did not provide combined medical/dental data, but said about one-quarter of its 4.7 million members had dental coverage.

Insurers say integration of dental and health products is the best way to help employers coordinate dental side services with health side savings.

At CIGNA, "integration and total health management have been a focus for the past several years," said Angela Saunders, marketing director of CIGNA Dental and Vision Care in Plantation, Fla.

"The association between oral health and systemic health is consistently demonstrated in clinical studies, and the findings are positively impacting the treatment and management of patients," said Mary Lee Conicella, Aetna Dental's national director of clinical operations.

Unlike fully insured employers, self-insured employers must pay for the extra services. Mr. Sanner says he hasn't heard of many self-insured employers signing up yet, but not because of costs, which are relatively low. Prices range from $60 to $150 for a cleaning, $180 to $300 for scaling and root planning, and $105 to $225 for periodontal maintenance. Rather, he says many self-insured employers do not have unified medical and dental coverage, and larger companies likely have the resources to administer two contracts rather than one.

Cost reduction

By consolidating coverage, Ms. Saunders says the extra treatments cost 3 cents per member per month and reduce medical costs an average of 15% for all three risk groups at CIGNA.

Aetna quotes similar cost reductions for combined medical-dental coverage: a 9% reduction for diabetes, 11% less for stroke and a 16% decline for coronary artery disease. The data is based on a retrospective of claims of 144,000 insured patients, comparing those who received regular dental care and those who did not.

BCBSM quotes a dollar figure--$1,500 saved in medical claims per year for diabetics and heart patients who take advantage of preventive dental care.

Aon's Mr. Sanner said he is skeptical of the quoted savings, and even the insurers say they need to be verified over time with additional retrospective claims studies. Mr. Sanner also questions whether the improvements are significant enough to persuade employers to align behind one insurer. "If you look at all the things that drive health care, these things (dental problems of a few risk groups) are pretty far down the list," he said.

But Donna Sexton, director of employee benefits at Costco Wholesale Corp., in Issaquah, Wash., says the mouth-body connection persuaded the self-insured company to choose Aetna for dental and medical coverage two years ago.

In a pilot program free to Costco, Aetna nurses contacted 2,200 Costco members in the three risk groups and encouraged them to visit the dentist. Aetna is now offering similar free outreach to other employers who sign up for its offering. Costco declined to provide data on savings.

Insurers say it is hard to measure the response rate to their offerings because not all people in the high-risk groups have been identified, and not all that need dental care seek it.

Aetna says 57% of members contacted in a 2003-2005 pilot outreach program for 500,000 members subsequently sought dental care. In contrast, BCBSM says 25,069 diabetics and heart patients were mailed coupons for free dental care last year, but only 4% actually redeemed them.

"If one person goes to the dentist because of this program, we feel that's a victory," a BCBSM spokesman said.

New York-based MetLife, a large dental insurer, does not have a joint program since it does not offer medical coverage. Dr. Alan Vogel, a MetLife vp and national dental director, says, for an extra charge, the company can mimic other insurers' dental offerings with tailored products for employers. He says MetLife can provide specified employee groups 100% coverage for certain services and provide outreach as well.

But like MetLife's competitors, Dr. Vogel said he believes in the significance of the dental-health connection.

"People are beginning to realize that the mouth is part of the body," Dr. Vogel said.