A Win to the Fourth Power

Krysia GabenskiFeatured News

By Cal Utke, D.D.S., CDA Immediate Past President
From the Spring 2015 Journal of the Colorado Dental Association

As 2015 starts to settle in, we look at those pesky New Year’s resolutions and rebalance our life goals, both personal and financial. It’s one thing to rebalance your investment portfolios—but why stop there? I think it’s time and imperative to rebalance another equation that has morphed for me and my colleagues in dentistry over the past 10 years.

The dental world balance I’m referring to is significantly more challenging than developing a balanced occlusion on your next denture case or balancing your office check book. The equation in need of balance involves four factors—business employers, dental insurance companies, dentists and patients. All are interchangeable and dynamic within the balanced equation. All are ever-changing models that need to be rebalanced to regain equilibrium—or what I envision as an “exponential epiphany” to gain a win to the fourth power.

This takes collaboration, initiative and willingness to admit the errors of the past. This is not a request for all the groups to hold hands in a circle and sing “Kumbaya,” but ego and competition must stay in the parking lot for it to work. Let me highlight the issues I think the four groups must address for future progress.

Employers have an extremely challenging benefit landscape because of the new Affordable Care Act regulations and compliance issues. Yes, medical and pharmacy will be nearly all-consuming, and benefit dollars will be at a premium. I understand that business owners have to make choices that benefit both their budgets and employees. That said, it really isn’t all that helpful to an employee to have a regressive dental benefit that denies portability and freedom of choice when selecting a provider. It shouldn’t be up to the employer to determine whom their employees are allowed select as their dentists.

We all understand that businesses need to have a sustainable budget and model to stay afloat, but so do dental offices and insurance providers. Why should dentists or patients be the ones to underwrite businesses’ sustainability? Businesses need to empower their employees to be wise healthcare consumers and allow them to make a decision based on value and relevance when they use their benefits. That means providing a budgeted benefit that incorporates a maximum plan benefit that is not subject to a closed panel provider list.

Dental Insurance Companies are dealing with a business community that expects an actuarially designed plan that “provides something for nothing.” Yes, it is a competitive market, but nothing within the financial reporting and disclosure of the dental insurance industry indicates a struggling sector. It is also not the responsibility of dental insurance companies to tell business employees which dental providers they must see to get benefits.

Recently, the chief financial officers of two businesses polled their 100-200 employees, and nearly 90% of the employees said they would rather go without dental insurance if having it kept them from maintaining their existing dental office relationships. I call this “out-of-network fatigue”—and it’s bad for insurance companies, dentists and patients. Research shows that not having a dental benefit will diminish the chance of working class patients to access care while encouraging them to avoid participation in oral wellness. The plan designs, however, are regressive, archaic and destructive. Closed panel plans that offer inadequate reimbursements, hinder sustainable business models for providers and create a cost-shifting mentality are perverse. Inadequate copayments and benefit coverage plans in the private sector would shift costs onto the backs of patients without insurance, which wouldn’t benefit any of the four groups.

Dentists by nature are a different subsector of the human genome. Looking at the dramatic shifts in materials, treatment modalities and protocols in those same 10 years, no one can say dentists don’t adapt. Whether they’ve been confronted by changes to insurance protocol, unrealistic expectations of patients or a sloth-like economic recovery that I liken to walking through knee-high wet cement, the only thing certain is they cannot stop moving forward.

The greatest issue facing the core values of the profession is upholding the standard of care and appropriateness of care. When I visit components, members often voice concern about a small group of dentists that gives the rest of those in the profession a bad name. This small group, often driven by reaching a quota or making more money, pushes the boundaries of what’s considered acceptable treatment. They skew the insurance actuarials while patients undergo inappropriate and unnecessary treatment. Responsibility in diagnosis is critical. We cannot expect collaboration by the other groups if we as dental providers do not take the lead in ensuring the highest ethical standards in patient care.

Patients have the most to gain with a four-way win. With the potential to be self-determined and power-centered healthcare consumers, patients will gain their place in the equation. When patients have skin in the game—or is it teeth in the game?—it will translate to stable cost structures across the whole dental economy and a healthy cost-control pressure on fees and procedure costs. More people will have access to care.

Most patients’ view themselves as not relevant to the equation. Are they right? Do the other three parts of the equation make decisions that entitle or, worse, enable patients to become dental zombies? Or do we buck the status quo and work to empower and then energize patients to become oral health winners? The dentist-patient relationship must be centric and stabilized just as a good bite must be. An enlightened patient is worth striving for.

The win to the fourth power is attainable. The key to success is sitting down together and recognizing the co-morbidity and co-mortality of each of the groups and being willing, if necessary, to go a different path than the rest of the country. Creating a balanced equation must happen without compromising core values and without resentment or bitterness.

There is a lot of work to be done. I hope that before I ride my golf cart into the sunset of retirement we can deliver the necessary equilibrium and get this win the oral health community so dearly needs. This is likely my last diatribe as a member of your executive committee, but it will not be the last of my participation in this effort. This equation is too important to be left to the status quo or the mindset of mediocrity. So who else wants to win?