“What makes prevention today different from past efforts is how it can be done. First, a wide range of new technologies and data analytics allows tracking of who and what is changing, making it possible to establish individualized targets, remedies, and incentives. Second, a systems approach helps companies go beyond single interventions to engage the entire insurance value chain — including local businesses, communities, and government — in the pursuit of these prevention gains. Third, with measurement linking risk-reduction milestones to improved business results, customers can be rewarded dynamically, with behavior-based pricing that encourages positive behaviors and leads to a virtuous shared-value cycle between risk reduction and profit.” HBR, June 2017.
With increasing research showing that oral health is directly linked to systemic health and that oral diseases can impact chronic health issues, and given a clear and rising demand to reduce health care costs, it is obvious that prevention will play an increasingly important role in dental care.
Dental insurance will align its commercial interests with preventive behaviors. Insurers, medical and dental, along with public services, can directly “monetize” better individual behavior as healthier or safer individual outcomes, lower claims costs, and improve risk pools, which can be translated into lower-priced premiums and a competitive advantage in the marketplace for health care insurance. Patients will be incentivized by lower premiums if they practice prevention.
Insurance can therefore become a natural shared value industry — one that can employ the idea proposed by Harvard Business School professor Michael Porter and Mark Kramer of FSG in 2011. On the “Shared Value Initiative” website research reports highlight how insurers are applying this model (see references for link).
As dental insurers become more and more embedded in medical insurance and more effort is put into controlling health care costs, greater emphasis will be on preventing dental disease. A medical-dental insurer goes to a large employer: “We can reduce your overall insurance costs, days lost, have healthier employees, and increase productivity, if you buy our medical-dental insurance.”
It is obvious that dentistry is being pulled into the primary care vortex. Hospitals, such as Kaiser Permanente, are building dental clinics. A number of primary care centers are now building dental clinics. Integrated care is rapidly being incorporated throughout the industry.
How will dentists, in solo or group practices, deal with becoming part of the larger whole? Dentistry has always been an independent health care entity. How will dentists feel when they must assimilate, report, and be part of much larger group, made up of other stakeholders – 3rd parties, physicians, hospitals, and insurance companies? How will dentists feel about being part of an integrated system?
Interesting times lie ahead for dentists, their practices and the industry itself given they have been acculturated as “repair service”, not as a prevention service. But, if employers and patients can reduce their premiums and co-pay by practicing prevention, bigger opportunities will rise for dental practices that provide and monitor prevention.
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References:
HBR
Can Insurance Companies Incentivize Their Customers to Be Healthier? by Adrian Gore, Peter Harmer, Marc W. Pfitzer and Nina Jais; Harvard Business Review, JUNE 23, 2017
https://hbr.org/2017/06/can-insurance-companies-incentivize-their-customers-to-be-healthier
Shared Value Initiative
Porter and Kramer’s Research Paper
http://www.sharedvalue.org/groups/insuring-shared-value-0
Kaiser Permanente Hospital
