Our DMI program was launched in 2007. It was the result of research that Aetna completed with Columbia University College of Dental Medicine, where we found that members with Diabetes, CAD and CVD who were receiving dental care had an average of 27% lower risk scores.1 In addition, we found that members with those conditions who had been treated over time for periodontal (gum) disease had an average of 12% lower medical costs.1 An additional study with Columbia showed that pregnant members who received dental care had 25% lower preterm delivery rates and 34% fewer incidents of low birth weight.2 Seeing those results made us want to encourage more of our members with those conditions to visit the dentist.
For members with those medical conditions, the DMI program includes postcard outreach for members who have not recently visited the dentist. The postcards provide education on the important connections between oral health and overall health. An additional feature of the program is enhanced dental benefits for DMI members, such as an extra cleaning and periodontal services covered at 100%.* A very important differentiator of the DMI program, compared to our competitors’ programs, is that we automatically identify members for the program and the outreach and enhanced benefits are automated as well. Members don’t even have to know about the program and they do not have to fill out any forms. Our unique program creates engagement in our members! Since the program began, over 1.5 million members have been identified and DMI members have received over $30 million in enhanced benefits.3 There is no cost to plan sponsors or members for DMI, and an average of about 7% of a client’s members can be impacted by these medical conditions, although we have seen it as high as 20% for some clients.4
Since the DMI program has been in place, we have been evaluating outcomes for our DMI members. Compared to a statistically matched control group without the DMI program, DMI members receive 10% more preventive dental care, and 42% less basic and major dental treatment.4 We also found that DMI members had an average of 17% lower medical costs.4 While these statistics typically apply to a small group of employees – around 7% - these members are the ones who can benefit from dental care the most, based on our published research. Another interesting finding is that looking year over year, DMI members had a 3.5% reduction in hospital admissions, compared to a 5.4% increase in admissions for the control group.4 For members with diabetes, we found that those in DMI had a 45% improvement in diabetes control over time. A member with diabetes that is well controlled (meaning that they have HbA1c results of less than 7,) can save about $7.49 PMPM compared to a member who is not well controlled.4
In a recent blog post, Mark Bertolini was quoted as saying the following at a healthcare reform conference: “While many may be talking about change, we are driving change.” This really sums up what our DMI program is all about.
*Exclusions and limitations may apply. Treatment offered is based on
member’s dental evaluation. Employee or dependent must have at least one
of the following conditions to be eligible for the additional covered
expenses: pregnancy; coronary artery disease/cardiovascular disease;
cerebrovascular disease; or Diabetes. Additional dental covered expenses
and frequency limitations (limited to one additional per year):
prophylaxis (cleaning); scaling and root planing, (4 or more teeth) per
quadrant; scaling and root planing (limited to 1-3 teeth) per quadrant;
full mouth debridement; periodontal maintenance; and localized delivery
of antimicrobial agents. (Not covered for pregnancy.)
1 Joint study with Columbia University College of Dental Medicine and Albert DAA, Sadowsky D, Papapanou P, Conicella ML, Ward A. An examination of periodontal treatment and per member per month (PMPM) medical costs in an insured population. BMC Health Services Research 2006; 6:103. Continued analysis of retrospective study proves sustained results, Aetna Health Analytics, August 2008.
2 David A. Albert, Melissa D. Begg, Howard F. Andrews, Sharifa Z. Williams, Angela Ward, Mary Lee Conicella, Virginia Rauh, Janet L. Thomson, and Panos N. Papapanou. An Examination of Periodontal Treatment, Dental Care, and Pregnancy Outcomes in an Insured Population in the United States. American Journal of Public Health: January 2011, Vol. 101, No. 1, pp. 151–156. doi: 10.2105/ AJPH.2009.185884.
3 Aetna DMI Program Book of Business report, as of December 2012.
4 Ongoing statistically valid analysis of Aetna DMI customers. Aetna Informatics, 2010–2012
Dental benefits and dental insurance plans are offered and/or underwritten by Aetna Health Inc., Aetna Dental Inc., Aetna Dental of California Inc. and/or Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.
This material is for information only and is not an offer or invitation to contract. Dental information programs provide general health and dental information and are not a substitute for diagnosis or treatment by a physician, dentist or other health or dental care professional. Dental providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to dental services. Dental benefits and dental insurance plans contain exclusions and limitations. Not all dental services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. The DMI program, as well as dental plan features and availability, may vary by location and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.
Policy forms issued in Oklahoma include: GR-9 / GR-9N, GR-23 and/or GR-29 / GR-29N.
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