How and Why Dental is the Twinkle in Medicare Advantage Stars

Health systems are facing what some are calling a triple threat this winter, with cases of flu, COVID-19 and RSV on the rise. And while capacity and staffing are often the primary challenges in focus, member/patient experience cannot be overlooked. Even amid public health emergencies, patients receive surveys about their experience with plans, providers and health systems, and those responses can have a major business impact.

Consider Medicare Advantage, a Medicare Part C program that allows Medicare beneficiaries to choose a plan to supplement their traditional Medicare coverage. Over the last decade, enrollment in optional Medicare Advantage plans has increased dramatically, and now nearly half of Medicare enrollees also have a Medicare Advantage plan.

Based in large part on patient-reported survey answers, CMS publishes annual star ratings to empower people to make more informed health care decisions including Medicare Advantage plan selection.

Collected with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, patient-reported data has actually doubled its impact on star ratings from 2022 to 2023. This means plans must pay even more attention to customer satisfaction – every interaction and every expectation or surprise that beneficiaries have with any part of their Medicare Advantage plan can affect how a member would respond to a CAHPS survey.

For example, many older Americans transitioning from employer-sponsored insurance to Medicare are surprised to find dental coverage is not included with the traditional plan. In fact, more than 90% of Medicare Advantage enrollees choose plans that offer a dental benefit. So, the question for Medicare Advantage plan administrators is not whether to offer dental, but how to administer it and what should be offered.

Dental benefits can be a game changer, not just for the opportunity to improve member satisfaction, but also to improve member outcomes. Much has been written about the importance of oral health care to one’s overall health, particularly over the last several years. And all that ink is warranted as research continues to show us new ways one’s oral health impacts the rest of the body. Look no further than this 2020 study that examined the link between ventilator-associated pneumonia (VAP) and dental care. VAP is a hospital-acquired infection in which a patient breathes bacteria from their mouth through the ventilator tube into their lungs.

According to the study, individuals who had at least one visit for routine dental care in the three years preceding being placed on a ventilator were 22% less likely to be diagnosed with VAP. And a VAP diagnosis can add roughly $40,000 and 7 days to a single hospital visit, not to mention declines in clinical condition and outcomes.

Think back to the early days of the COVID-19 pandemic, when ventilators were top of mind and tragic news of patients not surviving the disease despite the intervention of ventilators were commonplace. Many of these individuals were older Americans. While the VAP study is not specific to patients with COVID-19, its findings remain important.

As Medicare Advantage plans increase in popularity among seniors on Medicare, so has the popularity of plans that offer at least some dental benefits.

Choosing the right dental benefits administrator to partner with is a big decision for a plan, as it can have unintended consequences, for better or worse. As a former leader at a large Medicare Advantage plan, the critical importance of star ratings is not lost on me. And the importance of dental administrators understanding the needs of Medicare Advantage plans cannot be overstated – the partnership can be key to a plan’s success.

That’s why having experienced vision and dental benefits administrators with wide networks of providers and comprehensive member services is critical. And that’s exactly what DentaQuest offers Medicare Advantage plans.

We know that everything from the adequacy of a provider network to interactions with telephone customer service representatives to experiences with providers can be the basis for a strong or a poor member survey. We know that because DentaQuest is intentional about bringing in executives with strong experience leading Medicare Advantage plans.

As Medicare Advantage scores fell significantly from 2022 to 2023, largely due to CMS’s decision to lift temporary scoring relaxations, plans that were comfortably ranked as 4 or 5 star find themselves in a new, precarious position. That position is compounded by the fact that already enrolled members are choosing to switch plans at rates that have never been higher. While in the past, enrollees switched plans during open enrollment at relatively low rates (around 10% or less), new data shows that 17% of enrollees were abandoning their plan in favor of another.

With members moving from plan to plan at record rates, their satisfaction is critical to retention - and in turn the profitability of a plan, which needs members to stick around for years to achieve a meaningful return on investment.

All of this is to state the obvious: star ratings are incredibly important to a plan’s success. Perhaps less obvious is that choosing a dental administrator that understands stars and risk and the importance of the member experience on the plan’s bottom line should be top-of-mind for plan administrators. A member sees and experiences the plan name and brand they select, not the name of the dental benefits administrator. DentaQuest knows that, and we know that a good member experience can be worth millions in stars.

Originally published on LinkedIn by Dave Kaluhiokalani