Dental Industry Midyear Update: A Look at Where We Are and Where We’re Going

As we look into healthcare’s crystal ball, the near future looks a lot like the recent past. New technologies are constantly emerging that change the way providers do business and the financial environments in which they operate. Artificial intelligence (AI), automation, and advanced analytics are poised to transform many industries, with the dental industry just one among them. 

As dental providers look to the future, they can expect more Medicare Advantage patients, heavier administrative burdens for team members, and broader use cases for artificial intelligence. The insurance landscape is an important and everchanging piece of the picture that greatly influences patient care and provider financial health.

First, let’s take a snapshot of the industry, according to data recently released by the American Dental Association (ADA). 

An industry ripe for growth

One thing that is certain is that the dental industry has plenty of room for growth. Consider that just 43% of the U.S. population saw a dentist in 2021. (The ADA notes that this figure should be viewed as a “slight” underestimate of the true dental care use rate due to the survey’s methodology.)

While 50% of seniors and children visited a dentist in 2021, only 39% of adults aged 19 to 64 did, according to the ADA.

Also concerning, cost barriers are most severe for dental care services when compared with other types of healthcare services. Thirteen percent of the population reported cost barriers to dental care, compared with between 4% and 5% for other healthcare services, according to the ADA.

Even having insurance does not mean that patients are free from cost barriers, as 8% of patients with private insurance reported that they did not receive care in the prior year due to cost, compared with 15% with public insurance and 21% of the uninsured. 

On the brighter side, the percentage of children with no dental insurance continued its downward trend, to 9% in 2021 from 19% in 2002. The share of children with public dental assistance, such as Medicaid, grew to 38% in 2021, a significantly increase over 2002 (26.9%).

With adults, the insurance situation is a little murkier. About 61% have private insurance, but the ADA does not estimate the percentage of adults with public dental assistance because Medicaid programs differ widely when it comes to adult dental coverage. 

What to expect in the future

With that, let’s take a look at what to expect for the dental industry’s near-term outlook.

Medicare Advantage continues to explode: While some providers might wish it would go away, Medicare Advantage (MA) is doing just the opposite – exploding in growth. In 2023, 30.8 million people were enrolled in MA plans, accounting 51% of the eligible Medicare population, and $454 billion (or 54%) of total federal Medicare spending net of premiums, according to KFF. By comparison, in 2018, just 37% of the eligible Medicare population were enrolled in MA plans. 

MA insurers are increasingly narrowing their provider networks, causing potential headaches for patients who may no longer be in-network with dentists they’ve been seeing for years. When that happens, frustrated and confused patients often unjustifiably direct their anger at providers. To avoid these situations, providers should be aware of the MA plan designs of their patients so they can service these patients properly.  

Greater price transparency for patients: The No Surprises Act, a 2021 regulation that seeks to protect patients from surprise bills, has changed patients’ perceptions of their rights. They now expect greater price transparency; specifically, more and more patients are looking for accurate pre-service price estimates from their providers. The push toward greater price transparency is consistent with increasing “consumerization” of healthcare, in which patients expect many of the same benefits and conveniences from their providers that they have grown accustomed to in other industries such as retail. 

A growing role for AI: Throughout the dental industry, misconceptions have spread about how AI is being used by carriers and how the technology will affect human workers. However, the reality is that insurers have been using basic AI and machine learning programs to improve claim processing for years. Often, the technology is simply used to scrub claims, identify missing information, and ensure attachments or other documentation such as radiographs and images are helpful in claims adjudication. 

Rather than acting as an evil overlord, AI brings potential to reduce administrative burdens on team members by enabling them to perform routine, manual tasks more quickly. Dental practices that don’t embrace the technology run the risk of falling behind their peers. 

Slow, steady growth in administrative burdens: The dental industry, and healthcare more widely, has increasingly drawn scrutiny from legislators and regulators in recent years. For example, Florida recently passed a law requiring carriers to obtain a signature of compliance when paying with a virtual credit card. To stay up-to-date on the new rules affecting them, practice leaders should frequently check in with their state dental societies, which generally do a good job of monitoring these changes. 

When providers and payers unite around the common goal of delivering exceptional patient care, they can make strides to advance the industry. 

© 2024 Napa EA/MEDX, LLC. All rights reserved. All third-party trademarks and tradenames (including logos and icons) referenced are and remain the property of their respective owners. https://vynedental.com/legal/