Dental
The Benefits of an Effective Dental
Disease Management Program
How Dental Disease Management Can Help Drive Healthier Behavior

by David Guarrera

A dental disease management program can help influence employees’ oral health and control healthcare costs by driving healthier behavior. Wellness and disease management programs provide a logical, timely alternative to reducing benefits and shifting benefit costs to employees. Costly conditions, like coronary heart disease, have well-established disease management programs. But few, if any, disease management programs focus solely on the cost of dental services.

What’s more, a growing body of research indicates a strong potential link between oral health and overall health and that improving dental health may contribute to better outcomes for certain medical conditions. Almost one-third of people with diabetes have severe periodontal disease, according to the Centers for Disease Control and Prevention.

Adopting dental disease management programs may help employers get more value from the dental benefits they already provide. But since dental disease management is still a relatively new concept, confusion abounds about what constitutes an effective, comprehensive dental disease management program.

An Effective Dental Disease Management Program

An effective program starts with an appropriate plan design and should be flexible enough to perform as a stand-alone solution or coordinate with an employer’s current medical disease management or other wellness programs. It takes a robust education platform, and systems to measure and monitor the health of an employee population and the utilization of benefits over time to help influence the oral health – and potentially the healthcare costs – of a population.

To deliver value to both employers and employees, it is essential for a dental disease management programs to have six components that work together: education, employee engagement, disease risk and severity scoring, participant tracking, relevant education, and reporting.

The Importance of Education

Education should be the foundation of a dental disease management program. An educational program should be robust enough to stand on its own for employees who want to learn about oral health by themselves and should provide relevant education based on their oral health and risk for dental disease.

The educational component should contain reliable and timely information and address the association between oral health and overall health. For example, employees should be able to learn how some medications can affect their oral health and about the relationship between periodontal disease and diabetes. The educational component should be easy-to-navigate and contain interactive tools like risk assessments.

Driving Participation

The initial communication is the first step to employee engagement. There should be a strong invitation to participate along with support material, such as onsite posters, newsletter articles, and online presentations with audio for the launch of the program.

Next, employees should get reminders including messages to those who did not respond to the first invitation. Ongoing communications need to target employees who participate in the program. These communications should be delivered at least once a year and when employees level of risk or disease may have changed. This can be tracked by analyzing dental claim utilization, data reported by a medical wellness vendor, or it can be self reported by employees.

Measuring Risk & Severity of Disease

Scoring helps employees measure, understand, and track their risk and the severity of disease. This enables them to see changes over time and how their actions or lack of action affects their scores.
With scoring, data is the key. In fact, the more data points that are used, the higher the confidence level should be. Dental disease management programs can use the following:

• Self-reported health data, such as tobacco use, bleeding gums, medication (prescribed and over-the-counter), diet, and family history of conditions, such as diabetes and heart disease.

• Claims utilization data, such as the absence of benefits paid in the previous 12 or 24 months, the indication of only having received emergency dental services or extractions in the past 12 or 24 months, and employees with a history of periodontal services who did not complete the definitive treatment regime and/or the follow-up therapy.

• If available, data from medical disease management vendors identifying employees with conditions, such as diabetes, heart disease, hypertension and obesity.


Delivering Information When It Has the Most Impact

After giving employees their scores for risk and severity of disease, the program should provide information that employees can act on. For example, diabetics should get information about the link between diabetes and periodontal disease and tips to manage their oral health. Participants should get this information promptly, such as when they get their risk and severity scores, which is when it may have more impact. The program should provide the following information:

• Links to articles and resources that are relevant to their specific oral health needs.

• A summary of health concerns they should take note of.

• A recommended action plan that includes a list of suggestions employees can follow to help improve their oral health.

Uncovering How Benefit Plans Are Functioning

Aggregate-level reporting gives employers valuable insights into how benefit plans and disease management programs are working as well as the health of their participating employee population. For example, a dental disease management program can report on the following:

• Participation: The percentage of employees participating in the dental disease management program in a given period, which employees are participating, and risks for demographics, such as gender and age groupings.

• Risks: The number of participants with high and low risks and the health conditions most frequently associated with those risks according to various demographics.

• Health Conditions: The percentage of participants who self-reported medical and oral health conditions including hereditary factors by condition type.

• Change in health risk: Grouped according to participant demographics.

• Claim Costs: Average costs per claim and average costs per procedure for participants with high and low risk scores.

• Utilization: Analysis of claim data identifies patterns of care, disease, and outcomes such as the types of dental services rendered including follow-up care, using all employees (i.e., disease management participants and non-participants).

Insights for Dental Benefit Decisions

Lastly, a dental disease management program should help keep employees engaged and measure employees’ dental health and dental utilization over time. Employees can see how their risk for dental disease and their level of dental disease changes over time and how their actions, or lack of action, affect their scores. Employers can see how employees are using their dental benefits and changes in the dental health of the participating population.

Medical disease management vendors can be provided with historical employee-specific information, such as comparisons of individual risk and disease scores over time and histories of dental treatment. This data can be incorporated into the medical disease management programs for systemic conditions.

While it is important to start with an appropriate dental plan design, employers can make additional changes after they have a better understanding of the health of their employee population and how existing benefits are being used.

If you want to help clients control their costs while enhancing the value of their dental benefits, you should discuss dental disease management programs. Since dental disease management is a relatively new concept, you have an opportunity to present a fresh perspective and a new dialogue on increasing the value of a dental benefits program for employers and their workforce.
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Dr. David Guarrera, DDS, is vice president of MetLife’s Dental Product Management. He is responsible for the oversight of sales training and market positioning. He is also responsible for setting clinical policies in relation to the practice of dentistry as it relates to MetLife’s dental products, the oversight of MetLife’s professional claim review process as well as disease management and wellness initiatives. Dr. Guarrera can be contacted at dguarrera@metlife.com.