12:41 PM

Health Plans: How Reform-Ready Are You?

By Steve Pollock, DentaQuest Chief Operating Officer

The healthcare landscape is changing fast. In little more than a year, the Affordable Care Act (ACA) will require pediatric oral services as one of 10 mandatory categories of essential health benefits. This means that 23 million children across the country who currently do not have dental coverage will begin enrolling in oral health plans in 2014.

So what are the implications of this federal mandate on health plans? What components of dental benefit plan design, both front- and back-end do you need? And how do those managing health plans implement these changes?

On Oct. 16, DentaQuest addressed these questions and more when the New York Health Plans Association (NYHPA) hosted a webinar to give its members some perspective on the topic. Though specific to healthcare reform in New York, the webinar addressed the broad effects of pending ACA mandates and what organizations should be doing now to prepare themselves for 2014.

In New York for example, 2.4 million children are currently without dental coverage and 79,000 are expected to enroll through the state’s health insurance exchange. This is new territory for most plans. However, we are one of the few dental administrators in the nation with experience in an exchange program. Drawing on that experience, the webinar gave New York health plans information to start developing their roadmap for this aspect of healthcare reform and what to look for in a dental partner.

Among plans throughout the country, awareness of the pediatric mandate has risen during the last year from 50% to 75%, and those tasked with managing these plans are starting to make important decisions about expanding the benefits they will offer. Our research shows most health plans view the upcoming changes to healthcare as an opportunity to provide their members with new benefit options and to expand their business.

Via the webinar, participants looked for guidance to assess opportunities in their market, to identify how dental benefits might provide a competitive advantage, and how to conduct an internal assessment to determine whether their current model will support dental benefits. They reviewed the data, asked questions of Dr. Rob Compton, Bob Lynn, and Arlene Saffron, and by the end of the webinar were armed with information to build a strategy for incorporating or expanding their dental program, while also meeting the ACA’s pediatric dental mandate.

We know health plans are feeling regulatory and competitive pressures. But we view the challenges of healthcare reform as a chance to share our insights as a reform-ready partner working across the full spectrum of consumers on and off exchanges, whether group and individual, Medicaid, Medicare, CHIP, or the dual-eligible population. Oral health is an essential part of good overall health, and we know the coming year is one of great change – for the better. Are you ready? We are. Let’s talk.