Dataset Information

Pricing in commercial dental insurance and provider markets.

ABSTRACT:

Objective

To examine the impact of commercial dental insurer and provider concentration on dentist reimbursement.

Data sources

We utilized provider data from the American Dental Association, reimbursement data from IBM Watson MarketScan^® Commercial Research Databases, submitted billed charges from FAIR Health^® , dental insurance market concentration data from FAIR Health^® , and county-level demographic and economic data from the Area Health Resources File and the Council for Community and Economic Research.

Study design

We used the Herfindahl-Hirschman Index to separately measure commercial dental insurance concentration and dentist concentration. We studied the effect of provider and insurance concentration on dentist reimbursement. Using two-stage least squares, we accounted for potential endogeneity in dental insurer and provider concentration.

Principal findings

Across the dental procedures we examined, a 10 percent increase in dental insurance concentration is associated with a 1.95 percent (P-value = .033) reduction in gross payments to dentists. Conversely, a 10 percent increase in dentist concentration is associated with a more modest 0.71 percent (P-value = .024) increase in gross payments. A 10 percent increase in dental insurance concentration is associated with a 1.16 percentage point (P-value = .016) decline in the allowed-to-list price ratio, while a 10 percent increase in dentist concentration is associated with a 0.56 percentage point (P-value = .001) increase in the allowed-to-list price ratio. Similar patterns were found across dental procedure subcategories.

Conclusions

Dental provider markets are substantially less concentrated than insurance markets, which may limit the ability of dentists to garner higher reimbursement.

SUBMITTER: Nasseh K

PROVIDER: S-EPMC7839642 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Pricing in commercial dental insurance and provider markets.

Nasseh Kamyar K Bowblis John R JR Vujicic Marko M

Health services research 20200826 1

<h4>Objective</h4>To examine the impact of commercial dental insurer and provider concentration on dentist reimbursement.<h4>Data sources</h4>We utilized provider data from the American Dental Association, reimbursement data from IBM Watson MarketScan<sup>®</sup> Commercial Research Databases, submitted billed charges from FAIR Health<sup>®</sup> , dental insurance market concentration data from FAIR Health<sup>®</sup> , and county-level demographic and economic data from the Area Health Resourc ...[more]

PMID: 32844447

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Project description:BackgroundMedicaid managed care plans change provider networks frequently, yet there is no evidence about the performance of exiting providers relative to those that remain.ObjectivesTo investigate the association between provider cost and quality and network exit.DesignObservational study with provider network directory data linked to administrative claims from managed care plans in Tennessee's Medicaid program during the period 2010-2016.Participants1,966,022 recipients assigned to 9593 unique providers.Main measuresExposures were risk-adjusted total costs of care and nine measures from the Healthcare Effectiveness Data and Information Set (HEDIS) were used to construct a composite annual indicators of provider performance on quality. Outcome was provider exit from a Medicaid managed care plan. Differences in quality and cost between providers that exited and remained in managed care networks were estimated using a propensity score model to match exiting to nonexiting providers.Key resultsOver our study period, we found that 21% of participating providers exited at least one of the Medicaid managed care plans in Tennessee. As compared with providers that remained in networks, those that exited performed 3.8 percentage points [95% CI, 2.3, 5.3] worse on quality as measured by a composite of the nine HEDIS quality metrics. However, 22% of exiting providers performed above average in quality and cost and only 29% of exiting providers had lower than average quality scores and higher than average costs. Overall, exiting providers had lower aggregate costs in terms of the annual unadjusted cost of care per-member-month - $21.57 [95% CI, - $41.02, - $2.13], though difference in annual risk-adjusted cost per-member-month was nonsignificant.ConclusionsProviders exiting Medicaid managed care plans appear to have lower quality scores in the year prior to their exit than the providers who remain in network. Our study did not show that managed care plans disproportionately drop high-cost providers.

Dataset Information

Pricing in commercial dental insurance and provider markets.

Objective

Data sources

Study design

Principal findings

Conclusions

Publications

Pricing in commercial dental insurance and provider markets.

Similar Datasets

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