Aetna launches program that includes specialized pregnancy dental benefits
Aetna announced Oct. 30 it is launching a new Dental/Medical Integration Program, effective Jan. 1, 2007, that will offer educational outreach about dental care and enhanced dental benefits to members who are pregnant or have diabetes, coronary artery disease, or cerebrovascular disease (stroke). These changes come on the heels of a published research analysis from Aetna and the Columbia University College of Dental Medicine, which found that high-risk individuals who sought earlier dental care lowered the risk or severity of their condition and subsequently lowered their overall medical costs.(1)
"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 Dr. Mary Lee Conicella, Aetna Dental's national director of clinical operations. "Specifically, there is a significant body of research that indicates pregnant women and individuals with diabetes or heart disease benefit from early periodontal care. The member outreach program, in conjunction with enhancements to our dental offerings, is designed to motivate these individuals to seek care."
Enhanced benefits for pregnant women
The enhanced benefit program for pregnant women is available at no charge to plan sponsors with both Aetna medical and dental coverage and those with members enrolled in the Moms-to-Babies program. These benefit enhancements are fully covered with no deductible and include:
• One additional cleaning visit
• Nonsurgical removal of tartar, bacteria, and rough surfaces
• Removal of plaque and tartar as a first step to enable a dentist to perform an exam
• Follow-up visits that include spot removal of plaque and tartar to maintain a clean and healthy oral environment
Enhanced benefits for diabetes and coronary artery disease/cerebrovascular disease
The enhanced benefit program for diabetes and coronary artery disease/cerebrovascular disease (CAD/CVD) is available at an additional charge to plan sponsors that have both Aetna medical and dental coverage. This program targets members with diabetes and/or coronary artery disease/cerebrovascular disease.
These members are eligible for the same benefit enhancements as pregnant women, with the addition of localized delivery of antimicrobial agents to treat periodontal disease. This benefit is not included for pregnant women due to physicians' concerns about antibiotics during pregnancy.
Education and outreach
Aetna has been aggressive in supporting not only the clinical connections between oral and systemic health but also member awareness, education, and outreach in order to motivate at-risk members to seek appropriate dental care. In partnership with the Columbia University College of Dental Medicine, Aetna conducted a two-year educational outreach pilot with 500,000 members starting in 2003, which found approximately 57 percent of those at-risk members who received education sought subsequent dental care.(2) In response to this evidence, Aetna is offering plan sponsors an outreach program to pregnant women and other at-risk members who have not visited a dentist.
Aetna believes so strongly in the improved medical outcomes of the Dental/Medical Integration Program that it is offering the outreach program free of charge to all plan sponsors with an existing Aetna fully-insured medical plan in conjunction with any of Aetna's insured or self-insured dental plans (DMO, DPPO, or Dental Indemnity).
"We place great importance on the analysis of our medical data to determine who may be at risk for periodontal disease, and then conduct outreach and educate our members on the importance of proactive dental care," said Alan Hirschberg, head of Aetna Dental Products and Services. "This results in subsequently lower medical claims costs and overall improved employee health."
Aetna has also incorporated this educational component with existing disease management programs supporting pregnancy and targeted chronic conditions, available to plan sponsors and their employees who have both Aetna Medical and Aetna Dental.
Aetna is one of the nation's leading diversified health-care benefits companies, serving approximately 29.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, and government-sponsored plans. For more information, visit www.aetna.com.
References
1 An Examination of Periodontal Treatment and Per Member Per Month (PMPM) Medical Costs in an Insured Population, BMC Health Services Research, Aug. 16, 2006.
2 Preliminary pilot results (Dental Claim Activity by Medical Condition 4Q05).
