3 things insurance companies want you to know about integrated healthcare

2017 07 11 14 12 24 820 Towers Scott 400

If you're like many members of the healthcare community, you've probably heard the term "integrated healthcare" more and more frequently in recent months. But what is integrated healthcare? And as a dental care provider, why should you care?

Scott Towers, MBA, is the president of the dental division for Anthem.Scott Towers, MBA, is the president of the dental division for Anthem.

For our purposes, we define integrated healthcare as an employee benefits strategy that connects medical with nonmedical benefits, such as pharmacy, dental, vision, and disability data in a healthcare program. Integrated healthcare is designed to enhance a patient's experience with medical and ancillary care, including dental. The goal is to connect patient medical care with their ancillary benefits, attending to the overall health of the patient rather than treating issues in isolation.

Integrated healthcare is growing in popularity among employers and also insurance and healthcare providers. According to the 2017 Anthem Integrated Health Care Report, 60% of more than 200 surveyed employers are either implementing or actively considering implementing integrated healthcare benefit plans. In other words, it's likely at least some of your patients are or will be enrolled in this type of benefit plan.

3 things to know

As integrated healthcare's popularity grows, it's important for providers who may encounter these benefit plans to understand how they work and how they may impact individual practices.

The following are the top three things dental providers should know about integrated healthcare plans.

1. Encourage early disease detection

Integrated healthcare encourages the sharing of data and resources among a patient's disparate healthcare providers through the patient's insurance providers and/or wellness and care management providers.

“Through integrated healthcare, providers benefit from a more complete picture of a patient's overall health.”
— Scott Towers, MBA

The guiding principle behind integrated healthcare is that a patient's overall health is interconnected and managed among many benefit plans, so providers should be interconnected as well. For dental providers, this can be particularly important in detecting and treating a number of health conditions, including diabetes, pregnancy, heart disease, cancer, and others, that can show oral symptoms or may result in the onset of oral disease.

Through integrated healthcare, providers benefit from a more complete picture of a patient's overall health through access to a patient's medical history and other information. This also means dental offices can share the results of oral health visits with the patient's other healthcare providers. In this way, dental care works in harmony with other providers to maintain or improve the patient's overall health.

2. Provide supplemental care for chronic conditions

In many cases, patients receive additional dental coverage to help manage or prevent complications from chronic medical conditions. For example, patients with diabetes have shown improved health outcomes when periodontal disease is treated regularly. As a result, these patients are often provided three, or even four, periodontal maintenance treatments each plan year instead of the traditional two each plan year. Integrated healthcare arrangements often provide this coverage in addition to other services, including third or fourth cleanings, fluoride, and sealants.

Reimbursement is still product-based, keeping things simple. As stated, additional benefits may be available and are based on a multifaceted condition analysis, but claims remain straight-forward at the plan level.

3. Lower the administration burden

Most integrated healthcare plans include a care manager. The care manager can either be someone in the doctor's office or available through telephonic means. The care manager's physical location does not change the value of the interaction with the patient or the support provided for overall health outcomes. Care managers are assigned to patients based on their medical condition or on the individual care manager's specific clinical expertise -- this helps remove some of the burden of patient follow-up from providers while helping prevent patient complications and more intensive forms of treatment.

For example, a care manager is assigned to a patient scheduled for a kidney transplant and usually has experience working with transplant patients. In this example, the care manager would have access to all the patient's medical, pharmacy, dental, and vision records. If the patient has not seen a dentist recently, the care manager would know this and be able to reinforce the importance of getting to the dentist prior to entering the transplant process and in the waiting period to ensure good oral health. The care manager educates the patient regarding the negative impact that poor oral health and infections in the mouth, such as periodontal disease, can have on the ability to be on the transplant list, maintaining their eligibility for the waiting list, or the success of maintaining a transplanted organ.

Ideally, the goal is to have better outcomes for patients and their disparate healthcare providers. This results in lower costs for all involved with patients at the center of integrated healthcare arrangements -- not the insurance companies or companies managing care.

The sharing of information across a patient's network of providers also allows for more informed treatment plans to be developed to help manage a patient's condition. Information is shared through tools and notifications, such as care gap alerts and oral health assessments, along with the patient's insurance providers and wellness and care management providers sharing patient electronic health information. This increasingly includes medical providers acknowledging the value of dental providers in the maintenance and improvement of overall patient health.

As integrated healthcare continues to grow in popularity, please take time to consider your participation and the use of tools and resources with patients' insurance providers and/or wellness and care management providers. As healthcare evolves, these programs provide a unique opportunity to impact the lives and overall health of your patients while putting patients first. Dental providers are an integral and growing provider of care in an integrated healthcare model and a driver of overall improved health outcomes.

Scott Towers, MBA, is the president of the dental division for Anthem.

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.

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