New research studies are suggesting that improving the health of a worker’s gums could reduce the cost of caring for the rest of the worker’s body.
Carriers such as Aetna Inc., CIGNA Corp. and Dentegra Group Inc. are trying to spread the word that simply encouraging some workers’ to get their teeth cleaned 3 or 4 times a year, instead of 2 times a year, could help keep down or even cut medical expenses related to diabetes, premature birth and coronary artery disease.
“Every day, we uncover more information about dental treatment patterns and the connections between oral and overall health,” says Dr. Jed Jacobson, a senior vice president at Delta Dental of Michigan, Ohio and Indiana, Okemos, Mich.
Representatives for the dental carriers themselves warn against hyping preliminary research results that still face years of rigorous scientific scrutiny.
The exact relationships between oral health and general health “are not yet clearly understood,” says Jeff Album, a spokesman for Dentegra, San Francisco, the parent of the Delta Dental plans in California, New York and other states. “The correlations are not causal at this point.”
The producers trying to sell dental benefits say they are not quite sure how to use those findings to persuade employers to add new dental plans and improve the benefits in existing plans.
“There are correlations between dental health and general health, no doubt about it,” says Renny Thomas, executive vice president and managing general underwriter at Dentafits Inc., Palm Springs, Calif. “But you’ve got two overlapping risks. We’re underwriting a different kind of risk.”
But, if the dental health researchers are right about the link between dental and general health, and Americans act on that knowledge, the results might have a big effect on medical care.
Dr. Steven Offenbacher, a researcher at the University of North Carolina, has led a team that has estimated that gum disease may be responsible for about 50,000 premature births and billions of dollars in extra medical bills in the U.S. each year.
Dr. George Taylor, a researcher at the University of Michigan, is leading a team that has reported that simply offering 4 teeth cleanings per year to individuals with diabetes helped some of those individuals improve blood sugar control enough that they could stop taking insulin.
Some public health experts have asked whether results for the general population apply to workers who have had good health and dental benefits, or whether the results apply mainly to the many Americans who have no dental coverage.
Dr. David Albert, a researcher at Columbia University, recently presented preliminary results of a study addressing those questions in Orlando, Fla., at the annual meeting of the American Association for Dental Research, Alexandria, Va..
Albert’s team sifted through 2 years of data for 144,225 consumers who have both health and dental coverage from Aetna, Hartford. The researchers have found evidence that treating gum disease during the first year of the study actually cut the total cost of treating diabetes and coronary artery disease during the second year.
CIGNA Corp., Philadelphia, has reacted to studies by giving one free extra cleaning to every pregnant woman who has health coverage and dental coverage from units of CIGNA. The company also is paying 100% of the cost of periodontal scaling and root planing for pregnant women who have signs of gum disease, and it is covering 100% of the cost of treating inflamed gums around wisdom teeth.
But dental benefits experts interviewed say this is a tough environment for persuading employers to add or change dental benefits packages. Although most employers that have dental coverage are keeping their plans, few employers are adding new ones, marketers say.
Redesigning dental plans to provide extra cleanings and periodontal coverage for specific classes of employees, such as pregnant employees or employees with heart problems, could also be challenging, Album says. “Employers traditionally like a uniform level of benefits for all employees.”
At Dentafits, Thomas says employers can give employees the freedom to choose their own cleaning and periodontal treatment schedules by shifting to “dollar-based” plans, which offer employees a set amount of reimbursement for any care chosen during a year, and away from conventional “procedure-based” plans, which reimburse patients for the cost of specific procedures, such as cleanings.
Carriers offer dollar-based plans throughout the U.S., but “they’re just not promoted,” Thomas says.
Most carriers seem to stick with procedure-based plans, Thomas says.
Small employers that buy procedure-based plans usually have to stick with the carrier’s standard benefit menu, but an employer with a few thousand covered lives probably could work with a carrier to add extra cleaning and extra periodontal treatment benefits to a procedure-based plan, Thomas says.