BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.

To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.

To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.

Login Register Subscribe

Dental plan has tiered network


When Beth Moore, benefit/human resources information systems manager for Visant Corp., was looking to revamp the company's dental benefits program, she wanted a plan that jelled with the consumer-driven health care approach her company introduced on the medical side in 2005.

In January, the Armonk, N.Y.-based marketing and publishing services company launched a preferred provider organization-type dental plan offered by DeCare Dental that features a unique twist: placing dentists in tiers based on measures such as efficiency and the quality of care they provide.

DeCare Dental developed a set of analytic tools to track provider utilization, examining whether dentists are making treatment decisions based on necessity or on benefit plan design, said Chris Earl, chief sales officer for the Eagan, Minn.-based dental plan provider.

The analytics program, for example, allows the company to differentiate and identify dentists who automatically schedule visits every six months or X-ray exams every 12 months because the benefit plan pays for the services rather than making treatment determinations based on the patient's individual oral health.

The program looks at a dentist's historical claims data to determine practice patterns and compare them to the dentist's peers, adjusting for variations such as size of the patient population, age and gender. By examining this information, the insurer can tell whether a particular dentist takes a conservative or invasive approach when ordering dental services such as X-Ray exams, said Richard Hastreiger, dental director and vp of oral health analytics. Dentists who take a conservative approach are placed in the higher tier, he said.

The insurer works with employers to drive patients to dentists in the higher tier by offering incentives such as lower deductibles and higher annual maximum limits.

Creating tiered networks that rank dentists based on utilization--a greater driver of dental costs than dentist fees--can reduce costs by 10% to 20%, Mr. Earl said. One large employer that used the DeCare Dental program saved more than $3.5 million over a three-year period.

The concept of placing dentists in tiers based on objective measurements appealed to Visant because the company is asking its employees to manage their benefits efficiently and share the responsibility for health care costs, Ms. Moore said. Highlighting efficient dentists is an extension of the consumerism concept, she said. "It wasn't even as much motivated by an increasing trend so much as it was the right concept," Ms. Moore said.

To make the DeCare Dental plan more attractive to employees, Visant made the plan less expensive on a monthly premium basis compared to its traditional PPO plan, with a lower deductible and higher calendar year maximum benefits, Ms. Moore said. Under 10% of employees chose the plan when it was implemented in January, alongside the traditional PPO plan, she said.

One challenge Visant and DeCare Dental are dealing with is a limited number of dentists in certain rural communities where some of the company's employees are located. Visant is helping the insurer recruit dentists into its network by co-signing letters to dentists encouraging them to join, Ms. Moore said.