Overview of Benefit Issues
PRACTICE OF DENTISTRY
(BUSINESS
ASPECT)
VS.
PRACTICING DENTISTRY
(PROFESSIONAL
ASPECT)
Changes in the Delivery of
Dental Benefits
FEE-FOR-SERVICE
THE
DENTIST RECEIVES A FEE FOR EACH SERVICE
THE DENTIST IS NOT AT RISK
MANAGED DENTAL CARE:
…
attempts to manage the cost and quality of dental care through the use of
various delivery systems and reimbursement models
PREFERRED PROVIDER
ORGANIZATION
“PPO”
A dental plan with a
network of dentists
who have agreed to accept a specific
fees for covered services
Reimbursement is on a fee-for -service
basis
THE DENTIST IS NOT AT RISK
DENTAL
HMO
“CAPITATION/PREPAID”
A dental plan that reimburses the
dentists on a fixed “per capita” basis, usually monthly for each individual
or family
Payment is made irrespective of the
number of services rendered or beneficiaries seen
THE DENTIST IS AT RISK
The Dental Marketplace -
Delivery Models
Trends in Dental Care
Dental Vendors
Dental Vendors - Market
Share
Participation in dental plans (employees and dependents)
•Total
dental benefits market - 2000
Dental Care in Traditional
and Managed Plans
Cost
¹
“Quality”
(or appropriate care)
Dental Care in Traditional
& Managed
Plans
•No valid or reliable studies currently exist
which indicate that there is a “variance” in
quality between traditional and managed care
dental programs
•The limited studies available indicate there is
no distinction between
the care delivered under
dental benefit programs with differing financial incentives for dentists
(E.G.,
Massachusetts Employees Study, Washington Delta Study)
Dental Marketplace Data
Dental Benefits Enrollment
by Employer Type
- Full-Time Employees*
Dentist Income
Myth #1
Changes in the Dental
Marketplace
1998 Consumer Price Index - Increases in selected Items
The Dental Marketplace
- Financial Overview
Changes in the Dental
Marketplace
Projected Spending on Dental Services 1999 - 2008
($ in billions)
Dental Providers
Dental Providers
Effect of Managed Care on
Dentists’ Net Income
(responses among managed care participant dentists)
The Changing Face of the
Marketplace: is Managed Care Right for You?
RISK!
RISK
CHANGING DENTISTS’ MIND-SETS
THEY ARE NOT ALL ALIKE
Robert
Mehlman D.D.S.
KEY “REAL WORLD” FACTORS IN
CHOOSING A MANAGED CARE PROGRAM
KEY “REAL WORLD” FACTORS IN
CHOOSING A MANAGED CARE PROGRAM