How can a visit to the dentist help lower medical costs and improve health outcomes?
Those regular visits to the dentist for an exam, cleaning and a “No Cavities for Me!” sticker help keep your teeth and gums healthy and your smile bright. But they also help with much more – including your likelihood of needing emergency or urgent medical care services and your chances of developing periodontal (gum) disease. Just like going for an annual medical exam is important, preventive dental care visits also play a critical role in overall health and wellness.
The connection between oral and overall health is a guiding principle for everything we do, and it’s reflected in how we view dental health and the products we offer to help improve and maintain it. In today’s world, an effective dental plan is one that goes beyond just offering a list of covered procedures and discounted dentists. Dental plans should offer services and programs that reflect the connection between oral and overall health, and they should connect customers to the right solutions when, how and where they need them most, in a way that’s simple, affordable and predictable.
Our dental programs are designed to help reduce dental and medical costs, and help deliver better outcomes for all customers, including those who may need extra support to be their healthiest or who may be at a greater disadvantage due to social factors that impact health and access to care.
Critical to our approach is our clinical expertise which allows us to evaluate customers’ needs. One of the ways we do this is by harnessing the power of data and using insights from data analytics to deliver solutions that overcome barriers to good oral and overall health. Our ongoing, multi-year studies – initially begun in 2011 – on the impact for periodontal care on customers who also have medical coverage with us have enabled us to identify opportunities to help improve outcomes. It’s also enabled us to demonstrate the long-term, positive impact dental care has, not only on a person’s oral heath, but also on their health but on their medical costs, too.
Multi-year study validates impact of preventive dental care
In 2011, Cigna’s team of dental directors began what would become a multi-year study on the impact that dental care has on various costs and outcomes.
For the updated and expanded studies, our clinical dental team identified two groups of Cigna customers with dental and medical coverage: those who had three consecutive years of preventive dental care* (2012-2014) and those who received periodontal (gum disease) treatment** (2017) and subsequent maintenance for both years (2018-2019) following initial treatment. These groups were matched to similar customers who did not have consecutive years of preventive care, or periodontal treatment followed by maintenance, and a comparison was made on annual medical costs for each group beginning in 2015 through 2019 and year 2019, respectively. A sub-segment of the preventive care study was also identified to determine the impact preventive care has on those with diabetes.
This work continues today, with more data and insights coming from the cumulative reporting each year. All findings validate the profound impact that preventive and periodontal care can have on medical outcomes and costs.
This paper summarizes our most recent findings as measured during 2020 including the role social determinants of health can play when it comes to costs and savings.
Long-term impact of dental care and the social factors that contribute to higher costs and greater savings
Through the latest study results, we’re learning more about the long-term impact that routine preventive dental care and periodontal maintenance after treatment can have on adverse events, including emergency room and urgent care visits. By getting what may be perceived as “standard and routine” (e.g. routine exams, cleanings and x-rays) care at their dentist, customers are not only helping to improve and maintain good oral health, they are also helping to reduce medical costs by avoiding the ER and urgent care centers.
Routine preventive dental care can help reduce medical costs for five years following three consecutive years of care in customers with diabetes and those who are otherwise healthy
The average annual savings on total medical costs (TMC) over five years is 4.4% per member, per year (PMPY). These savings include a 22% reduction in emergency room and urgent care visits for this study group.
The savings is higher for those diagnosed with diabetes. TMC is reduced by an average of 12.25% over five years for the study sub-segment of customers diagnosed with diabetes, with the highest savings – 17.8% – measured in the first year following three consecutive years of preventive care.
The impact of these results go beyond just medical cost savings. Customers with diabetes are at greater risk for developing periodontal disease due to the impact diabetes can have on the immune system. And once periodontal disease is present, it can make it harder to manage blood sugar levels. Helping those customers with diabetes who are at a higher risk of periodontal disease is one of the reasons we launched the Cigna Dental Oral Health Integration Program®.*** By providing these customers with enhanced dental services at no extra cost, we are able to connect them to care and help them manage their disease.
Increase in risk for periodontal disease
During the analysis of results, we also determined that customers who did not have consecutive years of routine preventive care are 1.5 times more likely to develop periodontal disease over the course of the following five years compared to those who did get care. Helping to reduce the risks of periodontal disease is critical to helping customers mitigate potential complications to existing medical conditions such as diabetes. By proactively connecting them to dental services that can help manage certain diseases, we can help deliver better health outcomes and more savings to employers.
Periodontal maintenance following periodontal treatment is key to lowering medical costs
For customers with periodontal disease, meaningful savings on medical costs were seen in the final year (2019) following initial treatment and care totaling $759.40 (10.2%) PMPY. In addition, there was a reduction in the number of adverse events. Customers who completed periodontal maintenance following treatment average 21.8% fewer emergency or urgency care visits than those who don’t get maintenance.
Ongoing periodontal maintenance following initial treatment is key to driving cumulative medical cost savings.
Social factors impact cost and savings for those who get routine preventive dental care
In the most recent analysis of findings, we also gained insight into the impact social factors can have on oral health. This information is critical to our commitment to connecting customers to care when, how and where they need it most. When social factors create barriers to important preventive dental care, we must look for ways to overcome those barriers and help ensure that everyone is able to access care.
A deeper look at the medical cost savings among study group individuals who are impacted by “very high social determinant factors” illustrates the connection between cost and access to care, and social factors. This sub-group had additional savings of 37.3% over those customers who are not impacted by a high social index.
Social factors impact Americans of all ages, but can have an especially negative influence on children’s oral health. Oral health is critical to a child’s overall health and development, school attendance and performance, speech development and nutritional intake. Therefore, eliminating or minimizing the impact that social factors such as poverty or the suspension of school- and community-based dental programs due to COVID-19 becomes even more important to delivering improved outcomes for all Americans.
These insights clearly illustrate the critical impact social factors can have on an individual’s health outcomes, and the cost savings realized when preventive care is performed. But they also underscore the importance of moving the center of care in a way that brings affordable, simple and predictable dental care services to those who may not have the ability or means to access it. This can mean better overall health regardless of the challenges created by social factors, and more savings to employers.
What are Social Determinants of Health (SDOH)?
The Centers for Disease Control (CDC) defines SDOH as “conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes.” These include five key, place-based areas such as healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment. In simpler terms, SDOH are conditions in which people are born, grow, live, work and age and they are shaped by the distribution of money, power and resources at all levels within society.
Clinical insights that help inform meaningful solutions
Identify, educate, treat and prevent. The path to better health.
Insights from studies like this help guide the work we do to develop dental solutions that can help improve whole health. Looking to the future, key learnings such as the impact that social determinants of health can have on an individual’s access to care are critical to developing dental solutions that help reduce disparities and ensure equity for all Americans. By moving the center of care to where it’s needed most within our communities, we are committed to making access to important preventive dental care services equally simple and affordable for all of our customers.
Cigna’s Study: Demographics
Preventive Care Study Group – 60,015 DPPO members who received preventive care services consecutively between 2012-2014. Control Group – 60,015 DPPO members who did not receive preventive care services consecutively between 2012-2014. Medical outcomes measured for period 2015-2019. Result statistically significant with p-value<0.05
Diabetic Segment of Preventive Care Study Group – 6,934 DPPO members diagnosed with diabetes who received preventive care services consecutively between 2012-2014. Control Group – 6,934 DPPO members diagnosed with diabetes who did not receive preventive care services consecutively between 2012-2014. Medical outcomes measured for period 2015-2019. Result statistically significant with p-value<0.05
Periodontal Maintenance Study Group – 15,177 DPPO members who received periodontal treatment in 2017 and maintenance care in both 2018 and 2019. Consecutively between 2017-2019. Control Group – 15,177 DPPO members who received periodontal treatment. Medical outcomes measured concurrently with years treatment was received. Cumulative savings reflects updated data for medical outcomes in 2019. Result statistically significant with p-value<0.05
*For the purposes of this study, preventive dental care is defined as at least one routine dental exam and cleaning per year.
**For purposes of this study, treatment is defined as having received a root planning and scaling procedure.
*** This program provides reimbursement for certain eligible dental procedures for customers with qualifying medical conditions. Customers must enroll in the program prior to receiving dental services to be eligible for reimbursement. Reimbursement is applied to and subject to any applicable annual benefits maximum. See your plan documents or contact Cigna for complete program details.