BY DAVID BOTTOMS, REBC, RHU, CLU, CHFC
SENIOR VICE PRESIDENT, BENEFITS
Published: November 2020 Cobb Business Journal
Historically, employers who made a decision to integrate their medical and dental plans with a single insurance carrier came to that decision largely on the basis of desiring administrative convenience or packaging discounts.
While strong arguments still exist for the convenience and financial efficiencies of packaging, a new and perhaps even more compelling clinical argument is beginning to emerge as medical insurance providers have been increasingly (and somewhat quietly) investing in technology tools that are providing medical and dental professionals with the opportunity to leverage data on overall patient health, prescription usage, etc. as a means to improve patient outcomes.
These new carrier driven tools have the ability to integrate data in a way that even the best electronic medical records (EMR) systems have struggled to do given that medical and dental care is, from a provider perspective, often operating in two different data ecosystems.
Let’s consider a fictional example to illustrate how all of this could actually work.
Meet Alice. She has a great relationship with her medical providers and carefully follows their instructions. Both her primary care physician and the specialist physicians that she sees have the ability to view and share information regarding her medical care given that they all utilize a common EMR system. Alice has recently had some back surgery and her physicians have had her on a very measured dose of opioids to ease her post-surgical pain.
In a twist of bad luck, late one afternoon, Alice experiences a dental problem that requires a somewhat urgent root canal. Given all of the newfound dental pain that Alice is in, she forgets to mention to her endodontist that she is currently taking some opioids for her recent back surgery. Given that her endodontist does not have ready access to her medical records, he also prescribes a dose of opioids to help with her root canal recovery.
I suspect we can all think through the problems this fact set could present for Alice.
Alternatively, if Alice had an integrated insurance provider for both her medical and dental needs, the insurance provider is in a unique spot of being able to bridge the data gap that exists between the medical and dental realms of Alice’s care.
Under this scenario, Alice’s endodontist has the ability to review her current prescription information in the insurance carrier’s provider portal which flags Alice’s current use of opioids and leads her endodontist to prescribe non-opioid pain relief treatment and consult with Alice’s physicians to make them aware of her root canal and, in partnership, they all are able to work behind the scenes to help avoid any potential addiction to opioid pain killers.
Even in less dramatic examples, a lack of data integration between medical and dental providers can lead to troubling results and/or complications given that even the most well-meaning of patients may have trouble remembering the names of their medications and/or dosage amounts when they are asked to self-report what they are using.
As focus on wellness continues to be a key priority for employers and as investment in healthcare related technology tools continues to increase, the potential for integrated data to drive better results and improve overall patient wellness will likely grow.
As the clinical case for integration between medical and dental insurance continues to emerge, it is likely that the enhanced potential for patient outcomes could (and arguably should) begin to eclipse “integrated billing” and “packaging discounts” as the key reason for pursuing an integrated approach to coverage.
View article in Cobb Business Journal if you have a subscription.