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“ DENTAL WORKS! ”

“ DENTAL WORKS! ”. The California Association of Dental Plans. Overview. CADP mission and fast facts How CADP helps dental work Current legislative and regulatory issues. CADP Mission Statement. The mission of the California Association of Dental Plans is to: “ … provide leadership in the

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“ DENTAL WORKS! ”

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  1. “DENTAL WORKS!” The California Association of Dental Plans

  2. Overview • CADP mission and fast facts • How CADP helps dental work • Current legislative and regulatory issues

  3. CADP Mission Statement The mission of the California Association of Dental Plans is to: “…provide leadershipin the dental benefits industry  and topromote quality dental care through legislative, regulatory and educational advocacy.”

  4. CADP Fast Facts • CADP represents 27 dental plans covering more than 20 million Californians. • CADP is working to increase access to affordable, quality dental care for all Californians. • CADP advocates sound public policy to improve oral health.

  5. DENTAL WORKS!Underlying Principles of a Successful Dental Benefits Program • ensures QUALITYcare • improves ACCESS to treatment • keeps coverage AFFORDABLE • PREVENTS oral disease before treatment becomes necessary

  6. QUALITYUnderlying Principles of a Successful Dental Benefits Program • CADP member plans adhere to high standards of care and operation, sharing data and information to help member plans implement their state-mandated quality assessment programs. • Member plans undergo rigorous, quality of care audits and administrative and financial review by the Department of Managed Health Care.

  7. More on Quality • With input from organized dentistry, CADP developed a quality assurance assessment that feeds into a shared data warehouse. Together, these tools standardize the conduct of onsite dental office visits, and allows data to be shared among all CADP members, thereby minimizing dental office disruption. • CADP certifies plan auditors who screen and review dental offices for compliance with quality standards, and calibrate their use of the quality assurance assessment for consistency. • CADP works to educate California dentists on how onsite office visits are conducted and what to expect in the process.

  8. ACCESSUnderlying Principles of a Successful Dental Benefits Program • Access to dental coverage is the greatest factor in determining whether a person sees a dentist. • Dental HMO and PPO programs offer consumers alternative, cost-effective means of coverage. • CADP promotes legislative and regulatory solutions that increase the public’s access to dental benefits.

  9. AFFORDABILITYUnderlying Principles of a Successful Dental Benefits Program • Dental premiums average less than 10 percent of the cost of medical coverage, and even less for dental HMO and PPO programs. • Dental premiums increase at a far more steady and sustainable rate than medical premiums have for the last several years (5-8%). • As more people obtain dental coverage, the need for major restorative care declines.

  10. PREVENTIONUnderlying Principles of a Successful Dental Benefits Program • Dental health is an integral part of overall health • Dental disease is linked to the risk of oral cancer, pre-term births, diabetes and other medically significant ailments • Tooth decay and other forms of dental disease are 100 percent preventable • Most dental benefit programs encourage and promote preventive care through 100 percent coverage

  11. THE CADP AGENDAFighting for Consumers • CADP promotes legislative and regulatory policies that increase access to high quality, affordable dental care • Offers input and perspective to lawmakers and regulators based on actuarial and administrative experience • Educates the media and the general public on the underlying principles of successful benefit programs and the potential impact of proposed legislation and regulation on such programs • Works to improve industry standards and share best practices among members • Hosts events to promote discussion and action on industry challenges

  12. Key Themes • Consistent dental care translates into better oral health and better overall health outcomes • People with dental coverage are nearly twice as likely to visit a dentist at least once annually • The public loses and oral health suffers when market barriers to dental benefits are created • CADP member plans have an excellent track record in serving the public and improving oral health

  13. CADP Consumer Advocacy …as published in the San Diego, Stockton and Inland Empire business journals.

  14. Regulatory Issues • Language Assistance Regulations • CADP was a leading force and advocate for the dental industry during the recently concluded development of language assistance program (LAP) regulations. Our testimony and comments resulted in changes that will translate into more appropriate and effective regulation, benefiting our members’ customers and English-limited enrollees. We now stand ready to assist Plans in the implementation and approval of their LAP.

  15. Regulatory Issues • Timely Access Regulations • CADP has testified and commented to the Department of Managed Health Care in favor of dental-appropriate, timely access regulations. • Partnered with organized dentistry to advocate a regulatory approach that is less intrusive for the practicing dentist, and less burdensome for an industry that received just 9 access-related complaints in 2006 out of 20 million enrollees.

  16. Regulatory Issues • Knox Keene Reform • CADP participated at invitation of the California regulator with an ad hoc group of health plans working to streamline regulatory requirements and eliminate unnecessary forms and processes. • Ongoing Dialogue and Education • CADP sponsors regular meetings and informational exchanges with California regulators to improve understanding of dental industry issues and promote healthy interchange and communication with those who license new dental plans and products.

  17. Legislative Issues • AB 895 – Coordination of Benefits • CADP participated in negotiations with CDA and Assemblyman Greg Aghazarian to win passage for a bill that clarifies and standardizes how dental plans collaborate to pay claims for enrollees with dual coverage. • AB 1554 – Rate Filing • CADP joined other health plans to successfully oppose a bill that would require health and dental plans to win approval for any changes in rates, even though regulators lack the resources to understand how insurance underwriting works.

  18. Legislative Issues • Healthcare Reform • CADP developed and extended to the Schwarzenegger Administration a set of principles for considering how dental benefits should fit into large scale health care reform. These principles have served as a starting place to make certain any reform approach adopted does not inadvertently worsen oral health by siphoning away the existing financial resources of the state, its residents, or the employers who conduct business within the state. • CADP’s “Principles of Dental in Healthcare Reform” were well –received, and to date, appear to have been respected most of the proposals on the table.

  19. CADP Committed to California • Supporting community activities and initiatives that enhance oral health • Serving as an industry resource for public policy makers • Keeping California smiling

  20. Questions / Discussion

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