Medical insurance has been using tiered systems to provide care to patients for some time. A tiered system categorizes physicians by quality and cost efficiency standards. While the patient chooses their provider, the patient’s copay may vary based upon the provider tier that is chosen. Insurance companies can reimburse different tiers on different fee schedules potentially allowing network providers with better outcomes higher reimbursements. An example of medical insurance tiered system:
TIER 1
Providers meet excellent quality and/or cost efficiency standards
Members pay the lowest copayment
TIER 2
Providers meet good quality and/or cost efficiency standards
Members pay the mid-level copayment
TIER 3
Providers who are outside the insurance network
Members pay the highest copayment
As you know, trends in dentistry typically follow trends in medicine. While the tiered provider system is not yet here for dentistry, the concept of evaluating the quality of dental care has been on the horizon for some time, and will shortly be utilized by major dental insurers. How will this work?
A leader in this type of data analytics is P&R Dental Strategies. They have developed a unique, objective, quality measurement program for dentists. Their methodology, called DentaQual, leverages a nationwide, multi-payer dental claims database (DentaBase) to measure quality by analyzing cross-payer claims and dentist utilization data. Quality is measured based on metrics scored in each of 5 categories.
The DentaQual score for a dentist is based upon an individual dentist’s “standard deviation from the norm”, the norm being the average practice behavior of a dentist’s peers in a geographic area. It is not based upon predetermined or subjective benchmarks such as user reviews.
As the largest dental insurer in Arizona, Delta Dental of AZ, will soon make these quality scores available to patients to help them in selection of their dentist. Other insurers such as United Healthcare and other Delta Dentals have already incorporated this platform and it’s probable that other insurers will follow suit.
In order to better understand the purpose behind these metrics and how insurance companies will be using them, we have invited Mr. Mike Jones, President and CEO of Delta Dental of Arizona to participate in our upcoming seminar. Mr. Jones will provide us with an update of current and future initiatives and explain how Delta Dental will be leveraging these new metrics.
We have also invited Mr. Michael Urbach, President of New Markets for P&R Dental Strategies to come and explain how DentaQual works and what affect they expect to have on the dental insurance marketplace.
We look forward to their presentation on Tues, March 22, 2022 at 6:00pm at Superstition Springs Endodontics.