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- This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by Mike Adelberg,
who's the Executive Director
of National Association of Dental Plans.
Mike, it's a pleasure to have you on the podcast today.
- Well, thank you, Laura. It's a pleasure
to have the opportunity to speak with you
and your, uh, readers.
- You know, I, I'm really excited for our conversation
because, uh, there are big things happening in the dental
space today, and certainly it's just so important to have,
you know, the health plan
and coverage in, in those kinds of things.
Um, so I'm excited to learn more about
what you're seeing from your vantage point.
But before we dive into that discussion,
can you tell me a little bit more
about yourself and your background?
- Sure. So, uh, I've been in and around, uh, healthcare
and managed healthcare for, for about 30 years.
That includes, uh, 15 years in, uh,
the federal government in the Department of Health
and Human Services, where I held, uh,
senior positions in the Medicare program,
and then a senior position, uh,
rolling out the Affordable Care Act.
Uh, it was in that position that had responsibility
for the regulations for essential health benefits,
including pediatric dental as the 10th, uh, EHB,
and also for establishing standalone dental plans on the
Affordable Care Act, uh, health insurance exchanges.
So that's when I began, uh, working with dental plans
and working with the dental industry
and considering oral health issues.
Uh, before joining N-A-D-P-A year ago,
I spent eight years in a, uh,
boutique consultancy on K Street in Washington, DC uh,
focusing on health policy,
and had the, uh, opportunity to work on a number
of oral health issues in, uh, that position as well.
And I've been at NADP for one year now.
- Oh, wow. That's amazing to hear.
And definitely, you know, seems like you've gotten such
great experience throughout your career in leading you into
your role today with the NADP.
Um, from your perspective, what are some
of the biggest issues that
you're following right now in dental?
- Yeah. Uh, so for NADP,
at least our number one issue right now is medical loss
ratio and whether it should be applied to dental plans,
and if so, how?
And, uh, there is a law that probably,
uh, many of your readers are familiar with
that goes into effect on January 1st in Massachusetts
that would apply a medical
level medical loss ratio to dental plans in that state.
And already a number of carriers, uh, in
that state have indicated that they have to leave at least,
uh, one
or more of the, uh, markets,
insurance markets in the state of Massachusetts
because the law is, uh, unworkable.
And, and the fundamental problem with that is that a,
a medical and the dental plan, uh, have
the same administrative costs are very similar
administrative costs,
but the medical plan ballpark gets about 20 times
as much incoming income.
So it can just naturally achieve a higher loss ratio than a
dental plan can achieve,
or for that matter, any other low premium
product, uh, can achieve.
Uh, there are a number of other states
that have gone a different route on loss ratio, uh, such
as Maine, Colorado, Arizona, others, um,
where it's essentially a reporting
and an outlier remediation process.
And NADP is okay with that, uh, if, if that's,
uh, how states need to go.
Um, but there are a bunch of other issues
that interest us a great deal.
Uh, we are all about expanding, uh,
oral health access in this country.
Uh, so whether that be, uh,
more Medicaid programs adding adult dental benefits, uh,
whether that be, uh, states choosing
to add an adult dental essential health benefit, uh,
to their, uh, benchmark plan in the, uh, a CA markets,
uh, as a proposed regulation would allow,
or whether it be the establishment of a Medicare,
uh, dental benefit.
All of those issues are really important
to the nation's oral health,
and they're really important to NADP.
- Absolutely. That's fascinating
and really great work that, you know, you're doing in order
to bring more of these essential benefits to play
and really getting them integrated into more health plans.
From your perspective, is there much energy around that,
especially for, as you were talking through, you know, some
of the a CA plans in other, um, government funded plans.
Is there energy around being able to do that,
or what are the sticking points in, um, you know, trying
to get more, um, of the plans
to offer the dental essential health benefits?
- Yeah, so, uh, at, at least with regard
to essential health benefits, um, it, it's important to note
that the original CMS regulation at the start of the, uh,
implementation of the A CA actually forbid
adult dental as an essential health benefit,
um, in the states.
And, uh, the most recent, uh,
Biden administration regulation, if it's finalized
as proposed, would eliminate that prohibition.
And then states would have the opportunity to, uh,
establish, uh, an adult dental, uh, EHB,
and then the a CA, uh, plans in the individual
and small group markets would have to, uh,
offer an adult dental or in one way
or another, uh, there would have to be a partnership
with the state, uh, so
that the state is providing adult dental, uh,
through standalone plans, uh, or, or some other mechanism.
Um, this is only a proposed regulation, can't guarantee
how it's gonna turn out.
But, um, I do consider it a, an exciting development.
Certainly something that, uh, if it's done wisely will, uh,
help Americans, uh, get coverage.
And Amer we all know of, of that, Americans
who have dental coverage go to the dentist more,
and Americans who go
to the dentist more have better oral health.
And let's just complete the circle
and say, Americans who have better oral health have better
overall health, and that's what we should all be about.
- Agreed that we put it very well.
Now, Mike, when you look into the future,
what are you most excited about and what makes you nervous?
- Yeah, so in, in terms of being excited, um,
and I, I guess I, I set this up a little bit in my prior,
uh, response, but there is a stronger
and stronger realization in this country, uh, among, uh,
among policymakers, among business leaders, et cetera, that,
uh, oral health impacts overall health.
And, uh, I just use as, as one example, there was a,
a study published in the ADA's Journal, uh,
earlier this year that, uh, demonstrated that for people
with diabetes, when they receive appropriate PERO care,
they ca their overall healthcare costs go down 11
to 14%.
So that realization, I think is extremely exciting.
And, you know, all of us in dental at one point
or another have said, we have
to put the mouth back into the body,
but what does that really mean?
Well, the, the, the growing body
of scholarship that demonstrates
that when a person has good oral health, uh,
their overall health is likely to improve,
and then for, for certain chronic diseases that much more.
So that's extremely exciting
because that opens up the opportunity for all kinds
of payment reforms and, and funding, uh, opportunities.
And that's very exciting to me.
Uh, the other thing that's very exciting to me, and,
and I I think it's also a focus of, uh, your publication
is the growth of DSOs.
Historically, uh, the dental profession has,
has largely been small and solo practitioners.
And with the advent of DSOs, there is now scale
and sophistication
and administrative efficiencies that really allow for, uh,
increasingly cost effective, uh, oral health to be provided.
And I know my members are very excited, uh,
to work with DSOs.
I'm very excited to work with DSOs,
and I think their growth is a positive development.
- That's amazing to hear. And definitely, um, you know,
having that kind of economies of scale with some
of the DSOs, you know, hopefully can push this forward.
I think the message that you were talking about
on the stronger oral healthcare means better overall
healthcare, it, it seems like, like you mentioned,
is gaining momentum even within the broader organizations
and large organizations with some of their partnerships
and just really, um, you know, having that as the core of
what they're driving forward.
Um, so that is certainly exciting to see.
- Yeah, uh, very much agree.
And, uh, I know my members, uh, the carriers,
uh, are are excited about the partnerships
they have with DSOs.
Uh, I know, uh, I have individual companies
that have various pilots going with, with particular DSOs.
Uh, they, they really can become the,
the engine of innovation.
- Absolutely. So kind of on the flip side of that,
is there anything that you see as potential roadblocks or,
or that you're preparing for, um, that could be a roadblock
to success in the next couple years or so?
- Well, I, I guess I'd make a general observation, which is
that positive revolutions really do occur in healthcare.
And of course in oral healthcare is healthcare.
They really do occur, but they're always very bumpy
and they take a long time.
And I, I remember, uh, being part of, uh, the discussion
that led up to the Affordable Care Act sort of circa 2010,
uh, just as an example, over on the medical side of things,
there was all
of this exuberance about accountable care organizations
and how they were going to completely reform, uh, hospitals
and the way hospitals, uh, get paid
and the way hospitals, uh, manage bed days,
bed census, et cetera.
And we are now, you know, 13 years later
and ACOs have made a dent
and ACOs have had some positive impact.
Uh, but it's hard that revolution, if it is,
is in fact a revolution.
It's still a very unfinished revolution.
And, and things just take a long time, uh, for a variety
of good reasons in, in the healthcare field.
And so, uh, that what makes me nervous is that I think
the, the reformers
and the people who get really excited
are sometimes not sufficiently tempered by how much
inertia there is in our large
and clunky multi-stakeholder system.
And reforms just take time, improvements take time,
and then more narrowly, the the other thing
that makes me nervous, and I imagine it makes your readers
nervous too, is we have a, a provider shortage in,
in large parts of this country.
And if we don't have, uh, enough dentists,
if we don't have enough hygienists, et cetera,
we're in big trouble, especially as we seek to expand, uh,
access and get people, uh, attending all of the,
the dental office visits that we think they need to attend.
- Got it. Yeah, I, I think that's such a great point
and certainly helpful to know
and understand, um, from your perspective now, you know,
given everything we've talked about,
obviously some great opportunities,
exciting things happening, as well as challenges ahead,
what do you think it will take for healthcare effective
to have healthcare, um,
leaders be effective over the next few years or so?
- Yeah, that's, uh, that's a big question.
There are a lot of ways, uh, to take that.
Um, but I, I, I'll offer that all of us, uh, first
of all need, need to keep an open mind.
And when someone presents us with something
that's interesting,
but doesn't ring a hundred percent true to us,
the first time we hear it, uh, we should smile,
refrain, uh, restrain ourselves from a negative response
and think about it a little bit
and maybe follow up quietly two days later, uh,
rather than shooting something down in the public way
that's been going to close off open-minded dialogue.
Uh, so let's all keep an open-minded about
things more narrowly.
Uh, everyone is talking about ai. It's, it's scary.
It's, uh, has, has a lot of potential to be, uh,
mischievous, uh,
but it also has tremendous potential upsides in terms
of making, improving, uh, the consistency
and quality of care
and improving our administrative processes.
So, uh, that's, we should be open-minded to, uh,
how this technology develops.
We should be open-minded to payment reforms.
We should be open-minded to the development of transparency
and quality measures.
Frankly, if the, the plans
and the providers don't figure out how
to make some progress in some of these areas by ourselves,
at some point, the government's going to assist us
in moving in some of these directions.
So, uh, those are areas where we should be thoughtful,
we should do things in a incremental manner, uh,
but we should keep our minds open
and recognize that there may at some point be some
external pressures on us.
I, I haven't talked yet about, uh, some of the, the,
the clinical, uh, and scientific opportunities also,
but things like, uh, saliva samples
and all of the things that a dentist office can deliver
to overall health by, uh, saliva sampling
and then, uh, tissue regeneration
and its possibility to improve
what now might be a root canal
or a crown opportunity in the oppor, uh, the potential,
you know, in, in the relatively near future
to regenerate tissue instead.
Um, all of that is just extremely exciting, uh,
because it has the opportunity, uh, first of all
to make people healthier
and second, uh, potentially, uh,
make our overall healthcare system that much more efficient.
Because when we fix up people's mouths, uh,
we will improve their overall health.
- That's great to hear. Mike, thank you so much
for joining us on the podcast today.
This has been such a fun and interesting conversation,
and I look forward to connecting with you again soon.
- Yeah, I, I've really enjoyed it.
And, uh, I, I thank you
and your colleagues at, uh, Becker's for great work.
Uh, I'm a, I'm a regular reader.
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