It is no secret that the Massachusetts Dental Society (MDS) and its members have been at odds with Dental Service of Massachusetts (Delta Dental) for more than a decade. The relationship hit its lowest point in late 2016 when Delta Dental formed the PPO/Premier network under the for-profit Delta Dental.
When Delta unveiled the Total Choice network in late 2016, which would result in MDS members realizing a 25% to 30% reduction in reimbursements, the MDS Board of Trustees rigorously pursued every avenue possible to challenge and prevent the creation of this network.
Those actions included a petition and hearing before the Massachusetts Division of Insurance (DOI), a petition to the Massachusetts attorney general, and a legislative remedy. The MDS argued to keep Delta in the nonprofit section of the law, where its rate setting would remain under the scrutiny of the DOI.
Today, our organizations have come a long way toward a mutual understanding that neither dental benefits corporations nor providers can separately improve patient care or prevent rising healthcare costs. This is evident by the MDS Board of Trustees’ decision to support Delta Dental’s most recent fee methodology proposal and to testify on its behalf.
Recent Developments
On June 13, Delta filed its proposal to recalibrate the Premier product and rebase it, creating a 10% reduction in reimbursements. While no dentist wants a fee reduction, the MDS Board of Trustees determined that a modification to the Premier product, which ensures DOI oversight on any future fee changes, is a better alternative than the complete shift to Total Choice. Following a close review of the fee methodology, including an independent analysis by a noted health economist, the MDS Board of Trustees unanimously voted to support this proposal.
When only one dental carrier is expected to raise fees every year by the dental consumer price index, that carrier eventually will be priced out of the marketplace. This is exactly what is happening to Delta today. Two years ago, Delta tried to respond to this pricing issue by creating a new PPO product that gave it more flexibility in setting fees. Faced with a short timeframe to sign provider contracts and the idea of less oversight over the largest dental carrier in Massachusetts, the dental community including the MDS pushed back against this new product.
The MDS Board of Trustees views this fee change as a better alternative to the for-profit PPO product. By approving this fee methodology, Delta will remain under full DOI oversight and must come before the DOI prior to any future fee changes.
Support for this new fee methodology was not an easy decision for the MDS. But it is the best option to ensure a sustainable, predictable Premier Network for providers and an affordable Premier product for Massachusetts residents for years to come.
The MDS recognizes that there are dentists who are opposed to this proposal, but we want to assure them that the Society has done its due diligence. While not ideal, the MDS believes that the new methodology is a good alternative given the economic environment that currently exists.
Rising Costs
Many stakeholders believe healthcare costs are rising at a rate that threatens access to critical healthcare, including oral health, and that the dental profession faces significant changes toward accountable, value-based payment and care. The MDS has heard directly from legislators and policymakers that failure to act on rising costs of care will likely result in substantive reimbursement changes that are dictated to dentists.
Cost containment and quality measurement are top priorities among regulators, legislators, and Massachusetts Governor Charlie Baker. And, if changes are not made, drastic changes can be expected.
If Delta’s proposal does not get DOI approval, or if the DOI delays approval, Delta may elect to do some or all of the following potential options to stay competitive:
- Accelerate the sales of Total Choice (which has an estimated 30% fee reduction)
- Shift out-of-state Delta members to the Total Choice fee schedule immediately (approximately 1 million members)
- Reduce reimbursement for self-insured programs that do not require DOI approval (70% of Delta’s business is self-insured)
The impact on dentists would be significantly greater than the fee rebasing proposal if any or all of these options are implemented.
Based on our conversations around the new fee methodology proposal before the DOI, the MDS is hopeful that the lines of communication will remain open as each party develops and considers new ideas to improve patient care—especially as MDS urges Delta Dental to join the other major dental benefits corporations and allow patients to assign benefits to nonparticipating providers.
Including this provision as part of all contracts will directly help patients by limiting immediate out-of-pocket expenses and give them more flexibility in choosing their dental providers. Further, it ensures the continuum of care with their dental home regardless of participating provider status.
Reducing healthcare costs while ensuring that patients continue to have access to high-quality dental care requires a delicate balance, and we believe this proposal does just that. Ongoing efforts will require discussion and compromise if we are to have any real and long-lasting impact on the dental profession.
Dr. Zolot is a periodontist practicing in North Andover, Mass. He currently serves as president of the Massachusetts Dental Society and has held leadership roles with the Massachusetts Periodontal Society, Merrimack Valley Dental Society, and Haverhill Dental Society. He earned his bachelor’s degree in biology, with honors, at Fairleigh Dickinson School of Dentistry in Hackensack, NJ. He completed his master’s degree in physiology, as well as his doctorate in dental medicine (DMD). Dr. Zolot attended Boston University’s Henry M. Goldman School of Graduate Dentistry and earned a Certificate of Advanced Graduate Studies, Periodontology. He may be reached at howardzolotdmd@gmail.com.
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