America s Oral Health. A Market Report on Dental Benefits

Transcription

1 America s Oral Health A Market Report on Dental Benefits

2 Delta Dental 2 Understand the factors that impact America s oral health. Lack of Dental Coverage Just as access to health care results in better general health, access to dental care results in both improved oral and overall health. However, more than ı30 million children and adults still lack quality dental benefit coverage. ı According to a 2007 report, among the total population of approximately million Americans, only about ı69.6 million have dental insurance. ı Although 84.2 percent of the total population have medical coverage, only 56.6 percent of the total population have dental coverage. ı For every person without medical insurance, there are 2.7 people without Compiled and published by Delta Dental Plans Association, this industry report is intended to provide you with a better understanding of the dental benefits market, illustrate its relationship to the health benefits market and demonstrate the real value of dental benefits. Data from a number of industry and government sources were cited in completing this summary of the industry. You'll find these listed on the back page. dental insurance. 2 In 2005, 25.3 million adults (or about ı2 percent of the adult population) did not receive dental care because they couldn t afford it. 2 Preventative Care for Children Because preventative care is the most effective way to improve oral health, the impact on children can be even more significant. About one-fourth of children 2 ı7 years of age were reported not to have had a dental visit in the past year. 3 Uninsured children are 2.5 times less likely than insured children to receive dental care. 4 Twenty-five percent of low-income children have not visited a dentist before entering kindergarten. 4 One out of every five children under the age of 6 is living below the poverty line (annual income of $20,444 or below for a single family of four). 5 Twelve percent of children age 6 ıı from families with incomes below the federal poverty line had untreated tooth decay, compared with 4 percent of children from families with incomes above the poverty line. 5 Nearly half of all cavities among low-income children go untreated. 6 By age ı7, more than 7 percent of children have lost at least one permanent tooth to decay. 7

3 Percentage of People on Public Water Whose Systems Are Fluoridated 8 Water Fluoridation Dentist Visits As of the most recent survey, 44 of the 50 largest cities in the U.S. have community water fluoridation. That represents approximately 67.3 percent of the population. 5 Yet, one-third of the U.S. population or more than ı00 million Americans still lack access to water that contains enough fluoride to protect their teeth effectively. 4 Weighing the costs against the benefits, the value of making fluoridated water available to everyone becomes clear. The per capita cost of water fluoridation over a person s lifetime equals the cost of a single dental filling. 6 As of 2002, approximately $40 billion had been saved in reduced oral health care expenditures in the U.S. due to water fluoridation. 9 From ı990 to 2002, water fluoridation resulted in dental treatment cost savings of more than $25.7 billion. ı0 For communities with 20,000-plus residents, every dollar invested in community water fluoridation yielded $38 in savings each year from fewer cavities treated. ıı Tooth decay in America has decreased by percent because of fluoridation. ıı Oral health improves when people visit the dentist regularly. Without dental benefits ensuring that dental care is accessible and affordable, dental visits would decrease. In 2003, Americans made about 500 million visits to the dentist, and an estimated $74 billion was spent on dental services. ıı More than 70 percent of individuals with private dental insurance reported seeing a dentist in the past year, while only 50.8 percent of those without benefits did so. ı2 For people who receive periodontal maintenance during regular, biannual visits, there is a large cost savings for up to six years of follow-up for subsequent periodontal surgical procedures compared to people who receive only one periodontal exam per year. ı3 Percentage of Adults (18+ Years) Visiting Dentist in the Past Year 14 < > 3 Delta Dental Delta Dental member companies across the nation continue to be advocates for preventative efforts to improve America's oral health including water fluoridation.

4 Delta Dental 6 Improved Oral Health An oral health study examining ı5 years of Delta Dental claims data on approximately 750,000 of its enrollees demonstrated clear evidence that dental benefits and the increased accessibility to dental care they provide can lead to dramatic improvements in oral health. Americans are keeping their teeth longer. In ı960, Americans over age 65 Realize the power of preventative care. had only an average of seven original teeth. ı8 Today, this group retains an average of 24 original teeth. ı9 A study by Delta Dental shows that 43.8 percent of patients treated in 2002 had nothing more than preventative and diagnostic treatment. ı3 Overall Health During the past decade, there has been increasing evidence documenting the relationship between oral health and systemic disease. Systemic conditions that can be detected by an oral exam and therefore treated earlier include diabetes, HIV/AIDS, osteoporosis, respiratory and vascular diseases, osteoarthritis and rheumatoid arthritis, and many oral cancers. As many as ı20 physical illnesses can be detected, and therefore treated, by an examination of the mouth, throat and neck. ı5 More than 75 percent of oral cancers can be identified either visually or Cost Savings In a time of rising health costs, dental costs have remained moderate. Of the nation s $ı.98 trillion total health expenditures in 2005, only $86.6 billion or approximately 4.4 percent was spent on dental services. 5 In 200ı, dental insurance premiums accounted for around 0.5 percent of employee payroll, about $279 a year per employee. 20 The preventative care, early detection and treatment that dental benefits encourage save the U.S. $4 billion annually. 2ı Every $ı spent on prevention saves $4 in treatment. through palpation in a comprehensive oral exam. ı0 According to the Oral Health Foundation, someone in the U.S., is diagnosed with oral cancer every hour. When detected early, oral cancer has an percent cure rate, compared with only 50 percent if found late. ı6 Productivity Private Insurance Dollar Breakdown 22 Poor oral health increases time away from school and jobs. Pain and suffering due to untreated diseases can lead to problems in eating, speaking and learning. The Surgeon General reports that 5ı million school hours are missed each year because of dental-related illnesses. Among adults, more than ı64 million work hours are lost each year because of dental problems. ı7

5 Enrollment Percentage of U.S. Population with Dental Benefits 1 Nearly ı70 million Americans are covered by some form of dental benefit through an employer-sponsored group plan, other group plan or individual plan. This represents about 57 percent of the population of the United States. ı Not Covered Covered $200 Dental Premiums by Plan Type ( ) 1 See who s providing for America s oral health. Dollars (in Millions) $ı75 $ı50 $ı25 $ı00 $75 $50 $ ı Year of Enrollment Total Benefits Dental HMO Dental PPO Dental 7 Delta Dental By definition, Medicaid was primarily included in the DHMO and Dental enrollment numbers prior to Medicare enrollment was concentrated in DHMO and Discount enrollment numbers prior to 2005.

6 Delta Dental 10 Employers Contributions Plan Contributors by Plan Type 24 Dental benefits have become a necessary part of employee compensation packages and continue to grow at the same pace as the population. About 89 percent of large employers offer some type of dental benefit to their workers. When you take large and small employers into account, however, the percentage of companies offering dental benefits drops to 54 percent. Overall, about 40 percent of the U.S. workforce lacks dental benefits. ı2 While employee-pay-all-benefits make up a significant portion of dental plans, employers still make a majority contribution in plans in which they share costs with the employee. ı Percentage of Large Employers Offering Dental Benefits 12 Percentage of Large & Small Employers Offering Dental Benefits 12 Percent ı0 DPPO DHMO Discount Offer Dental Benefits Do Not Offer Dental Benefits Offer Dental Benefits Do Not Offer Dental Benefits Employee Pay All Employer Pay All or Partial As indicated below, while all sizes of companies are adding dental benefits, about half of new sales are found in the three segments collectively representing companies with ı0 499 enrollees. $700 $600 Dental Cost per Employee per Year 25 Percentage of New Sales 2006 Group Dental Case Size Segmentation 23 Percentage of In-Force Premium Dollars $500 $ to lives to lives lives to lives to 999 lives to 9 lives to 49 lives to 499 lives to 199 lives to lives to lives lives to lives to 9 lives to 49 lives to 999 lives to 199 lives to 499 lives $300 $200 $ı00 ASO Fully Insured DPPO ASO DPPO Fully Insured 2006 Partial Cost of New Dental Coverage Premium per Subscriber DHMO

7 Review the industry trends. Plan Types PPO Trend The market continues to shift away from traditional indemnity/ Discount/Access Plans Although Penetration of Total Dental Benefits to Population by Benefit Type 1 DHMO products and toward PPO products. Much stronger competition is expected in the PPO segment versus the traditional indemnity segment among carriers and for provider network development. CDH Dental carriers continue to monitor consumer-driven health plans and evaluate possible new plan designs that will provide choices for employees while still meeting the fiscal constraints of employer benefit budgets. Voluntary The dental market is expected to experience increased demand for voluntary plans as employers scale back on ancillary lines, such as dental coverage, due to rising health care insurance costs. carriers continue to market discount/ access plans, discount plans are not key focuses for most group dental benefits carriers. Hybrid PPO/Access Plans Hybrid PPO/ access plans that include both discount and insured components will be the primary forms in which access plans will develop in the market. 9% ı7% 39% (based on total population of individuals who have dental benefits) 2% 2% 7% 8% 7% 9% 8% 7% ı5% ı5% ı5% ı5% ı5% ı4% 23% 26% 33% 26% 35% 38% Employer-Paid Mid- and large-size organizations will continue to offer employer-paid dental benefits. Many companies continue to expand their voluntary product offerings to include more plan features (e.g., the option 35% 39% 42% 45% 50% 49% 54% to shift endodontics and periodontics from basic service to major service). Maximum Rollover Plans Companies promoting maximum rollover plans continue to experience strong sales growth of approximately ı5 percent annually, due to the high perceived value of these plan features. A few other carriers indicate that they are considering offering maximum rollover plans in the near future ı DPPO Dental DHMO Discount Dental Direct Reimbursement Public Benefits such as Medicaid and SCHIP represent about 13 percent of the total market. However, for the purpose of trending, we assume that 50 percent of Medicaid and Medicare benefits are similar to DHMO products and 50 percent are similar to indemnity products. Based on this assumption, the DHMO and Dental segments include estimations for publicly funded benefits. 11 Delta Dental

8 Delta Dental 14 Distribution of Covered Lives by Segment 1 5% 5% 0.3% 2.4% 0.8% ı.6% ı0.3% Other Factors Evidence-Based Dentistry Active research continues to examine the effects of oral health on various systemic medical conditions and research 90% 96.6% 97.6% 89.7% conducted by the U.S. Surgeon General indicates there are correlations between periodontal disease and health care costs for certain medical conditions. Consolidation Carriers are pursuing acquisition-based growth strategies intended to diversify their business mix. Technology Key areas of technology support focus on employee and DHMO DPPO Dental Discount Dental provider services regarding billing and payment, claims, enrollment and communication. Dental carriers continue efforts geared toward improving utilization of their online services across all constituencies to enhance customer service, provide greater flexibility and improve their operating efficiency and cost structure. Commercial Funding Sources for Employer-Based Dental Benefits 1 ı3% ı.6% ı0% 37% 48% 67% 49% ı4% 20% 4ı% DHMO DPPO Dental The method for collecting this information has been changed to more accurately reflect the realities of the marketplace. In previous years, the method for collecting this data did not allow for a complete picture of the Shared portion of the funding equation, placing most of that component with the Employer-Paid component.

9 Industry Growth Based on the new lives added annually, total number of lives insured and Group Dental Total In-Force Lives Group Dental In-Force Lives 23 in-force premiums, it s clear that many employers realize the highly costeffective nature, overall value and general importance of dental benefits Market Growth Highlights 23 Industry New Sales Lives ı6.6ı million Change vs Increased ı0.7% People (in millions) ı70 ı65 ı60 ı55 ı50 ı56.43 ı58.22 ı60.57 ı Voluntary 7.2 Voluntary PPO 6.8 DHMO 1.6 Voluntary DHMO 2.5 Access Total In-Force Lives ı64.39 million Change vs Increased 2.4% New Revenue (Direct Premiums + ASO Fees) $2.79 billion Change vs Increased ıı.7% ı45 ı PPO Total In-Force Revenue (Direct Premiums + ASO Fees)... $20.2ı billion Change vs Increased 7.3% Some carriers are unable to specifically break out provider access plan sales, and thus some access plan lives may be included in PPO lives total. Also, some carriers may include business as PPO business and vice versa New Lives 23 Group Dental Total In-Force Premiums Group Dental In-Force Revenue DHMO Voluntary 7.4 Voluntary PPO 1.8 Voluntary DHMO 1.1 Access 59.6 PPO Premium (in billions) $22 $20 $ı8 $ı6 $ı4 ı8.00 ı8.48 ı year CAGR = 4.7% 20.2ı 5.7 DHMO Voluntary 8.0 Voluntary PPO 1.5 Voluntary DHMO 54.5 PPO This chart is based upon the weighted average group dental product segmentation of 11 of the 12 largest carriers in the market. Market size includes direct premiums and ASO fees and excludes premium equivalents. Market premium persistency (2003 to 2004) = 89.13%. This chart is based upon the weighted average group dental product segmentation of 11 of the 12 largest carriers in the market. 15 Delta Dental

10 Delta Dental 18 Rate Stability In a time of rising health costs, dental benefits remain a good value for both employer and employees because dental plan rates continue to display stability and experience high-volume, low-cost claims. 26 Catastrophic claims are rare, and maximums keep high claims under control. Utilization is the primary driver of trend rates. Trend rates represent national averages and include the following components: price inflation, deductible leveraging, utilization, technological advances and cost shifting. Demonstrate the value of dental benefits. Trend Survey of Dental Plan Rate Increases % 8.0% Percent Increase 7.0% 6.0% 5.0% 4.0% 3.0% Fall 200ı Spring 2002 Fall 2002 Spring 2003 Fall 2003 Spring 2004 Fall 2004 Spring 2005 Fall 2005 Spring 2006 Fall 2006 Spring 2007

11 Most Important Attributes Industry Leadership Below are results from the Delta Dental Brand Awareness Study, administered Delta Dental member companies serve more than one-fourth of the nearly by The Long Group in Each stakeholder group was asked to rank ı70 million Americans with dental coverage providing dental benefits to attributes of dental benefits in order of importance. 28 Demonstrating a clear more than 5ı million people in 93,000-plus groups across the nation. understanding of our clients needs, Delta Dental receives consistently high satisfaction ratings in those areas most important to the audiences we serve. Products Because every business is different, we tailor our group dental benefits programs to fit each company s requirements and the needs of its enrollees. Networks Importance of Attributes: Producers 28 Importance of Attributes: Benefit Decision Makers 28 Approximately three out of four dentists in the U.S. are part of the Delta Dental Premier network. The country s most extensive offering of providers, Percentage Responding Very Important Percentage Responding Very Important ı ı Customer Service Best Value Easy to Administer Fast Claims Importance of Attributes: Dentists 28 Importance of Attributes: Consumers 28 Percentage Responding Very Important Percentage Responding Very Important ı ı Best Value Customer Service Fast Claims Easy to Use it includes more than ı20,000 unique dentists. March 2008 Network Comparisons Unique Dentist Summary 29 Network Unique Dentists General Dentists Endodontists Orthodontists Oral Surgeons Pediatric Dentists Periodontists Prosthodontists Delta Dental Premier ı20,838 98,839 3,348 6,ı6ı 5,440 3,757 3,ı67 99ı Delta Dental PPO SM 62,574 47,886 2,429 3,463 4,348 ı,958 2,38ı 427 Guardian 59,842 50,069 ı,320 2,585 3,226 ı,486 ı, MetLife 59,2ı0 48,987 ı,282 3,ı56 2,95ı ı,440 ı, CIGNA 53,060 44,207 ı,ı8ı 2,780 2,73ı ı,327 ı, Aetna 5ı,0ı3 42,037 ı,ı30 2,698 2,680 ı,ı97 ı,305 ı62 United Concordia Advantage 47,507 39,4ı ,ı8ı 2,ı36 ı,300 9ı6 240 Ameritas 43,2ı2 35,24ı 928 2,343 2,4ı2 ı,237 ı,ı Humana 4ı,ıı5 35,ı ı,903 2, DenteMax 36,3ı6 29, ,409 2,ı4ı ı80 United Healthcare Options 35,493 30,ı ,22ı ı, Fast Claims Prompt Payment Customer Service Complex Issue Resolution Easy to Use Best Value Customer Service Quality of Care 19 Delta Dental

12 Savings (in billions of dollars) Savings Delta Dental saved groups nearly $5.9 billion in 2007 through unique cost-control measures and contractual agreements with dentists that ensure dental care at moderate fees. Since ı954, Delta Dental has been working hard to improve oral health in our country by developing relationships that emphasize prevention and positive oral health care results over the long term. We pursue our mission by increasing access to benefits, offering the largest national network of dentists, adding innovative new plan features, aggressively working to keep costs down, and supporting philanthropic programs that encourage better overall oral health. As the first company to specialize in dental benefits, we remain passionate about oral health and its importance to future generations and we strive daily to make dental care more accessible to everybody. ı.5 ı ı Service In 2007, Delta Dental processed nearly 76 million dental claims or an average of more than ı.4 million per week, with an accuracy rate greater than 99 percent.

13 Sources ı. National Association of Dental Plans (NADP)/Delta Dental Plans Association (DDPA) 2007 Dental Benefits Joint Report: Enrollment, August U.S. Census Bureau: Income, Poverty, and Health Insurance Coverage in the United States, National Center for Health Statistics: Health U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, National Center for Health Statistics: Trends in Oral Health Status, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Oral Health: Preventing Cavities, Gum Disease and Mouth and Throat Cancer, National Center for Chronic Disease Prevention and Health Promotion: Oral Health Resources, Fact Sheet: Children s Oral Health, May CDC, Populations Receiving Optimally Fluoridated Public Drinking Water United States, MMWR 2002; 5ı:ı CDC Disc: Dental, Oral and Craniofacial Data Resource Center. Oral Health U.S., ı0. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Fact Sheet: Preventing Dental Cavities, ıı. CDC Oral Health: Preventing Cavities, Gum Disease, and Oral Cancers, ı2. NADP: Fact Sheet on Dental Benefits, March ı3. Delta Dental Plans Association, Dental Data Analysis Center, ı4. Centers for Disease Control and Prevention, National Oral Health Surveillance System. BRFSS, ı5. Steven L. Bricker, Robert P. Langlais and Craig S. Miller, Oral Diagnosis, Oral Medicine and Treatment Planning (Philadelphia: Lea & Febiger, 1994). ı6. Oral Cancer Foundation: oralcancerfoundation.org, January 21, ı7. American Dental Education Association: Journal of Dental Education, June 200ı. ı8. Hope Health Newsletter. ı9. The American Dental Hygienists Association (ADHA): Senior Oral Health, LIMRA International and NADP: U.S. Group Dental Plans, ı. Business Courier, Health insurers open up, say Ah!; to getting in on dental market, November 3, Centers for Medicare and Medicaid Services, IBIS Associates 2006 Annual Group Dental Insurance Market Overview. 24. BenefitNews Adviser, Dental enrollment flattens, discount plans increase membership, November 5, U.S. Group Dental Plans: Third Quarter Review 2006, LIMRA & NADP Joint Report /200ı Mercer/Foster Higgins National Survey of Employer Sponsored Health Plans. 27. Aon Spring Trend Survey, The Long Group, NetMinder, March 2008.