This is Part Two of our series on dental. Part One is here.
When was the last time you revamped your dental benefit?
And here’s why no one does: the annual maximum dollar limit for dental is typically lower than the annual deductible for medical. Hence, you don’t spend much money on dental, even if your employees do.
Consider a few factoids
First, many acute medical problems go away on their own (“self-limiting”) and yet many employees treat them anyway. By contrast, most dental problems do not do away on their own and yet many employees don’t treat them, due to cost or fear of the dentist.
Second, tooth decay is your #1 “chronic disease” in that list making up the alleged 75% of your total cost spent by people with chronic disease. Tooth decay has been called a “silent epidemic.”
Likewise, filling cavities is your #1 medical “procedure.” To put that in perspective, every 1000 people you cover will fill about 300-400 cavities/year, but 1000 covered people only generate one admission to the hospital primary-coded for diabetes.
“Yes,” you may think, “but my employees are sicker and have more diabetes.” That probably also means they and their families get many more cavities too. Not to mention more root canals, crowns, extractions, gum disease, and abscesses.
Third, virtually every plan that covers preventive care uses a one-size-fits-all model, where 1 or 2 visits are fully covered. However, as with checkups (where only a portion of the working-age population should get them annually), the right number of dental checkups varies from person to person. Some people are fine with one, while others need 3 or 4. And it’s that latter category – which gets no economic support in a dental benefit – which is most likely to have cavities turn into root canals or abscesses…or even significant medical issues.
By themselves, those three issues would merit a second look at the dental benefit. Because you are preventing bigger problems, for about the same cost as 100% coverage of 2 visits and encouraging everyone to get exactly 2, you could cover 4 visits – assuming you use Quizzify to educate employees on how to decide how many they should get. (The “visit your dentist twice a year” mantra can be traced to an old Pepsodent ad, not science.)
But wait…there’s more. Now how much would you save?
Those of you who follow Quizzify know that the large majority of cavities no longer need to be filled. They can be treated with Silver Diamine Fluoride (SDF), the only dental innovation awarded “Breakthrough Technology” status by the FDA. Application of SDF takes two very painless and needle-free minutes, and costs less than $40. I described my own experience in Part One of this series.
The highlight? Here’s my EOB. This uncovered procedure cost $39.92, while a 50%-covered cavity would have cost my wife’s employer and me $80 apiece. Plus, my appointment was at 11:00 AM, I was back at work at 11:15, and I wasn’t drooling for an hour afterwards. SDF can even be applied during the same visit as a checkup, no second appointment needed.
Considering the large number of cavities, the lack of novocaine, and the time saved, this is probably your #1 productivity improvement possible through the health benefit!
The only downside? The decay turns black. Dentists, who with few exceptions are generally opposed to SDF because treating every cavity that way (as they do in Japan) would cost them a large chunk of income, describe this as a horribly disfiguring outcome.
Mine did too, but I pointed out that:
This cavity was in a back molar so no one would see it;
I don’t have to impress anyone because I'm already married.
Redesigning your benefit
There is more to it than what can be fit into the back third of a blog post, but you can follow up with us and we can walk you through it.
Cover more checkups, at least 80%. Then use Quizzify's dental health quizzes to help employees understand how many they should get, based on their own circumstances. (Kids should still get at least 2!)
Cover SDF.
To the second point, perhaps reimburse a fixed amount (like $70) per cavity at least for a year or two, so that employees could actually make money by filling cavities. It may seem counterintuitive to pay people to seek medical care but you already do that with workplace screenings and/or annual checkups, and SDF has much more value.
Not all cavities can be treated this way, if they get too deep. For kids, cavities can be very expensive and traumatic. For kids who get their two checkups, perhaps cover cavities at 100% since the parents did their best.
Next comes the hard part
You now must convince employees that SDF is a good idea. Their view will be: “If it’s so good, how come my dentist didn’t tell me about it?”
That’s where Quizzify comes in. We have a complete quiz, carrying the Harvard Medical School logo, on SDF. It covers all the benefits and leads employees to understand why so many dentists view SDF as a threat. This quiz can be repeated and/or you can specifically offer a bonus for completing it.
Ideally, you can get an intern to call the "80-20 rule" of higher-volume dentists in your network to find the ones who willingly apply SDF. No, this is not a contractually prohibited subnetwork. You aren’t changing the price and the “subnetwork” is wide open. Ideally, you wish every dentist would sign on. Quizzify can then be adapted so that zip codes can be matched with dentists, allowing employees to locate the closest ones.
And, finally, the best part
You’ll be saving money, and the amount of employee time at the dentist will decline significantly. (In addition to taking minutes and being applicable during the same visit as a checkup, you can treat multiple cavities at once.) And you’ll save children from unneeded trauma or even general anesthesia.
Most importantly, you’ll be putting a smile on the faces of 30% of your employees or their kids every year. Those dentists will tell you that those smiles will include a black spot where the decay was, of course.
But just like they won’t tell you that SDF exists, they also won’t tell you that a simple follow-up application of potassium iodide will lighten those spots to the point where, except on front teeth, they won’t be noticeable.
More on SDF from Quizzify
Quizzify is the key to getting employees to use SDF. In addition to the quizzes (on both dental health and SDF) available to customers, we have blog posts for you:
Part One of this series
The 4-part series on the preschooler whose dentist fought for general anesthesia
