Corporate Health Care Determinants

An article in The Wall Street Journal details plans by a number of large corporations to choose the physicians to be included in their health care plans with the stated goals of improving patient outcomes and reducing health care costs. The companies locate these doctors by reviewing health care records and “public” data.  Exactly what public data is not specified. Physicians with the best results and lowest fees and overall expenses are favored in the selection process, while poor performers are eliminated from consideration.

Some companies are even paying travel costs to bring patients to their selected doctors, and the article reports that some workers have been disappointed by the lengthy travel required. Based on the initial results, however, this approach appears to achieve the goals set by these employers. According to a study by the Harvard Business Review, employees spent less time in the hospital, had fewer postoperative problems, and returned to work sooner than individuals treated outside the system.

The goals of these companies are indeed laudable, but the process of selecting physicians and their clinics is still a work in progress. And it is been hampered by the fact patients may have been treated by multiple physicians based on contracts previously negotiated by insurance companies and hospitals.

Bearing in mind that dentists deal with chronic diseases, how might this approach affect dentistry? The conditions that impact oral health are directly affected by the patient’s behavior over long periods, similar to care for individuals with diabetes and other chronic illnesses. Considering noncompliance with professional health recommendations is common in these patients, this may complicate evaluation of the efficacy of treatment. In turn, this could lead to evaluations based on cost alone.

BEARING IN MIND THAT DENTISTS DEAL WITH CHRONIC DISEASES, HOW MIGHT THIS APPROACH AFFECT DENTISTRY?

If companies pick dentists based on cost, it will increase the pressures to deliver less expensive dental care. This will continue to fuel the movement from individual practice to group practice, including corporate dentistry settings. It will also increase pressure to use less expensive laboratories and ramp up treatment by dental auxiliaries. In other words, there would be less direct dentist-to-patient contact. Unfortunately, it may also lead to pressure to recommend unnecessary treatment.

Under this model of care, management consultants (in some cases, non-dentists) may be driving treatment plans. In medicine, this approach to keeping people healthy and minimizing treatment costs has led physicians to cherry-pick healthy patients to ensure their outcomes look good on paper. Like it not, this situation is here and becoming more intense.

While improving outcomes and reducing health care costs are worthy goals, treatment plans and the provision of care should not be entirely dictated by corporations. All stakeholders need to maintain a voice in these decisions, and practitioners should strive to provide care in a manner that is efficient, patient-centered and outcome driven.

Thomas G. Wilson Jr., DDS

Editor in Chief

twilson@belmontpublications.com

From Decisions in Dentistry. June 2019;5(6):6.