DENTAL WORKS

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DENTAL WORKS!

• The California Association of Dental Plans

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Overview

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

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CADP Mission Statement

• The mission of the California Association of
  Dental Plans is to
• provide leadership in the
• dental benefits industry 
• and to promote quality dental care through
  legislative, regulatory
• and educational advocacy.

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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.

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DENTAL WORKS!Underlying Principles of a
Successful Dental Benefits Program

• ensures QUALITY care
• improves ACCESS to treatment
• keeps coverage AFFORDABLE
• PREVENTS oral disease before treatment becomes
  necessary

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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.

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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.

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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 publics access to
  dental benefits.

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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.

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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

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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

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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

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

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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.

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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.

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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.

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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.
• CADPs Principles of Dental in Healthcare
  Reform were well received, and to date, appear
  to have been respected most of the proposals on
  the table.

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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

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Questions / Discussion