The dental insurance side of dentistry has not seen much meaningful change in years, seriously lagging behind other aspects of the industry, according to this CEO.
Stephen Thorne, the founder and CEO of Henderson, Nev.-based PDS Health, said that he has not seen much in the way of innovation for dental plans since he started in the dental industry more than 30 years ago.
“Dental plans have not changed much since I started in this industry in 1989,” Mr. Thorne told Becker’s. “There’s been so little innovation in the dental plan industry in 36 years. It’s hard to think of another part of healthcare, or any industry, that has seen this little change. That needs to be addressed.”
PDS Health is one of the largest organizations in the dental industry, supporting more than 1,000 dental and primary care practices. The company is focusing on ways to bring an integrated dental and medical plan to patients with the aim of improving both oral health and overall health.
Medicare Advantage, for example, could be drastically improved and more tailored to dental care with a few tweaks. Individuals with existing health problems would benefit greatly from expanded dental coverage, according to Mr. Thorne.
“Think about a patient with diabetes. With the right diagnostic coding in a Medicare Advantage plan, that patient would be eligible for four or six cleanings a year to help control their condition. It’s a simple idea with the potential for a huge impact,” Mr. Thorne said. “Or take cardiovascular disease. Keeping the mouth clean and inflammation under control is critical. That might mean more coverage for cleanings or abscess treatment. These are real issues for seniors, and we can do more to support them.”
Dental-related ER visits are another area where improvement is possible. Many patients end up in the emergency room for dental pain but don’t receive the care they actually need.
“ERs aren’t equipped to treat dental issues, so patients often leave with a prescription and are told to see a dentist,” Mr. Thorne said. “That’s not effective care, and it’s very expensive.”
Dental plans and organizations like PDS Health have the opportunity to change the way the dental insurance industry operates by partnering up and developing an integrated plan with dental and medical benefits.
“There’s a real opportunity here,” Mr. Thorne said. “Dental plans could partner with a company our size to better manage their population and share in the responsibility for outcomes. That kind of partnership doesn’t exist today, but it should. We’re working hard on that, and that’s where this needs to go if we want to truly have an impact.”
