One of the duties of the Minnesota Dental Association’s Dental Marketplace Committee is to “collect, review, and collate information on the effect of third-party involvement in the dental marketplace”. We attempt to keep abreast of the dynamic dental workplace and provide Association members with the most accurate information and advice. To aid in this goal, a survey of third-party providers was initiated to create a Payor Report Card. The survey was conducted at the end of 2008.
This survey concept was approved by the MDA Board of Trustees (BOT) and funded by budgeting at the 2007 House of Delegates. MORI Research, an outside firm that has specialized in market research for more than 25 years, administered the survey, with some MDA oversight. Outside expertise was sought for the following reasons:
• To eliminate potential bias in the survey process
• To safeguard confidentiality of respondents
• To format the survey in a user-friendly design
• To compile data in an efficient manner
• To avoid unduly burdening MDA staff
Establishing the Format
The first decision involved selecting who we would survey. Our choices included patients/subscribers,employers/HR staff, and dental service providers/dental offices. Each group has its own perspective and varied experience. The Committee chose to begin with the dental providers/dental offices due to pool size, likely product knowledge, and ready access to email addresses.
This choice provided a manageably sized group (2,066) with an active email list, a survey group with vested interest in the topic, and the ability to ask more sophisticated questions. The possibility of additional future surveys of other targeted groups remains.
Another decision was how to conduct the survey. Options included mail, telephone, email, or a combination of these. The choice of email was selected due to lower associated costs, speed, easier data compilation, the desire to move our membership forward technically, and the desire to create a model which will allow the MDA to better conduct their own online surveys in the future.
This decision was integral in the selection of MORI research, as they expressed electronic surveys as an area of strength.
Making It Work
The Dental Marketplace Committee understood we would not reach everyone (75% of the membership have shared their email addresses) and that getting past some email filters could also be an issue.
The survey was designed to be completed by the “most knowledgeable person” in the office, which could be dentist, receptionist, business manager, and so on, so it could be delegated to the appropriate person. It was designed to be completed in 20 minutes or less. As an additional incentive to complete the survey, three randomly selected participants were awarded $100 gift vouchers. The potential goals included:
• Learning about our members’ perception of their most utilized third-party payors
• Finding critical areas of comparison of payors
• Assessing strengths and weaknesses of payors
• Helping MDA members become more aware of comparison criteria
• Providing payors feedback and helping them improve performance
• Creating an ongoing process to measure performance
• Determining the level of concern on this topic by the membership
• Enhancing the MDA’s ability to conduct surveys, especially of its Membership
The Marketplace Committee also brought forward several considerations for the BOT to consider prior to the survey’s approval:
• Results would be dependent upon member (office) cooperation. We need a reasonable number of respondents to allow for valid conclusions.
• Results may not differentiate payors.
• It is difficult to conduct a survey without some degree of bias that may jeopardize the validity of results.
• New state law for “Uniform Electronic Transmissions” may make portions of the survey quickly obsolete.
• A survey will not serve all our members equally; i.e., those who do not participate in any programs, those who have no choice in their participation, etc. may not see the same value in the survey.
The Marketplace Committee, and subsequently the BOT, felt the potential outweighed the concerns. The Committee also felt this may allow us to tap into the silent majority of our members.
Twenty-five questions (plus demographic information) were asked, generating 330 pages of data. Respondents were asked to evaluate only their top three payors by volume to provide a broad claim experience. Among our demographic questions was inquiry as to who in the office completed the survey. Seventy-seven percent of the surveys were completed by a dentist.
Questions about coding, contract issues, reimbursement, and service issues were posed. Several questions did not closely differentiate between some or all payors. Results offered here are a sampling of responses that indicated perceived differences.
Sampling of Results
Delta Dental of Minnesota was reported by 78.6% of respondents as their largest payor. Public programs were second with 6.1%, and Met Life and HealthPartners tied for third with 3%.
Asked if bundling, downcoding, or code changing occurred “every time or often” and asked if alternative benefit provisions were administered fairly, nearly an inverse relationship existed, as outlined below:
On Contract Issues:
1. Fairness of provider contract
2. The clear majority of respondents felt their contract was unclear about extending the provider network to other purchasers, although Doral/UCare, United Concordia, and MDB fared best.
3. Site audits were conducted at respondent’s office by:
4. Respondents felt all audits were fairly conducted, except for 36.4% of those by Delta Dental of Minnesota (8 audits).
When asked about the typical reimbursement for office usual and customary fees, respondents reported: Public programs: 50% were reimbursed at less than 40% of their
office fees, 68% were reimbursed at less than 50% of their office fees, 87% were reimbursed at less than 60% of their office fees.
Questioned about benefit/eligibility files, all payors were judged somewhat to very accurate.
Rated on timeliness of an appeal/re-submission, Guardian and MDB were judged superior.
Questioned about usefulness of information on payor website, MDB and Public Programs outscored the competition, with Aetna and Cigna at the bottom.
Evaluating timeliness to speak to a network representative, HealthPartners, MDB, and Delta received the top scores, while Doral/U Care finished last.
Under co-ordination of benefits, Doral/U Care and United Concordia scored the lowest on promptness and were also judged least accurate.
For access to a decision-maker, MDB scored highest, while Doral/UCare was judged significantly worse than other third-party payors.
Asked about timeliness and helpfulness of information updates and newsletters, Delta Dental and MDB both scored highest, with Doral/UCare and Cigna at or near the bottom of both categories.
Unfortunately, the Committee was disappointed by the poor response from our membership. A considerable amount of time and resources were spent on this project, but without good participation, no survey generates valuable information. Only 164 responses (139 general practitioners) were received, which is only about 8% of the 2,066 emails sent. If calculated against total MDA membership or total dentists in the state, the percentage would be lower yet. This low rate of response makes even the strongest distinctions questionable. Such a small group is likely to have a large proportion of respondents with above average interests in the topic. This potentially introduces another type of error.
Possible reasons for the low response rate include:
MDA membership dislikes being surveyed or is surveyed too frequently
An online survey is the wrong method at this time.
This topic doesn’t generate adequate interest.
Whatever the reason, the Marketplace Committee would like to thank those who did respond and will continue to explore ways to provide information about the dental workplace.
*Dr. Kurkowski serves as ex officio to the Dental Marketplace Committee from the MDA Board of Trustees, and produced this article at their request. He is the MDA Speaker of the House, and a general dentist in private practice in Saint Paul, Minnesota.