Are insurance companies finally waking up to the oral-systemic link?

Lack of treatment acceptance due to dental insurance coverage is a huge obstacle to care. Now, as the oral-systemic link goes mainstream, some insurance companies are changing their products to promote prevention.

One of the challenges we face as oral health care professionals is treatment acceptance based on procedures covered by patients’ insurance. Many are not aware that dental insurance is not meant to cover all necessary procedures, but to offset costs. Some insurance companies now realize that not everyone is created equal. Medical diseases or conditions can affect oral health. Conversely, periodontal disease can affect general health. This article will review current thinking regarding this connection.

Oral complications of systemic diseases have been recognized by the National Institutes for Health and the Surgeon General for some time. (1, 2) Research has linked periodontal disease and other oral conditions to a number of systemic diseases. The greatest evidence exists for the connection with diabetes, however, many associations are being studied and evidence continues to grow. Some of these associations are heart and lung disease, low birth weight, oral and pancreatic cancers, and respiratory infections.

Dental insurance companies are finally realizing that prevention works. By preventing oral health problems, they realize that systemic health may also be enhanced. Insurance companies that offer both dental and medical insurance are acutely aware of this connection. An example is Delta Dental and the heart and mouth connection, and how oral and heat health are linked. (3) They described risk factors, warning signs, and preventive issues for their clients. More third–party payers are designing benefit plans that link one’s oral health to the rest of their body.

Another illustration is Cigna’s Dental Oral Health Integration Program. (4) The program is available for eligible customers enrolled in a Cigna Dental HMO or Cigna Dental PPO plan. Those with certain medical conditions can receive reimbursement for specific dental services used to treat or help prevent periodontal disease or tooth decay. Resources available for their customers include a video on YouTube in English and Spanish, a customer flyer in English and Spanish, postcard reminders on preventive dental care, prewritten content for newsletters, and a podcast on oral and overall health.

Aetna also has a similar program, and since 2006, have joined forces with Columbia University to conduct research on which they based their Dental Medical Integration (DMI) program. (5) They believe that about 20% of members will have better health outcomes when their medical and dental information is integrated. One study showed that, when compared with members not in the program, DMI members received more preventive care, used fewer major and basic services, had fewer hospital admissions, had better control of diabetes, and had lower claims costs. (6) This two-year retrospective study of the insurance company database revealed a possible association between periodontal treatment and Per Member Per Month (PMPM) medical costs. The findings propose that periodontitis treatment has an impact on the PMPM medical costs for the three chronic conditions of diabetes mellitus, coronary artery disease, and cerebrovascular disease.

Northeast Delta Dental’s Health Through Oral Wellness (HOW) Program is a patient-centered wellness program. (7) It is “designed to help members maintain oral health through education, risk assessment, and evidence-based models of care. Patients at greater risk for oral diseases or medical complications related to oral health will be eligible for enhanced preventive benefits.” (7) There are articles written on the medical and dental communities collaborating to help patients prevent and manage the oral and systemic effects of diseases. (8)

It is our responsibility to help patients to understand their coverage, and the necessity of receiving treatment that may not be covered by insurance. As always, prevention saves pain, suffering, and resources.

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References
1. Oral Complications of Systemic Diseases. National Institute of Dental and Craniofacial Research website. http://www.nidcr.nih.gov/OralHealth/OralHealthInformation/SystemicDiseases/. Accessed May 2, 2016.
2. Oral Health in America: A Report of the Surgeon General (Executive Summary). National Institute of Dental and Craniofacial Research website. http://nidcr.nih.gov/DataStatistics/SurgeonGeneral/Report/ExecutiveSummary.htm. Accessed May 2, 2016.
3. The heart and mouth connection: How heart disease and oral health link. Delta Dental website.https://www.deltadentalins.com/oral_health/heart.html. Updated October 2014. Accessed May 2, 2016.
4. Cigna Dental Oral Health Integration Program. Cigna website. http://communication.cigna.com/?elqPURLPage=830. Accessed May 2, 2016.
5. Dental Medical Integration Program. Aetna website. https://www.aetna.com/insurance-producer/dental-plans-programs/dental-medical-integration-program.html. Accessed May 2, 2016.
6. Albert DA, Sadowsky D, Papapanou P, Conicella ML, Ward A. An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population. BMC Health Serv Res. 2006;6:103.
7. Northeast Delta Dental’s Health Through Oral Wellness (HOW) Program. NEEBCo website. http://www.neebco.com/news/northeast-delta-dentals-health-through-oral-wellness-how-program/. Published March 18, 2015. Accessed May 2, 2016.
8. Gesko DS, Rush WA, Durand EU. The Oral-Systemic Link: An Opportunity for Collaboration. Diabetes Spectrum. 2001;24(4):187-189.