Employers, and therefore brokers and consultants, often put their emphasis on the size of the provider network when selecting between dental benefits plans. Many people consider network size as a primary determinant of the plan’s value – thinking that the larger the network, the greater the employee access and overall savings. However, that simplistic approach may ultimately be shortchanging your clients and their employees.

“While a large network is important because of the potential for greater access, choice and savings it may provide to employees, it is important to actually do calculations to see if the potential for value can become the reality,” notes Alan Hirschberg, vice president, MetLife Dental Products. “One should take a closer look at whether the combination of network size and the negotiated fees with each dentist are actually driving value and savings for employers and employees.”

MetLife’s recently released guide, Check the Label: To Find the Dental Network That’s Right for Your Company, explains how employers must go beyond the standard measurement tools to better evaluate and compare the true value found in carrier networks. While accessibility and discount reports may provide employers with important insight about dental networks, these standard instruments also have limitations that can create “noise” in the numbers if applied too broadly. Even when a network appears to be much larger or smaller than others in these reports, there may be critical differences between the networks upon closer inspection – differences that could affect employee savings and satisfaction.

Determining the Size of the Network

Size comparisons may overlook significant differences in factors such as counting methodology, file maintenance and utilization of dentists in a network. For example, some carriers may count network access points, which help to quantify the distribution of dentists practicing at each location, while others may count unique dentists, which reduces the variation caused by counting differences.

“Unfortunately, there is no dental industry standard for counting how many dentists are in a network. Employers looking at just the initial numbers offered aren’t getting a complete picture; they must also take into account factors such as contracting strategy (i.e., degree of customization) and emerging network trends (e.g., turnover) to get a clearer understanding of what those numbers represent,” explains Hirschberg.

To counteract the potential differences between reports from carrier to carrier, Hirschberg suggests that employers be as specific as possible with their data requests and make sure they are working with timely data sets. Incomplete, inconsistent or aged data diminishes the validity of an employer’s analysis and may result in less meaningful reports, which could lead to poor benefits decisions.

MetLife’s recommendations for employers include:

Collect between six months and one year’s worth of provider disruption data to help ensure that enough current information is available to analyze and produce an effective report.
Specify the type of file used to deliver data. Spreadsheet programs such as Microsoft Excel, Microsoft Access and Database are recommended since they can be modified and compared with minimal conversion issues.
Ensure that data elements such as the time period covered and the geographic areas included are the same across carriers, in order to make meaningful comparisons.

In-Network Negotiated Fees and Effective Discounts

It is also important to look beyond the face value of percentages cited with regard to a network’s negotiated fees.

“Employers must ask: what are these fees based on? Are carriers counting dentists the same way? Are these reported savings based on consistent reductions or special fee arrangements?” says Hirschberg. “Those types of questions go beyond the limitations of traditional analysis tools and can help employers get at the heart of a plan’s true value.”

The “effective discount” is what is meaningful for determining the value of the plan to employees. That means understanding not only the strength of a network’s access and negotiated fees, but also how employees make use of those benefits. If employees still use non-participating dentists or participating dentists with higher negotiated fees (less discounted) because those are the ones they want to visit, then the effective discount for that particular carrier is lower. By looking at both the negotiated fees and how often they are used, employers can better understand what a plan will mean for employees and ensure that a carrier has the “right” dentists to meet their needs.

Other Plan Elements to Consider

A provider network is actually just one of many building blocks that determine the value of a dental benefits plan. The others – plan design, claims management, quality management, health promotion and service excellence – are also crucial. According to MetLife’s Check the Label guide, employers that make use of comprehensive evaluation techniques, in addition to the standard measurement reports, are more likely to understand how multiple factors work together to create value.

“Obviously, it is important to have a dental network that offers employees choice and location convenience, but there are many other criteria to evaluate in order to optimize plan value and employee savings and satisfaction,” notes Hirschberg.

By taking a closer look at dental network presentations, employers can improve the overall value of their benefits programs. While some employers use size as a proxy for value, it is only one part of the equation. The more important measures are satisfaction and savings.

To obtain an easy-to-use checklist of questions to help in your dental plan evaluation or to download a copy of Check the Label: To Find the Dental Network That’s Right for Your Company, visit metlife.com/dentalinsights.

Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force. Please contact MetLife or your plan administrator for costs and complete details.

Metropolitan Life Insurance Company, New York, NY 10166

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Beyond Size: Reconsidering How to Evaluate Dental Provider Networks

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