Health insurance is a major topic of conversation right now—and for good reason. There is uncertainty and confusion surrounding health care reform, mandates, cost, and the Supreme Court decision that will be rendered by the end of the year. It gets even more unclear when you start to look at specific medical and dental benefits and how businesses and patients will be impacted by any changes.

The good news is that Delta Dental and Washington Dental Service, from a national and a local perspective, respectively, and many others throughout the health care industry have been working diligently for some time to be certain this evolving market is being served.

We're moving toward greater integration with overall health care through improved outcomes and making sure consumers are aware of their options. Regardless of how health care changes in the coming years, oral health must continue to be part of the equation.

Changing marketplace

Let's start with health care reform and what we know today. Pending the judicial decision, we assume the Health Care Exchange will be in place Jan. 1, 2014. At this point, each state can determine what's included as their essential benefits. In Washington state, oral health care for children will be included in the mandated plans, which will be designed to cover those who were previously uninsured or those who work for companies with fewer than 100 employees.

While dental benefits won't be mandated for adults, it's important to remember that good oral health is as important for adults as it is for children. That's why Delta Dental/WDS is working hard to ensure that patients will continue to have access to dental benefits.

Delta Dental/WDS focuses solely on dental care; we know where we can be most effective in designing and providing the specific dental benefits to fit the needs of each individual. We also take into account the importance of the relationship between patient and dentist and want to ensure these connections can be maintained in an affordable way.

Younger people are covered in Washington state, but what about retirees and seniors? We have 10,000 people turning 65 each day in the U.S. Theirs is the first generation of senior citizens to have their teeth, due in large part to the fact they were the first to grow up with fluoridated water and see a dentist on a regular basis. Dental insurance providers are developing benefit structures that are both cost effective and health effective for them.

And when it comes to employee-sponsored benefits, many of us are heading into uncharted territory. Traditionally, employers have offered a host of benefits for their employees, who were glad to have the coverage but probably didn't spend a lot of time reviewing the details.

With health care reform, an individual will go out to the open market and choose a plan that fits his or her needs. Now empowered by an increased freedom of choice, it then will be up to consumers to understand the need for a dental benefits plan and to educate themselves. In turn, we will need to do a better job communicating our value proposition.

The real challenge for everyone, young and old, is to be able to access care via a product that's effective for an individual. Such a product should be designed with the consumer in mind. To that end, Delta Dental developed an entirely new individual dental plan, the Delta Dental Clear plan, which was based on significant consumer research.

Patients told us they wanted a simple-to-understand dental plan without a lot of classes of care, percentages, or restrictions. The Delta Dental Clear plan covers the treatments dentists are most likely to recommend without maximums, deductibles, or waiting periods. It offers transparent information on the cost to the patient, and those costs are clustered by the type of visit. For example, patient co-pays for exams, cleanings, and X-rays are clustered into one fixed co-pay amount for a preventive visit.

Care coordination benefits

The critical factor left out of health care reform is cost. Moving forward, providers will be challenged with demonstrating the cost effectiveness of the services they deliver. Through comprehensive collaboration with all providers, employers can see more cost-effective use of their dollars. Accountable Care Organizations will be responsible for the total health care dollar.

For years I have been advocating for greater coordination of medical and dental health care to improve the overall health of the individual. Dental health isn't just about teeth; it also can be an indicator of one's overall health.

The Accountable Care Organizations will be looking at the management of a number of systemic diseases in order to manage and reduce cost and improve people's health. Dentists can be the first line of defense in detecting diabetes, cardiovascular disease, and others.

Delta Dental/WDS recently completed a study with Group Health that ultimately demonstrated that people who accessed their dental benefits had better diabetes outcomes. Studies like these show the importance of care coordination.

While the uncertainty surrounding health care reform remains, now more than ever, it's imperative that consumers continue to educate themselves. As the connection between oral and overall health becomes increasingly apparent, the industry will move toward greater integration and care coordination, ultimately enforcing the necessity of oral health as an imperative piece of the health care reform puzzle.

And as these proposed changes become a reality, the team at Delta Dental/WDS must continue to communicate the importance of providing dental benefits and quality care.