Lower Medical Claims Costs Linked to Payer's Dental Program

Six years after launching a dental medical integration program, Aetna reports that hospital admissions and claims costs are down, while diabetes control has improved by 45% among 1.5 million patients.

Much of the traditional focus of the care continuum has been to link pre-acute, inpatient, and post-acute healthcare in an effort to improve outcomes and reduce inpatient readmissions. While medical doctors and specialists have long been essential players, dentists are now being added to the mix as health insurers pay attention to the relationship between physical health and dental health.

In 2007 Aetna launched its dental medical integration program as part of a research program with the Columbia University College of Dental Medicine. The DMI program uses claims data to identify Aetna members who are pregnant, have diabetes or cardiovascular disease, and haven't visited a dentist lately. An outreach program connects with those members.

Six years and 1.5 million patients later, Aetna has released some results. DMI program members who visited the dentist have:

• Lowered their medical claims costs by 17%
• Improved diabetes control by 45%
• Reduced their use of major and basic dental services by 42%
• Required 3.5% fewer hospital admissions year-over-year compared to a 5.4% increase for non-DMI members

I recently spoke with Mary Lee Conicella, DMD, the chief dental officer at Aetna, about the DMI program, its place in the healthcare industry, and the program challenges.

HLM: What's the relationship between periodontal disease and chronic disease?

Conicella: What has been concluded in the scientific literature is that there is an association between periodontal disease and several chronic conditions. The three conditions with the strongest evidence of associations are the three conditions in our program:

• Diabetes
• Heart disease
• Pregnancy

For example, we know that the inflammation associated with periodontal disease can make it more difficult for a patient with diabetes to control her blood glucose. We have found that members in the program who have diabetes and have started going to the dentist have better control of their blood glucose in subsequent years.

HLM: How do you find potential DMI participants?

Conicella: All of our dental and medical member data is on the same platform. That provides us with the advantage of having all the data in the same place. Our system can easily identify members who have the medical conditions we include in the program. We use a fairly broad algorithm that includes many, many diagnoses codes for identifying those members.

We will also loop in members who have kidney problems associated with diabetes or heart disease, or hypertension. We use the categories of diabetes and heart disease somewhat generally, then we look at a broad grouping of members within those general categories.

We identify them from the medical data and look at their dental data to see if they have recent dental claims. If they have not, we proceed with the outreach.

HLM: Walk me through the DMI process.

Conicella: Once they are identified, the members receive a postcard to let them know about the enhanced dental benefits available to them. They can access a toll-free number to talk with one of our dental care coordinators who can help them find a dentist.

Keep in mind, these are members who have not visited the dentist recently. We continue to follow them for about three months. If they still haven't had a dental appointment then we follow up with a telephone call.

We find each year we are successful with getting more than 50% of those members identified to a dental appointment within a few months of our outreach. We have also found that they tend to have sustained use of dental services, so those members tend to keep going to the dentist once they get the encouragement and go for their initial visit.

HLM: Do electronic health records play a role?

Conicella: The EHR is available to the providers of services, to physicians and dentists. Where it can play a role is when a physician enters information about a patient into the EHR, and if the [patient's] dentist would also have access to that record, that would be another way to know more about the total health of their patient.

I see an advantage of having access to an EHR if you are a clinician, just to be able to have that bigger picture of your patient, rather than just the information that the patient might fill out on their dental health history form, for example.

We also have a health risk assessment that our members complete. It includes questions about their dental care and their dental health, so that's another way we can use data to get a picture of our members' total health.

HLM: Is DMI part of your ACO strategy?

Conicella: We would very much like to include dentists and dental services in our ACOs in the future. Aetna's ACO team is working with our dental group. Our ultimate goal is to find a way to use the ACO strategy to loop in dentists so all of the providers of care for a particular patient have an opportunity to coordinate with one another.

HLM: What challenges has the DMI program faced?

Conicella: When we first started the program, getting the medical team at Aetna, and physicians in general, on board was a bit of a challenge. I think dentists embraced it right away because of the research coming out in dental journals.

Physicians weren't reading about the connections. Now our chief medical officer at Aetna and the medical directors I work with have embraced the program and embraced the opportunities for integration.

I would say the main challenge now is how to motivate that segment of the population that despite our outreach, doesn't make a dental appointment. We're very happy with the success we have achieved, but we would love to find a way to motivate the rest of the members to start going to the dentist.