What’s in store for dental plans within the next 12 months and beyond? From September 23-26, dental benefit industry leaders and key decision-makers came together at CONVERGE 2024 to network, share best practices, and discuss all things benefits as we move into 2025. Hosted by the National Association of Dental Plans (NADP), this flagship event is an essential opportunity to get a pulse of what's changing in the world of dental benefits.
So: what’s on the horizon? Check out our key takeaways below.
1. Total health includes oral health
In a significant regulatory shift, the Centers for Medicare & Medicaid Services (CMS) has removed prohibition on adult dental benefits as essential health benefits (EHB), clearing the path for states to start including routine dental visits as an EHB as soon as 2027 (if they choose to do so; the change is not mandated).
This marks a major change. Historically, only children’s oral health has been considered essential; this ruling paves the way for addressing long-standing gaps in adult oral health coverage across the U.S.
What does this mean for payers and providers? Prepare for a potential uptick in volume. As the market grows, maintaining a robust provider network will be absolutely critical to meeting increased demand.
2. Consumers are seeking trust – and growing frustrated
The U.S. dental services market is expected to grow at an annual compound rate of 6.8% from 2023 to 2030. And while reliably steady growth is typically welcome, the increased threat of oversaturation has some payers and providers worried about capturing market share and keeping members within their member network.
Increased competition from traditional, nontraditional, and direct to consumer providers gives consumers more options than they’ve ever had – and more reasons to leave your network for someone else that’s better suited to meet their needs.
Preventing member leakage starts with solving for consumer trust. Start by asking whether your plan can deliver on their minimum expectations, ideal preferences, and unrecognized long-term needs. Members have to – at a minimum – be able to reliably find network providers, understand the limits of their eligibility, and move through your system with ease. Otherwise, it won’t be long before they find another plan that can provide what they’re looking for.
3. Data quality trumps data quantity
If providers and dental support organizations (DSOs) have an end goal of ultimately offering members a high-quality experience and building trust, what’s the big picture approach that helps them meet that standard?
The expected increase in consumers seeking routine dental care and influx of provider options means data quality – not just quantity – will play an essential role in differentiating your dental plan.
More and more dental practices are entering leased relationships, where one carrier agrees to share at least some of its network with another carrier or a third-party insurance administrator (sometimes referred to as an aggregator). These arrangements can vary state-by-state.
While some argue that network leasing offers many advantages, this stratification can often cause issues; ambiguity surrounding cost, fees and billing, network size, and quality all threaten to have negative downstream effects on patients.
That’s why data transparency and quality are so essential. Consistent, reliable data sharing (and scrubbing) between payers and providers offers both parties the real-time insight they need to operate efficiently and ultimately offer members a more seamless experience.
The power of expanding operational efficiency
What kind of impact can unified provider data have on your organization?
Humana Dental, a large dental plan with 100,000+ clinicians, collaborated with Verifiable to speed up slow credentialing times and maximize operational efficiency. Download the case study here and discover how our team helped them achieve seven-figure cost savings and ultimately provide members with a superior experience.
