Advice for new contracting with DHMO plans as part of the continuing b

[Guest bbruno]

We are going into a bid cycle for our plans. Our concern is to get the most bang for the buck, especially in quality and services provided by dental providers to member employees. Because we are not self-funded but insured, the desire is to create performance standards for the contracting plans to be held accountable for in the quality of benefits provided under this type of plan and access to providers. The thought is what kinds of performance standards might be reasonable and useful with a DHMO and how effective the use fo financial penalties would be based on quality assessments made based on employee survey results (e.g., survey results obtained by the plan vs. those obtained by the administrator), or if it is even feasible to do so. As DHMOs tend to run on slimmer operating margins, financial penalties may or may not be a feasible alternative based on survey results from employees, as an example- so, looking for any advise, history or comments on this matter. Any comments or ideas would be appreciated.

[KIP KRAUS]

I guess I’m a little confused, but that’s not uncommon these days. In 25 years I haven’t heard of one case where a person was overly concerned with the quality of care they received from their dentist. This of course doesn’t mean that dissatisfaction doesn’t occur. If you give employees the choice to use any dentists they wish to use you’ve done your job.

Participating in an HMO dental network in my opinion isn’t going to necessarily going to guarantee quality care. In my opinion the only reason to participate in an HMO dental network is to avail ones self of the discounted rates charged by the dentists. If the employees use these participants they save on their co-payments and the employer saves on claims payments.

As to self-insured versus fully insured I say you can have the best of both worlds by self-insuring and having an HMO process claims and allow you to use their network. By the way, there may also be other TPAs in your area that have dental networks.

My philosophy is that if your dental plan covers 200 or more employees you self-insure it and have a qualified TPA/HMO adjudicate claims for a fee.