““DENTAL WORKS!”DENTAL WORKS!”

The California Association of Dental PlansThe California Association of Dental Plans

OverviewOverview

CADP mission and fast factsCADP mission and fast facts

How CADP helps dental workHow CADP helps dental work

Current legislative and regulatory issuesCurrent legislative and regulatory issues

CADP Mission StatementCADP Mission Statement

The mission of the California Association of Dental Plans is to:The mission of the California Association of Dental Plans is to:

“…“…provide leadershipprovide leadership in the in the

dental benefits industry dental benefits industry 

and toand to promote quality dental promote quality dental care through legislative, care through legislative,

regulatory regulatory

and educational advocacy.”and educational advocacy.”

CADP Fast FactsCADP Fast Facts

CADP represents 27 dental plans covering more than 20 CADP represents 27 dental plans covering more than 20 million Californians.million Californians.

CADP is working to increase access to affordable, quality CADP is working to increase access to affordable, quality dental care for all Californians.dental care for all Californians.

CADP advocates sound public policy to improve oral health.CADP advocates sound public policy to improve oral health.

DENTAL WORKS!DENTAL WORKS!Underlying Principles of a Successful Underlying Principles of a Successful

Dental Benefits ProgramDental Benefits Program

ensures ensures QUALITYQUALITY carecare

improves improves ACCESSACCESS to treatment to treatment

keeps coverage keeps coverage AFFORDABLEAFFORDABLE

PREVENTSPREVENTS oral disease before treatment becomes oral disease before treatment becomes

necessarynecessary

QUALITYQUALITYUnderlying Principles of a Successful Underlying Principles of a Successful

Dental Benefits ProgramDental Benefits Program

CADP member plans adhere to high standards of care and CADP member plans adhere to high standards of care and operation, sharing data and information to help member operation, sharing data and information to help member plans implement their state-mandated quality assessment plans implement their state-mandated quality assessment programs.programs.

Member plans undergo rigorous, quality of care audits and Member plans undergo rigorous, quality of care audits and administrative and financial review by the Department of administrative and financial review by the Department of Managed Health Care.Managed Health Care.

More on QualityMore on Quality

With input from organized dentistry, CADP developed a quality With input from organized dentistry, CADP developed a quality assurance assessment that feeds into a shared data warehouse. assurance assessment that feeds into a shared data warehouse. Together, these tools standardize the conduct of onsite dental Together, these tools standardize the conduct of onsite dental office visits, and allows data to be shared among all CADP office visits, and allows data to be shared among all CADP members, thereby minimizing dental office disruption.members, thereby minimizing dental office disruption.

CADP certifies plan auditors who screen and review dental offices for CADP certifies plan auditors who screen and review dental offices for compliance with quality standards, and calibrate their use of the quality compliance with quality standards, and calibrate their use of the quality assurance assessment for consistency.assurance assessment for consistency.

CADP works to educate California dentists on how onsite office visits CADP works to educate California dentists on how onsite office visits are conducted and what to expect in the process.are conducted and what to expect in the process.

ACCESSACCESSUnderlying Principles of a Successful Underlying Principles of a Successful

Dental Benefits ProgramDental Benefits Program

Access to dental coverage is the greatest factor in Access to dental coverage is the greatest factor in determining whether a person sees a dentist.determining whether a person sees a dentist.

Dental HMO and PPO programs offer consumers Dental HMO and PPO programs offer consumers alternative, cost-effective means of coverage.alternative, cost-effective means of coverage.

CADP promotes legislative and regulatory solutions that CADP promotes legislative and regulatory solutions that increase the public’s access to dental benefits.increase the public’s access to dental benefits.

AFFORDABILITYAFFORDABILITYUnderlying Principles of a Successful Underlying Principles of a Successful

Dental Benefits ProgramDental Benefits Program

Dental premiums average less than 10 percent of the cost Dental premiums average less than 10 percent of the cost of medical coverage, and even less for dental HMO and of medical coverage, and even less for dental HMO and PPO programs.PPO programs.

Dental premiums increase at a far more steady and Dental premiums increase at a far more steady and sustainable rate than medical premiums have for the last sustainable rate than medical premiums have for the last several years (5-8%).several years (5-8%).

As more people obtain dental coverage, the need for major As more people obtain dental coverage, the need for major restorative care declines.restorative care declines.

PREVENTIONPREVENTIONUnderlying Principles of a Successful Underlying Principles of a Successful

Dental Benefits ProgramDental Benefits Program Dental health is an integral part of overall healthDental health is an integral part of overall health

Dental disease is linked to the risk of oral cancer, pre-term Dental disease is linked to the risk of oral cancer, pre-term births, diabetes and other medically significant ailmentsbirths, diabetes and other medically significant ailments

Tooth decay and other forms of dental disease are 100 Tooth decay and other forms of dental disease are 100 percent preventablepercent preventable

Most dental benefit programs encourage and promote Most dental benefit programs encourage and promote preventive care through 100 percent coveragepreventive care through 100 percent coverage

THE CADP AGENDATHE CADP AGENDAFighting for ConsumersFighting for Consumers

CADP promotes legislative and regulatory policies that CADP promotes legislative and regulatory policies that increase access to high quality, affordable dental careincrease access to high quality, affordable dental care

Offers input and perspective to lawmakers and regulators based on Offers input and perspective to lawmakers and regulators based on actuarial and administrative experienceactuarial and administrative experience

Educates the media and the general public on the underlying principles of Educates the media and the general public on the underlying principles of successful benefit programs and the potential impact of proposed successful benefit programs and the potential impact of proposed legislation and regulation on such programslegislation and regulation on such programs

Works to improve industry standards and share best practices among Works to improve industry standards and share best practices among membersmembers

Hosts events to promote discussion and action on industry challengesHosts events to promote discussion and action on industry challenges

Key ThemesKey Themes

Consistent dental care translates into better oral health and Consistent dental care translates into better oral health and

better overall health outcomesbetter overall health outcomes

People with dental coverage are nearly twice as likely to People with dental coverage are nearly twice as likely to

visit a dentist at least once annuallyvisit a dentist at least once annually

The public loses and oral health suffers when market The public loses and oral health suffers when market

barriers to dental benefits are createdbarriers to dental benefits are created

CADP member plans have an excellent track record in CADP member plans have an excellent track record in

serving the public and improving oral healthserving the public and improving oral health

CADP Consumer AdvocacyCADP Consumer Advocacy

…as published in the San Diego, Stockton and Inland Empire business journals.

Regulatory Issues Regulatory Issues Language Assistance RegulationsLanguage Assistance Regulations

CADP was a leading force and advocate for the dental industry CADP was a leading force and advocate for the dental industry

during the recently concluded development of language assistance during the recently concluded development of language assistance

program (LAP) regulations. Our testimony and comments resulted in program (LAP) regulations. Our testimony and comments resulted in

changes that will translate into more appropriate and effective changes that will translate into more appropriate and effective

regulation, benefiting our members’ customers and English-limited regulation, benefiting our members’ customers and English-limited

enrollees. We now stand ready to assist Plans in the implementation enrollees. We now stand ready to assist Plans in the implementation

and approval of their LAP.and approval of their LAP.

Regulatory Issues Regulatory Issues

Timely Access RegulationsTimely Access Regulations

CADP has testified and commented to the Department of CADP has testified and commented to the Department of

Managed Health Care in favor of dental-appropriate, timely Managed Health Care in favor of dental-appropriate, timely

access regulations.access regulations.

– Partnered with organized dentistry to advocate a regulatory approach Partnered with organized dentistry to advocate a regulatory approach

that is less intrusive for the practicing dentist, and less burdensome for that is less intrusive for the practicing dentist, and less burdensome for

an industry that received just 9 access-related complaints in 2006 out an industry that received just 9 access-related complaints in 2006 out

of 20 million enrollees.of 20 million enrollees.

Regulatory Issues Regulatory Issues Knox Keene ReformKnox Keene Reform

CADP participated at invitation of the California regulator with an ad hoc CADP participated at invitation of the California regulator with an ad hoc

group of health plans working to streamline regulatory requirements and group of health plans working to streamline regulatory requirements and

eliminate unnecessary forms and processes.eliminate unnecessary forms and processes.

Ongoing Dialogue and EducationOngoing Dialogue and Education

CADP sponsors regular meetings and informational exchanges with CADP sponsors regular meetings and informational exchanges with

California regulators to improve understanding of dental industry issues California regulators to improve understanding of dental industry issues

and promote healthy interchange and communication with those who and promote healthy interchange and communication with those who

license new dental plans and products.license new dental plans and products.

Legislative IssuesLegislative Issues AB 895 – Coordination of BenefitsAB 895 – Coordination of Benefits

CADP participated in negotiations with CDA and Assemblyman Greg CADP participated in negotiations with CDA and Assemblyman Greg

Aghazarian to win passage for a bill that clarifies and standardizes how Aghazarian to win passage for a bill that clarifies and standardizes how

dental plans collaborate to pay claims for enrollees with dual coverage.dental plans collaborate to pay claims for enrollees with dual coverage.

AB 1554 – Rate FilingAB 1554 – Rate Filing

CADP joined other health plans to successfully oppose a bill that would 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, require health and dental plans to win approval for any changes in rates,

even though regulators lack the resources to understand how insurance even though regulators lack the resources to understand how insurance

underwriting works.underwriting works.

Legislative IssuesLegislative Issues

Healthcare ReformHealthcare Reform CADP developed and extended to the Schwarzenegger CADP developed and extended to the Schwarzenegger

Administration a set of principles for considering how dental Administration a set of principles for considering how dental benefits should fit into large scale health care reform. These benefits should fit into large scale health care reform. These principles have served as a starting place to make certain any principles have served as a starting place to make certain any reform approach adopted does not inadvertently worsen oral health reform approach adopted does not inadvertently worsen oral health by siphoning away the existing financial resources of the state, its by siphoning away the existing financial resources of the state, its residents, or the employers who conduct business within the state.residents, or the employers who conduct business within the state.

CADP’s “Principles of Dental in Healthcare Reform” were well –CADP’s “Principles of Dental in Healthcare Reform” were well –received, and to date, appear to have been respected most of the received, and to date, appear to have been respected most of the proposals on the table. proposals on the table.

CADP CADP Committed to CaliforniaCommitted to California

Supporting community activities and initiatives that Supporting community activities and initiatives that

enhance oral healthenhance oral health

Serving as an industry resource for public policy makersServing as an industry resource for public policy makers

Keeping California smilingKeeping California smiling

Questions / DiscussionQuestions / Discussion