Gum, systemic disease link gains traction with plan providers (From March 2008 Health Management)

The link between gum disease and systemic disease is becoming more top-of-mind with health plan and dental providers alike.

Armed with medical and dental claims data, DenteMax, a PPO dental network and a wholly owned subsidiary of Blue Cross Blue Shield of Michigan in Southfield, is aligning its providers-medical and dental-and the health plan to identify at-risk patients; urge medical/dental members who suffer from ischemic heart disease or diabetes and who are pregnant to obtain preventive and periodontal services through an extra free cleaning; educate and counsel patients; and build awareness of the connection between oral and systemic disease.

In addition, the "Quit the Nic" smoking cessation program offers participants who are more susceptible to periodontal disease, an extra free cleaning.

Carl Stoel, senior dental consultant for DenteMax, points out that a dentist can detect 120 disease symptoms in the mouth, making these providers key to preventive care.

Blue Cross and Blue Shield of Texas (BCBSTX) and Blue Cross and Blue Shield of Illinois are also taking advantage of medical and dental claims data to develop a personalized plan for members through a new program, BlueCare Dental Connection. Both plans will reach out to members at-risk for health conditions exacerbated by dental disease to prevent further problems. Its efforts will include mailings, staff outreach, expanded Web tools, and information on the plan's Web site.

"The BlueCare Dental Program focuses its efforts on education, intervention and outreach," Timothy Custer, DDS, dental director, Dental Network of America, the administrator for BlueCare Dental Connection, says. "Our intent is to create an educated healthcare consumer by targeting individuals most in need of information formulated through evidence-based research."

Doyle Williams, DDS, chief dental officer of Boston-based Delta Dental of Massachusetts, is a firm believer that if gum disease is caught early and treated, members can reverse their situations and even reduce the cost of treating conditions such as diabetes and cardiovascular disease.

The dental plan covers four dental cleanings a year, rather than two, for any members that are at-risk for gum disease. The dental plan also pays for chlorhexidine-a "Listerine on steroids," prescription-only mouthwash to treat early periodontal disease that has reduced full-blown gum disease by 93%.

Mark Matzke, chief operating officer, HumanaDental in Green Bay, Wis., sees quite a bit of opportunity for members who are covered by both Humana's dental and health plans. Acknowledging that even though members with dental insurance are twice as likely to see a dentist, 50% of members in disease management programs do not take advantage of dental services.

HumanaDental coverage doubles visits to dentists to four a year–two to a regular dentist and two to a periodontist–and has developed an online tool that offers a dental health risk assessment, resulting in more knowledge about the link between oral and physical health and a scorecard with health tips.