For the past several years, our members have been searching for viable ways to survive recent cuts made by dental insurance carriers. And while measures like improving business efficiencies and expanding practice models have helped some, they have not proven to be a remedy for the loss in revenue. After years of concerted efforts by a small group of dentists and WSDA staff to seek a solution to our needs, a product will be rolled out this year that has the potential to be a major player in the insurance business. Like any fledgling concept, it’s not going to achieve its potential tomorrow (or likely even this year), but we’re excited at the promise of LifeMap’s Dollar-Based Dental (DBD) product. Before we tell you what it is, though, we should probably tell you how it came about.
“It was a dark and stormy night…”
Okay, maybe not. But by some accounts, a darkness has descended on dentistry in Washington state. Because of recent rate cuts, a grassroots effort was born — a few dentists, an insurance broker, and two staffers from WSDA — Executive Director Bracken Killpack and Vice President of Communications Kainoa Trotter— initiated meetings with third-party providers around the state to try and brainstorm solutions to the cuts: they wanted an allowance system that was based on electronic banking, they wanted few controls on either the dentists or the patients, and they wanted a viable product in the dental benefits market. They thought the solution was some form of direct reimbursement (DR) plan, but there were inherent problems with them.
Killpack explains, “It’s not that DR plans can’t work, but there are disadvantages with the plans. From the company’s perspective, one of the advantages to traditional insurance plans is that you simply pay someone else to handle the administration of it. There aren’t many companies willing to take on the admin associated with DR plans. Plus, there was a tremendous disincentive in the marketplace because brokers weren’t paid commissions on DR plans. If a company was thinking of administering their own DR plan, brokers would simply try to dissuade them and steer them back into traditional products. With this LifeMap product we’ve aligned everyone’s incentives. Brokers and agents want to sell them because they get a commission just like they would with a regular dental plan, and the companies buying the product don’t have to do anything different than they would with a traditional plan — they can set the parameters of the plan and be done with it.”
Eventually, the WSDA group met with a regional health care provider on the topic. Killpack recalls a two-hour meeting on health care reform that things really started to gel. “From there we got connected to LifeMap representatives and they were interested in pursuing the idea,” said Killpack.
The LifeMap reps agreed that it was an ideal time to simplify dental insurance options. Their work was cut out for them — all that stood in their way was finalizing what the plan would look like and getting people to understand how it works. “The really fascinating part of this,” said Trotter, “is that many people have never seen such a simple or innovative plan. It’s easy to explain, but it’s not what people expect from a dental plan.” Dr. Chris Pickel, former WSDA Board member and chair of WSDA’s advisory board to LifeMap, is excited by the plan and says, “It has a real chance of succeeding. LifeMap is backed by Cambia Health Solutions and they see an opportunity to be a leader in a new marketplace.” And so it is that nearly four years later, LifeMap is getting ready to roll out the product.
LifeMap: What it is, and what it isn’t
We reached out to LifeMap executive Patricia Yu, Director of Product and Marketing, as well as Andrea Oswald, Marketing Specialist, and Katrina Tuke, Product Manager to find out why LifeMap will appeal to dentists, patients, companies, and even the producers (brokers and agents selling policies to companies) in a way that traditional plans might not. We asked for an honest appraisal of the plan’s potential — and we got it.
A quick review
How are DR, DBD and traditional policies different? First and foremost, it’s not DR, says Oswald, “Dollar-Based Dental benefits are paid to the provider, not the patient, and we administer the plans, not the company.” However, it’s not like traditional insurance, either. LifeMap calls their plan more robust than traditional insurance plans because, “There are not any limitations, and very few exclusions,” explains Tuke, “not dozens like you might see in a typical plan. There are a handful that are required, and then a handful that can be determined by the employer group when they sign up for the plan, but that’s it.” Yu, says, “In traditional insurance plans, the type of treatment being offered drives the percentage paid by the insurance company, but with this dollar-based product, the point that you choose to use the dental dollars determines what is paid. A root canal at a traditional plan will typically cover 50 percent of the cost, but we don’t look at it as a root canal or a cleaning, we allow for the first X amount of dollars to be covered at 100 percent, the next Y amount could be covered at say, 80 percent.”
The dollar amounts and the tiers are determined by the employer when they purchase for their group, and LifeMap doesn’t discriminate based upon the treatment — they simply have a tiered approach to how many dollars are covered as you use them up. Unlike traditional insurance plans, policyholders can determine their own treatment schedules — for instance, getting a root canal without satisfying the yearly cleaning requirement — and in their Open Access plan there are no restrictions regarding dental providers, either. Yu explains, “Traditional insurance policies can throw a lot of roadblocks at patients, but DBD plans do not, for the most part. With the Open Access plan patients can see any provider they want, they don’t have to leave their dentist or try to find one who is covered.”
Employer-chosen exclusions are typically premium-driven —they can exclude implants for a lower premium, for instance. Some aesthetic procedures like teeth bleaching and veneers, orthodontia, and some other cosmetic procedures are excluded, but ortho can easily be added back in as a rider. “We excluded ortho from the base policy to keep the funds separate –money for preventive or restorative separate from money for ortho,” says Tuke. Other exclusions could include third party liability treatment if patient is injured on the job, as this would be covered by worker’s comp. There’s a downside too, for keeping something like implants in the mix, Tuke explains, “In general, premiums increase as more of their employees use up more of their dental dollars. We’re betting on a particular utilization rate, and traditional dental has a way of controlling that with percentages on levels of treatment limitations— one crown every seven years, for instance. This type of plan doesn’t have that, so there’s a higher likelihood that people will use up all their dollars, and that generally requires a higher premium.”
And, as Yu explains, the beauty of LifeMap’s product is its simplicity and its flexibility. “When you have a traditional plan, typically the annual max is $1,500 or $2,000, but we can easily make the annual max $5,000 and then vary the tier structure to determine how they reach it. But the patient isn’t limited to just that 50 percent for the root canal service, it just depends on the plan their employer has chosen. It’s flexible for the employer, too, because they can change and customize the plans in so many different ways. If they just want to pay 100 percent up to a maximum of $2,500 they can do that, but alternatively they could choose to pay just the first $100 at 100 percent and then have four tiers with the final tier paying just 50 percent of the last $1,000.” With exclusion, maximum, tier and network flexibility, there are myriad ways to configure the product. Yu also said that larger companies could conceivably offer several different tier options to their employees if they wanted, allowing for even more flexibility. Big company or small, deep pockets or tight budget, LifeMap’s DBD plan offers an alternative way to think about dental.
Getting the word out
As the LifeMap team tells it, producers (brokers and agents working in the field) love products like LifeMap’s DBD plan. Yu explains, “Brokers want new things to talk about with their policyholders when they go in, because they tend to have the same policies. This gives them a reason to go and sit in front of a group, remind them who their broker is.”
Their goal is to train all of their sales teams in Washington, Oregon, Idaho and Utah in February so that they can start talking to their clients in March. DBD is not an apples-to-apples comparison with traditional dental, so it will require conversations between LifeMap staff and producers to understand the real benefits the plan offers. Ultimately, the employer group will determine what plan structure works best for their employees and their budget. “If there is a group that is super excited about it we will be able to enroll them as early as April 1,” says Yu, “but that may not be realistic.” Oswald concurs, adding, “It’s a different product so it’s going to take some time for adoption. We don’t have any particular sales goals out there — we need to get the product out and get some experience and feedback about it. We would be thrilled to have at least a handful of employers adopt and use the product so that we can hear from them, the providers, and the patients to gauge the overall experience.” Their goal is to take the insurance company out of the mix as much as possible, give patients the responsibility to manage their dental dollars, and imbue the providers with a sensitivity about how their treatment plans will go through available dollars in a DBD plan.
LifeMap wants to make sure that WSDA members understand how the plan works, and that the plan works well for both dentists and patients. Even though the concept is extraordinarily flexible in comparison to traditional plans, it has controls in place — it’s not a free-for-all, or free dental dollars. WSDA will also assist in the process by getting the word out to members and supporting it in our publications and on our websites — and we’ll also encourage our members to have meaningful conversations with patients who may have expertise or influence in the workplace.
Yu says, “We’d love it if your members would talk with their patients about the benefits of the plan, but chairside conversations might not be reasonable. It’s an unconventional channel for us, partnering with a provider population. Most of our relationships are with brokers and agents. This is a ground floor approach –generating demand for the product and going back upstream to the brokers. But if providers are seeing patients who are having problems with their insurance, that might open the door for a conversation about this product, especially if those patients are HR or employee benefits personnel, or brokers themselves - I’m sure they get their teeth cleaned too.” Pickel agrees, saying, “Find out as much as you can about this product. Use the resources available through the WSDA on the Source and find out if you have patients or friends that are decision makers in businesses —like HR directors, CFO’s, presidents, etc. Give them the contact information we will provide so that we can guide LifeMap brokers to them to answer their questions. We sometimes forget how much our patients value our opinion when it comes to their benefits. They want you to be able to provide the best for them.”
The Wellero connection — making the policy mobile
A conversation about LifeMap wouldn’t be complete without including Wellero, the app that works in tandem with a number of insurance products, including LifeMap. Yu says, “Wellero and LifeMap together are a nice marketing message in Washington because the people here are so tech savvy. It’s synergistic in that it’s an innovative point of sale or payment option for Wellero, and we’re rolling it out with this interesting, innovative dental product as well. It works that we’re entering this new space together.” We wanted to find out more about this synergy, so we talked with Hanny Freiwat, Wellero CEO to see just what this app would do, and found that it allows patients to find a dentist, view their benefits and pay their responsibility for services. Patients with the free Wellero app can view their real-time benefit details at check-in, so they know up front what their financial obligation will be. At the end of the visit, payments for services can be paid with a stored debit, credit or HSA card right from the app. Patients also have the ability to pay their bill from the app if there an outstanding balance.
For dentists, Wellero offers a free mobile app presence for their practice to make it easier for existing patients to interact with them, and for new patients to find them. The platform also supports patient payment from mobile or from Wellero’s POS portal. The benefit to the patient is the ability to pay via mobile and view their benefits in real-time. Payments made through the Wellero app are logged, so patients can quickly see their payment history in one place even if they change insurance companies. For the provider, Wellero collects patient payments at the time of service through its POS system, or when a patient uses their Wellero mobile app. Payments made through Wellero are typically deposited via EFT within 48 hours. This should reduce dentist’s operational costs by reducing phone calls and the number of bills mailed, while creating a high satisfaction rate by patients. And, Wellero is essentially a free mobile app with your logo, messaging, and practice details.
Go to wsdasource.org for information regarding LifeMap and Wellero, and to the Wellero site to get your practice started. LifeMap plans to produce leave-behinds for dentists to have out in their waiting rooms to help educate consumers, and WSDA leadership plans a series of meetings across the state with component societies to map out the ways in which dentists can help the process along. And, while we’re all cognizant that these products may take a while to catch on, they’re exciting, innovative and should give WSDA members the hope for an environment with more options than just. Pickel says, “Both products have enormous appeal — with LifeMap’s Dollar-Based Dental and Open Access plan, they can choose any dentist they want as there is no network. With limited exclusions, they can tailor their care to their individual needs and their budget. The Wellero app will give them many tools at their fingertips like helping them find providers and real time eligibility and benefits remaining to help them with their decisions. It returns the conversation about their care back to them and their provider”
SIDEBAR: Exploring Wellero — How does it work?
The dentist practice creates a profile in the Wellero point-of-sale (POS) portal. Then, the practice staff asks patients to download the free Wellero app, available for iOS and Android smartphones, when they schedule an appointment, check-in, or on a bill. Once a patient enters their dollar-based dental member information, the app syncs and displays the latest version of their benefits.
The patient can also store their HSA, debit or credit card for payment directly from the PCI-compliant app. At the end of a visit, ask the patient if they would like to pay with their Wellero app or you can also accept payment through the Wellero POS terminal, where you enter in or swipe a credit card. Or, they can pay their bill when they get it using the mobile app. Once a payment is complete, you will receive an email notification and all payments can be viewed and exported from the Wellero POS system.