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News from the week of November 28, 2022

• DENTAL INSURANCE REFORM LANDSLIDE IN MASS. SPURS ADA TO TAKE THE ISSUE NATIONAL (Insurance Newsnet) – The recent overwhelming passage of an ADA-backed measure in Massachusetts, which will create a medical loss ratio framework for dental insurance, is spurring the organization to take the issue national.


• MEDICAID DIRECTORS: UNCERTAINTY ABOUT PUBLIC HEALTH EMERGENCY 'NO LONGER TENABLE' (Healthcare Innovation Group) – The National Association of Medicaid Directors is asking Congress for greater certainty and an extended notice period on the end of the Public Health Emergency. The uncertainty is impacting budget planning and other issues.


• A GROWING FOCUS ON EQUITABLE ORAL CARE FOR PEOPLE WITH DISABILITIES (Penn Today) – Penn’s School of Dental Medicine’s Care Center for Persons with Disabilities is focused on improving access to dental care for people with disabilities through training students and dentists to improve care.


• STUDY SHEDS NEW LIGHT ON THE LINK BETWEEN ORAL BACTERIA AND DISEASES (Medical Xpress) – A new Swedish study has identified the bacteria often found in severe oral infections, which could have implications for treating diseases often linked to poor oral healh.


• ACA SIGN-UPS TOP 3M SINCE START OF OPEN ENROLLMENT, A 17% BUMP COMPARED TO LAST YEAR (Fierce Healthcare) – ACA signups since the beginning of November are up 17% over last year. An extension of enhanced subsidies as well as increased marketing of healthcare.gov may be impacting registrations.


• KLAS: STATE OF VALUE-BASED CARE REIMBURSEMENT IN 2022 TRENDS (HIT Consultant) – KLAS recently released their Value-Based Care Reimbursement 2022 report to reveal key themes and trends among healthcare executives.

News from the week of November 14, 2022

• MEDICARE ADVANTAGE 2023 SPOTLIGHT: FIRST LOOK and EXTRA BENEFITS OFFERED BY MEDICARE ADVANTAGE FIRMS VARY (KFF) –KFF is out with a pair of reports providing an overview of Medicare Advantage plans available for 2023 and key trends they are seeing. A second report also details extra benefits plans are offering that are not included in traditional Medicare, including vision (eyeglasses and/or eye exams), hearing (exams and/or aids), fitness, and dental services.


• WHAT RECENT STATE ELECTIONS MEAN FOR HEALTHCARE (Health Affairs) – Health Affairs provides a post-election look at changes in health policy at the state level including Medicaid and health care costs.


• NADP WARNS OF UNEXPECTED CONSEQUENCES OF MASS. INSURANCE LAW (Dr. Bicuspid) – The National Association of Dental Plans (NADP) warns that a new dental loss ratio law in Massachusetts could lead to increases in premiums and fewer dental plan options.


• ADA SUPPORTS ELIMINATING WAITING, LOCKOUT PERIODS FOR DENTAL CARE IN CHIP (ADA News) – The ADA provided recommendations to CMS for simplifying Medicaid/CHIP enrollment and eligibility checks, including eliminating waiting and lock-out periods for dental care and increasing reimbursement and reducing administrative processes in credentialing, audit and clean claims payment within 15 days.


• CMS ESTABLISHES NEW PAYMENT CODE FOR DENTAL SURGERIES PERFORMED IN HOSPITAL ORs (ADA News) – CMS will establish a new dental billing and payment arrangement to improve access for dental surgeries performed in hospital operating rooms.


• HHS TO MAINTAIN COVID-19 PUBLIC HEALTH EMERGENCY PAST JANUARY (Becker's Payer Issues) – The current public health emergency will be extended again through at least mid-April, giving states additional time to prepare for impacts to their Medicaid rolls.


• TELEDENTISTRY TRENDS IN THE UNITED STATES DURING THE COVID-19 PANDEMIC (Center for Health Workforce Studies) – A new study from the Oral Health Workforce Research Center looks at teledentistry trends in four states.

News from the week of NOvember 7, 2022

• SOUTH DAKOTA VOTERS APPROVED MEDICAID EXPANSION, BUT IMPLEMENTATION MAY NOT BE EASY (Kaiser Health News) – South Dakotans passed a ballot initiative to expand Medicaid, although they may see a slow, rocky rollout much like Missouri’s due to opposition from the Governor and legislature.


• MASS. VOTERS APPROVE BALLOT QUESTION TO FORCE DENTAL INSURERS TO ADOPT NEW SPENDING RULES (WBUR) – Massachusetts voters approved the first-in-the-nation dental medical loss ratio measure. Beginning in 2024, dental insurers will be required to spend at least 83% of customer premiums on patient care and initiatives aimed at improving the quality of care, rather than business expenses like overhead, marketing and executive salaries. 


• ADA HPI MONTHLY ECONOMIC OUTLOOK SURVEY (ADA HPI) – HPI’s monthly survey reports that dental practice schedules have been steady for the past six months, dropping slightly to 83% full in October due to patient no-shows, cancellations and low patient demand.


• STOPPING THE CHURN: CALIFORNIA AND OTHER STATES WANT TO GUARANTEE MEDICAID FOR CHILDREN (Santa Cruz Sentinel) – California and a few other states are exploring changing Medicaid enrollment rules to allow children who qualify for Medicaid and enroll at birth to stay enrolled until at least age 5. States are hoping to prevent gaps in coverage and cut back on bureaucratic paperwork.


• CONSUMERS NEED BETTER COMMUNICATION FROM THEIR HEALTH PLANS, SURVEY SHOWS (MedCity News) – A recent survey reveals confusion among consumers regarding their health plan communications.


• PANDEMIC SIDE EFFECT: 22% OF AMERICANS GOT BETTER HEALTH INSURANCE (Medical Economics) – While the number of insured has risen, high cost of care is still a barrier which prompts many to opt out of treatment.


• HALF OF DENTISTS SAY PATIENTS HIGH AT DENTAL APPOINTMENTS (Medical Xpress) – Dentists report limiting treatment to patients who were high due to the impact marijuana and anesthesia have on the central nervous system. The ADA has called for additional research around marijuana and oral health and will continue to monitor the science to provide clinical recommendations for dentists and patients.

News from the week of October 31, 2022

• SKYGEN PREDICTS: VIRTUAL OPTIONS, NEW OPPORTUNITIES & MORE IN 2023 (Fierce Healthcare) – Read all about SKYGEN’s predictions for the specialty benefits sector in 2023 and beyond.
   
• MEDICARE FINALIZES PAYING FOR SELECT DENTAL SERVICES IN 2023 (Dr. Bicuspid) – CMS released their 2023 Physician Fee Schedule final rule, which clarifies the expansion of dental services that were announced in recent months, including expanded payment for dental services that are essential to a beneficiary's primary medical condition.
   
• NEW CONSUMER RESEARCH UNDERSCORES SELF-SERVICE DIGITAL PATIENT ACCESS AS ESSENTIAL FOR HEALTHCARE ORGANIZATIONS (Kyruus) – A new survey of consumer preferences for accessing healthcare finds a preference for digital channels when seeking information about new providers, booking appointments and handling pre-appointment tasks. Results also showed that convenience, quality and cost weighed heavily on healthcare choices.
   
• CMS RULE SEEKS TO CURB DELAYS IN MEDICARE COVERAGE, EXPANDS SPECIAL ENROLLMENT PERIODS (Fierce Healthcare) – CMS is also directing that Medicare coverage begins the month after enrollment and expanding special enrollment periods, including for those whose Medicaid coverage is terminated after the COVID-19 public health emergency expires.
   
• 2022 EMPLOYER HEALTH BENEFITS SURVEY (KFF) – KFF’s annual survey of trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs and employer practices.
   
• 3 TRENDS TO WATCH AS ACA OPEN ENROLLMENT BEGINS (Fierce Healthcare) – Enrollment on the ACA exchanges grew to 14.5 million during 2021 due to enhanced subsidies and extended special enrollment periods. Some things to watch as open enrollment begins are rising premiums for unsubsidized plans, lower costs and a streamlined enrollment for people previously impacted by the family glitch and expanded offerings from payers.
   
• TWO NEW KFF ANALYSES SHOW THAT A RELATIVELY SMALL SHARE OF MEDICARE BENEFICIARIES COMPARED PLAN OPTIONS OR SWITCHED PLANS DURING A RECENT OPEN ENROLLMENT PERIOD (KFF) – KFF reports that only three in 10 Medicare beneficiaries shop around and only one in 10 switch plans during open enrollment, which could end up impacting their coverage and costs.
   
• STUDY: RACIAL, ETHNIC MINORITIES EXPERIENCED MORE BARRIERS TO HEALTHCARE OVER A NEARLY 20-YEAR SPAN (Fierce Healthcare) – A Yale research study examined data from 1999 to 2018 and found that barriers to health access increased over time with racial and ethnic minorities seeing the greatest disparities.

News from the week of October 24, 2022

• KFF: MEDICAID ENROLLMENT GROWTH SLOWED IN 2022 AS STATES BRACE FOR DROP AFTER COVID-19 EMERGENCY ENDS (Fierce Healthcare) – KFF, NAMD and Health Management Associates are out with the annual state Medicaid budget survey. As states anticipate the end of PHE, their priorities include addressing health inequities, workforce challenges, a focus on payment, delivery and IT system improvements.


• EXPANDING MEDICAID IS POPULAR. THAT'S WHY IT'S A KEY ISSUE IN SOME STATEWIDE MIDTERMS (NPR) – Medicaid expansion is an important issue in several states' midterm elections, including South Dakota where voters will be able to voice their preferences in a ballot initiative. In states like Georgia and Texas, a lack of Medicaid expansion has provided a way to attack incumbent governors.


• STATE OF THE AMERICAN WORKER: 38% LACK MEDICAID INSURANCE; MORE LACK DENTAL AND VISION CARE (BenefitsPro) – Insurance coverage is nowhere near universal among American businesses. A survey of employees revealed that 49% had no dental or vision insurance through their employer.


• ANOTHER BILLION REASONS FOR A MEDICARE DENTAL BENEFIT (CareQuest Institute) – CareQuest is out with a study showing potential savings in the billions of dollars per year in care for patients with diabetes and heart disease if a comprehensive dental benefit were added to Medicare.


• THE 2022 STATE OF AMERICA'S ORAL HEALTH AND WELLNESS REPORT (DDPA) – The Delta Dental Plan Associations' annual survey looks at the public’s oral health practices, gaps in understanding links to overall health and attitudes regarding dental insurance.  


• KENTUCKY GOV. ANDY BESHEAR TO EXPAND MEDICAID COVERAGE TO DENTAL, VISION AND HEARING CARE (Courier Journal) – 900,000 adults in Kentucky will gain access to dental, vision and hearing care through their Medicaid coverage beginning January 1, 2023. The Governor touted the program as a way to increase workforce participation in the state.  


• ADA, ADSO SIGNAL COLLABORATION FOR DENTISTRY'S FUTURE (Dr. Bicuspid) – ADA and ADSO leaders recently presented their thoughts on areas for collaboration between the two groups, including managing changes in technology, patient expectations and workforce shortages.


• MEDICAL VS. DENTAL CARE SPENDING: 9 STATS TO KNOW (Becker's Dental) – Becker’s compiled data on medical and dental spending in 2020 and found that the U.S. spent $142.4 billion on dental care in 2020, a 1.8% decrease from 2019.


• HOW TECHNOLOGY CAN FIX PRIOR AUTHORIZATION CHALLENGES FOR PAYERS (Fierce Healthcare) – A recent article illustrates how technology can help solve some of the issues payers face with prior authorizations. In particular, they noted how digital workflows can help improve communication between providers and payers.


• ARE PRIMARY CARE PROVIDERS ADDRESSING KIDS' DENTAL HEALTH? (Dr. Bicuspid) – A recent study looked at how often primary care physicians self-report oral health evaluations versus the codes they list for visits and found discrepancies.

News from the week of October 10, 2022

• WASTEFUL ADMINISTRATIVE SPENDING COSTS U.S. HEALTHCARE UP TO $570B A YEAR, RESEARCH FINDS (Fierce Healthcare) – A review of recent research shows that the U.S. spends more on healthcare administration than comparable countries, and between $285B to $570B of that spending does not “contribute to health outcomes”.


• EMPLOYERS FACE TRICKY BENEFITS YEAR AMID INFLATION, TIGHT LABOR MARKET (Axios) and SURVEY: EMPLOYERS REIN IN HEALTH BENEFITS FOR PRE-MEDICARE AND MEDICARE-ELIGIBLE RETIREES (Fierce Healthcare) – High inflation and a tight job market is pushing employers to adopt digital tools and shift to a greater focus on preventive and primary care and to look for more cost-effective ways to offer retiree health benefits.


• MEDICARE ADVANTAGE AT THE TIPPING POINT: A PREVIEW OF 2023 OPEN ENROLLMENT (Fierce Healthcare) – As Medicare Advantage plans begin open enrollment, they face new challenges including declines in star ratings, closer federal scrutiny of risk adjustment practices, and an increasingly concentrated market.


• 'THE CASH MONSTER WAS INSATIABLE': HOW INSURERS EXPLOITED MEDICARE FOR BILLIONS (New York Times) – An article critical of the growth of Medicare Advantage points at high costs and accusations of fraud.


• MASS. BALLOT INITIATIVE MAY REPRESENT START OF NATIONWIDE DENTAL INSURANCE REFORM (Insurance NewsNet) – Advocates say that a Massachusetts ballot initiative that would require dental insurers to spend at least 83% of premium dollars on patient care could spur nationwide changes in dental insurance.


• HOW MN MEDICAID USED COMMUNITY ENGAGEMENT TO ADDRESS HEALTH DISPARITIES (HealthPayerIntelligence) – Minnesota’s Medicaid program recently received an innovation award for its’ program to increase community engagement to help address access to care and other disparities.


• TOOTH LOSS INCREASES RISK OF DEATH IN OLDER ADULTS (Dr. Bicsupid) – A recent study looks at tooth loss as a risk factor for increased death in older adults, possibly due to malnutrition.

News from the week of OCTOBER 3, 2022

• STATE OF THE DENTAL ECONOMY: Q3 2022 UPDATE (ADA HPI) – The ADA’s HPI presented their latest webinar on trends in the dental economy with a panel that included the CEOs of Pacific Dental Services and Overjet. Key takeaways included data on staffing shortages and lower profitability due to static reimbursements with increasing operating costs. 


• DENTAL WORKFORCE SHORTAGES: DATA TO NAVIGATE TODAY'S LABOR MARKET (ADA HPI) – The ADA and ADHA take a deeper dive into the dental sector’s ongoing challenges in recruiting and retaining dental hygienists and assistants. While the majority are satisfied with their current situation, about 1/3 expect to retire in the next five years.


• 2 DENTAL GROUPS JOIN BIDEN ADMINISTRATION'S NUTRITION, HUNGER INITIATIVE: 6 THINGS TO KNOW (Becker's Dental) – Two dental organizations added their support to the Biden Administration’s nutrition and hunger initiative through their focus on improving dentists' nutrition education.


• ADA, DENTAL QUALITY ALLIANCE APPLAUD CMS PROPOSED RULE FOR MEDICAID, CHIP: 6 NOTES (Becker's Dental) – The ADA and Dental Quality Alliance are highlighting CMS’s inclusion of three oral health measures in the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP.


• PROFESSIONALL ACTIVE DENTISTS BY SPECIALTY FIELD (KFF) – KFF has released data from 2021 on numbers of dentists in each state, broken down into specialties. They find just over 200,000 dentists that are actively practicing in the United States.


• CONSUMER CONCERNED ABOUT RISING HEALTHCARE COSTS AS OPEN ENROLLMENT PERIOD DRAWS NEAR (Fierce Healthcare) – A recent survey shows consumers are concerned about whether their health plan will cover the health care services that they need and whether they will be able to afford to pay for the cost of insurance.


• JAMA STUDY FINDS THAT MEDICAL DEBT A PREDICTOR OF HOUSING AND FOOD INSECURITY (Fierce Healthcare) – A new study has found a link between patients' medical debt and a higher risk of experiencing housing and food insecurity. Risk factors for medical debt included “hospitalization, disability and having private high-deductible, Medicare Advantage or no coverage were risk factors associated with medical indebtedness. Residing in a Medicaid expansion state was found to be protective.”


• NEW ANALYSIS HIGHLIGHTS THE NEED TO PRIORITIZE ADDRESSING PREVENTABLE VISION LOSS IN CHILDREN IN AMERICA (News Medical) – Researchers using data from the IRIS registry have looked at the types of childhood vision loss in the U.S. and documented how treatment delays have contributed to cases of blindness in children that were preventable. 

News from the week of September 26, 2022

• ADA PUTS MONEY WERE ITS MOUTH IS ON INSURANCE REFORM (Dr. Bicuspid) – The ADA is investing $5 million on a medical loss ratio (MLR) ballot initiative in Massachusetts, which would require dental insurers to operate at least an 83% MLR, signaling a new priority on insurance reform for the association.


• PREGNANT, POSTPARTUM MEDICAID ENROLLESS TO HAVE DENTAL COVERAGE AT LEAST 60 DAYS AFTER PREGNANCY (ADA) – CMS has announced that beginning October 1st, postpartum Medicaid dental coverage will be extended to at least 60 days nationwide.


• THOUSANDS MORE MAINERS NOW HAVE ACCESS TO DENTAL CARE, BUT CAN'T FIND A DENTIST (Yahoo News) – Now that Maine has expanded Medicaid, patients are experiencing difficulties accessing dental care due to a lack of available dentists.


• ACADEMICS MAKE STRONGER CONNECTIONS BETWEEN GUM DISEASE AND ALZHEIMER'S DISEASE (Medical Xpress) – Two new studies strengthen our understanding of the links between oral health and Alzheimer’s disease.


• NORTH CAROLINA: MEDICAID LEADER, MEDICAID LAGGARD (Managed Healthcare Executive) – North Carolina has a history of delivering innovative Medicaid programs. However, the state remains a holdout on expanding Medicaid to roughly 1.1 million Medicaid-eligible adult residents.


• THE GATHERING STORM: AN OPPORTUNITY TO REORDER THE HEALTHCARE INDUSTRY (McKinsey) – McKinsey is out with a new report urging payers to cut costs for care and administration, among other measures, so that they will be able to weather cost increases and other market challenges.


• HOW EMERGING TECHNOLOGIES WILL ENABLE THE FUTURE OF CONSUMER DIGITAL EXPERIENCES (Forbes) – Forrester outlines future trends in consumer digital experiences and the technology that will help companies differentiate. 


• 5 WAYS APPS CAN TRANSFORM THE PATIENT EXPERIENCE (Dental Economics) – Craig Kasten, SKYGEN’s Founder and Chairman, has published an article on how mobile apps can transform the experience for dental patients. 

News from the week of September 19, 2022

• ADA PUTS MONEY WHERE ITS MOUTH IS ON INSURANCE REFORM (Dr. Bicuspid) – The ADA is investing $5 million on a medical loss ratio (MLR) ballot initiative in Massachusetts, which would require dental insurers to operate at least at an 83% MLR, signaling a new priority on insurance reform for the association.


• HEALTHCARE INDUSTRY'S RESILIENCY TO SURGING INFLATION IS POISED TO EBB (Healthcare Dive) – Healthcare providers are already feeling the impact of inflation on supplies and labor costs, and payers are anticipating higher reimbursement rates and are also increasing premiums, which may end up decreasing healthcare utilization in the coming years.


• U.S. EMPLOYERS BRACE FOR HEALTHCARE COSTS TO RISE IN NEXT 3 YEARS (Fierce Healthcare) – A Willis Towers Watson survey reports that over half of employers say their healthcare costs will be over budget in 2023, with an average 6% cost increase. A majority of employers are expecting increases to continue over the next three years.


• BENEFICIARY EXPERIENCE, AFFORDABILITY, UTILIZATION, AND QUALITY IN MEDICARE ADVANTAGE AND TRADITIONAL MEDICARE: A REVIEW OF THE LITERATURE (KFF) – A KFF review of Medicare and Medicare advantage studies since 2016 show limited differences between the programs relating to member satisfaction and access to care.


• ERIC ROBERTS ON DUAL ELIGIBLES COVERAGE (Health Affairs) – Podcast and transcript discussing research comparing the experience of dual eligible members (D-SNPs) with those in Medicare Advantage and traditional Medicare. These studies find opportunities to improve integration but policy changes may be the most effective approach for improving care.


• 4 TRENDS SHOWING PEOPLE ARE HEADING BACK TO THE DENTIST (Warwick Online) – A report from Zocdoc finds several trends. While preventive care visits are back, more patients are dealing with deferred care and stress-related conditions. Cosmetic treatments are also on the rise.


• DENTISTS WHO PARTICIPATE IN MEDICAID: WHO THEY ARE, WHERE THEY LOCATE, HOW THEY PRACTICE (ADA HPI) – The webinar recording is now available for last week’s ADA HPI study on dentists are serving Medicaid/CHIP patients. Watch the recording on demand; view the participation webinar slides; read the research report Medical Care Research and Review. 

News from the week of September 12, 2022

• DENTISTS WHO PARTICIPATE IN MEDICAID: WHO THEY ARE, WHERE THEY LOCATE, HOW THEY PRACTICE (ADA HPI) – A recent study and webinar by the ADA’s HPI delves deeply into which dentists are serving Medicaid/CHIP patients and finds links between race, practice size and location in determining Medicaid dental patient numbers per dentist.


• BIGGER MEDICAID PAYMENTS TIED TO BETTER KIDS' HEALTH (Dr. Bicuspid) – A recent study associates increases in Medicaid dental reimbursement ratios to improvements in children’s oral health as well as potential reductions in school absences.


• MEDICAID ENROLLMENT UP NEARLY 25% SINCE COVID-19 PANDEMIC STARTED, ANALYSIS FINDS (Becker's Payer) – A recent KFF analysis shows that since the start of the pandemic Medicaid/CHIP enrollment has risen nearly 25%. Enrollment levels have slowed in recent months but continue to inch upwards and the increases are much smaller for CHIP than adult Medicaid.


• 6 STATES EARN HONORS FOR INNOVATIVE MEDICAID PROGRAMS (Health Leaders Media) – Six states have been recognized for innovation in Medicaid through programs designed to reduce barriers to access to healthcare. Programs included innovations in enrollment, maternal health, foster care health care access, SDOH and more. 


• HHS EXPECTED TO RENEW COVID-19 PHE FOR 11TH TIME (Becker's) – HHS is set to renew the COVID-19 Public Health Emergency through at least mid-January, giving states additional time to prepare for the end of the PHE which will trigger state Medicaid disenrollment processes.


• STUDY: LESS IS SPENT ON LOW-VALUE CARE IN MA THAN IN TRADITIONAL MEDICARE (Fierce Healthcare) – A study showed Medicare Advantage beneficiaries received 9.2% fewer “low-value services” such as tests, treatments and procedures that only marginally improve outcomes or don’t improve them at all, compared to those enrolled in traditional Medicare. The authors suggest that greater plan design flexibility in MA provides opportunities to “optimize network design, product design, utilization management, value-based payment, and other elements of insurance design to reduce the prevalence of low-value care”.


• DENTAL SALARIES DOWN 7.5%: 7 EMPLOYMENT STATS FOR DENTISTS TO KNOW IN 2022 (Becker's Dental) – Dentist salaries hit a five-year low in 2021. Wisconsin, Hawaii and Iowa are among the top states for dental salaries.


• DENTAL GROUPS DEVELOPING LEGISLATION TO INCREASE LICENSURE PORTABILITY: 6 NOTES (Becker's Dental) – A coalition of groups has drafted legislation to make it easier for dentists and hygienists to relocate to other states by making licensure more portable.


• VERILY CLINCHES $1B FROM PARENT COMPANY ALPHABET, SHAKES UP LEADERSHIP TEAM (Fierce Healthcare) – Alphabet’s precision health business, Verily, received $1B to fund core initiatives including healthcare data platform research and development.