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Dental and medical health insurance are converging. Right here’s what it


Well being insurers are transferring in on the worthwhile turf dental insurers have claimed for many years; the variety of well being plans providing grownup dental advantages greater than doubled previously two years, in keeping with a brand new survey of dental- and health-insurance leaders we performed earlier this yr.

Because the convergence accelerates, extra customers can anticipate their well being plans to supply dental insurance coverage, albeit with a separate premium – a mannequin that would come to dominate the market within the subsequent few years.

With any basic shift in healthcare, nonetheless, comes a slew of pressing, complicated questions: Will some dental payers be left within the mud? How can they greatest adapt to those altering circumstances? What are the obstacles to convergence? And what is going to this shift imply for customers?

Convergence: a possibility or a menace?
Whereas the overwhelming majority of customers nonetheless depend on standalone dental insurance coverage, such insurers are quick discovering the bottom shifting beneath their ft: in keeping with a latest survey, by 2025, most foresee partnering with a well being insurer and almost half anticipate advantages to be bundled.

But whereas 28 p.c of dental-plan leaders see this as a possibility, almost half (49 p.c) understand it as each a possibility and a menace.

One want look no additional than the promise of value-based well being plans at this time to understand the potential upsides: partnering with the best well being plan – and getting access to its capital, scale, community and technological infrastructure – can present dental insurers with a extra holistic view of their sufferers and assist ship higher well being outcomes to extra sufferers at a decrease value.

But a few of these very belongings give well being plans the flexibility to upend susceptible dental payers. Executives we spoke to famous that well being insurers wield deeper pockets, have “extra premium to play with” – which means they’ll decrease costs extra flexibly than dental plans – and may provide one-stop-shop comfort that can be particularly interesting to youthful clients.

On the identical time, dental payers eyeing potential partnerships could also be cautious concerning the healthcare trade’s tendency towards deliberate – generally reluctant – change, as evidenced by the gradual adoption of pay-for-performance reimbursement fashions. And insurers have nonetheless not seen the blueprint for integrating the 2 merchandise and coordinating subsequent care between physicians and dentists.

Worse, well being plans will not be the one ones excited about competing in a market traditionally dominated by conventional standalone plans. Half of the executives surveyed consider that non-medical, ancillary insurers are additionally exerting vital stress on oral advantages.  Whereas a net-entrant into this area, many consider they might start grabbing membership and market share.

To thrive – and to search out the best partnerships – dental plans might want to get proactive and strategic: innovating in areas like various fee fashions, tele-dentistry and information sharing; tackling their know-how debt; optimizing processes by way of information administration methods and improved working metrics; and exploring their very own choices for diversification, be it by turning into third-party directors, buying or merging with different firms or providing ancillary merchandise (e.g. imaginative and prescient, listening to, life, pet) of their very own.

“It’s not just like the mouth isn’t linked to the physique”
Even supposing solely 37 p.c of US adults visited the dentist final yr, respondents to the survey say the largest issue driving dental-and-health plan convergence is the mixing of oral well being into total well being. This integration – mixed with value-based dentistry, partnerships with well being plans and the truth that having dental protection is the perfect determinant of whether or not a person will make common dental visits – ought to finally result in the next quantity of visits total.

On the medical facet, dental-health plan partnerships – particularly these with efficient know-how platforms – can drive higher well being outcomes, care coordination and larger simplicity for customers used to navigating a posh well being system.

The acquisition of a one-product, two-premium plan (i.e., dental advantages bundled with broader medical health insurance) also needs to converse to a millennial client base more and more in quest of comfort. As different insurance coverage markets converge, there could even be alternatives for enabling customers to bundle medical, dental, imaginative and prescient, and pet insurance coverage into single buying choices. Akin to the recognition of bundling house, life, and auto…some consider that this development could transfer in the direction of healthcare.

Although Covid-19 could sow uncertainty into the approaching convergence of dental and well being plans, now just isn’t the time for dental payers to take a seat idly by. With the momentum for bundling with well being plans rising and competitors from ancillary insurers heating up, solely those that take proactive steps to stake out a spot for themselves on this aggressive panorama will thrive as convergence accelerates. So, too, will their members.

Picture: Dmitrii_Guzhanin, Getty Photos


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Don’t forget to eat your veggies. Lots of them. . . . #veggies #vegetables…


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WATCH VIDEO | HEALTH MATTERS | Wellness experts say raising heart-healthy kids involves families, schools | News


With heart disease still the leading cause of death for both men and women, experts say it’s never too early to begin preventive measures.

“We start recommendations for a heart-healthy lifestyle in the OB (obstetrics unit),” Dr. Brenda Mendizabal said in a telephone interview from UPMC Children’s Hospital.

New mothers are given information and encouragement about health value of breast milk and risk of overfeeding, Mendizabal said.

“They set the conversation right away,” she said.

Mendizabal is a pediatric cardiologist who sees patients in Johnstown on Mondays at UPMC Children’s Specialty Care Center, 865 Eisenhower Boulevard.

A healthy diet, regular physical activity and not using tobacco are keys to preventing cardiovascular disease, the American Heart Association says.

It’s easier to practice a healthy lifestyle if you’ve grown up with it, Mendizabal said.

She provided some advice for parents raising healthy children.

“It really comes into play in the toddler years by encouraging more fruits and vegetables and less processed food,” she said. “Have at least one meal a day as a family.”

‘Mindless eating’

Children’s Health of Dallas, Texas, suggests planning meals, cooking and shopping for groceries with children to help them understand labels and healthy choices. Children’s Health is a pediatric health system associated with Children’s Medical Center of Dallas.

Time spent in front of the television, computer or other screen not only reduces time for physical activity, it can affect healthy eating, Mendizabal said.

“Don’t allow children to eat in front of the TV or a screen,” she said. “If you are eating in front of a screen, it’s really mindless eating. If they get away from the screen, they can pay attention and think about what they are eating and it allows kids to say, ‘I’m full.’ ”

Children’s Health suggests limiting a child’s screen time to two hours a day.

“Excessive screen time leads to a sedentary lifestyle and constant snacking, which increases the risk for obesity and cardiovascular disease,” Children’s Health website says.

Some apps on cell phones, tablets or other portable screens can encourage physical activity. Mendizabal tells parents that activity involved in Pokémon GO and similar apps can get kids off the couch and moving.

“In the age of technology, that’s all that they know,” Mendizabal said. “What I like to do is to use it as a tool to get them to get up and move.”

Regular activity is an important part of healthy living. To be effective, the activity should get the child sweating and out of breath.

“If you can get them to do that for 15 minutes a day, most kids aren’t even getting that,” she said.

‘A family affair’ 

Parents should set the example of a healthy diet and active lifestyle, the American Heart Association says on its website.

“We all need to do our best to walk the walk,” the Heart Association says. “If we want our kids to eat healthy and exercise, we’ve got to model that behavior. You’re not perfect, but if you’re determined and persistent, there’s not much that can stop you.”

Setting the example will also benefit parents, Mendizabal said.

“This is a family affair,” she said. “If a child needs to lose weight, he’s not the only one going on a diet. Nine out of 10 times, the whole family needs the same thing.

“This is an opportunity to make healthy decisions. This is an opportunity for parents to do something for themselves, too.”

When children start school, it becomes more challenging for parents to encourage their kids’ nutritious food choices, as well as their physical activity, Mendizabal said.

With tight budgets, cafeteria menus can feature more processed food, while emphasis on mandated testing and academics has reduced physical education requirements in many schools.

Wellness and education

Local school leaders say they continue to promote the health and wellness of their students.

Through a federal Fresh Fruits and Vegetables Program grant, Greater Johnstown School District is able to offer elementary and middle school students fresh options every day. The district also qualifies to offer all students free meals. Superintendent Amy Arcurio said.

But Arcurio admits the school can’t offer as much physical activity time during the school day as experts recommend.

“We are challenged with how much of our school day is spent teaching kids to read and core academics like science, math and history, while ensuring they have time to exercise and play,”Arcurio said. “At times there are not enough hours in our day to do it all. We strongly encourage our students to take full advantage of the many offerings of sports and after-school programs that also provide opportunities promoting physical activity and a healthy lifestyle.”

Central Cambria continues to address student wellness, Superintendent Jason Moore said.

“We are fortunate to have several members of our board of directors who have worked in the healthcare field or who are currently doing so, so health and wellness is a big priority for us,” Moore said.

He commends the district’s food service vendor, The Nutrition Group, for providing meals that exceed federal requirements.

“Our high school and middle school students have additional options beyond the menu,” Moore said. “They can choose from many different kinds of salads, and we have a fresh sandwich bar in which students can choose from a selection of meats and vegetables.”

Central Cambria elective classes include strength and conditioning, self defense and yoga, he said.

‘Stay in shape’

At Portage Area High School, a wellness center with free weights and cardiovascular and strength training machines is popular with both students and staff, Athletic Director Jeremy Burkett said.

Students can come to the center before or after school, but there is also a daily wellness class with instructor Martin Slonac.

The class is an elective beyond physical education, which is required for half the year.

“We take it to better ourselves,” Payton Zaytek said in the center.

“By taking this all year round, it helps us stay in shape,” Kory Kargo said.

Both juniors are three-sport athletes at Portage, but Slonac said about a third of the wellness class students are not on sports teams.

Principal Ralph Cecere said students regularly work out beside teachers who come to the center before or after school.

“We try to lead by example,” he said.


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Nutrition 101 with Dr. Mike

Dr. Mike explains the basics of a proper diet to help you get started on the path to a healthier life. If you have questions or comments for Dr. Mike please visit his Youtube channel: https://w…