David 0:00

Dental insurance was launched way back in 1954. What's changed since then? And what are some new developments coming your way? We'll find out on this episode of Shift Shapers.

Announcer 0:13

Change either paralyzes or energizes. The choice is yours. You're listening to the Shift Shapers podcast. You're about to learn firsthand from businesses and entrepreneurs who have successfully shaped the shifts in their industries. Get ready to become the change you want to see. This episode is brought to you by Shift Shaper Strategies. In sales, if you confuse, you lose. Clarify your message so you win more clients, crush your sales goals, and build your practice. Learn more at ChipchaperStrategies.com. And now, here's your host, Storybrand Certified Guide and Chief Transformation Strategist. At Chip Taper Strategies, David Saltzman. It's a fact.

David 1:06

We all have 32 teeth. And dental insurance has been around forever. And dental insurance has not really changed much, and it's something that we all do, but it's not really exciting. As a matter of fact, since it was invented in 1954, not an awful lot has changed. But there are some new and interesting developments. And that's why we've asked Josh Jackson, founder of Promptist, to join us today. Josh, welcome. Hey, thanks so much for having me on the show, David. It's a pleasure. So there's been a big resurgence in partially self-funded medical plans, but nobody has really thought, at least I haven't ever heard before you and I met, about somebody thinking about delivering dental on a self-funded platform. Talk about that. Talk about how it works and what it does.

SPEAKER_02 1:53

Yeah, so I would just say that the application of self-funding for medical is a great one. Employers are doing that today to obviously battle cost containment and the unsustainable rise of healthcare cost. And when you look at dental, it serves as a great application to self-fund because of its characteristics in nature. Dental is predictable, it's underutilized, the risk is low. So there's a big opportunity for employers actually to make their dental plans more cost effective by making that switch over to self-funded. The differences between a self-funded medical plan and a self-funded dental plan, there are a few differences. Well, one for dental plans, dental plans have a cap. That doesn't change with a fully insured plan. Fully insured plans have a cap involved, obviously, to cap the maximum exposure. But the second thing is that self-funded medical plan doesn't have stop loss unlike a traditional self-funded medical plan. So that is the core difference. And I would say that the one big opportunity employers have when they self-fund their dental plans, it's not only about cost savings, but there's an opportunity to really provide a better dental plan in general because again, you as the employer are taking the risk on. So you have the ability to take a lot of the traditional restrictions and exclusions, limitations out of your normal dental plan and in turn make it a better benefit that's designed to be used.

David 3:31

So what kind of plan designs do you generally build?

SPEAKER_02 3:36

Yeah, so our plans work. We actually take everything we know about dental plans and we throw it in the garbage. We're designing a dental plan that's actually designed to be used rather than a plan that's not designed to be used and it's complicated, it's hard, it's hard to understand, it's difficult to navigate. So, what type of plans do we design? So it really varies on the max that the employer wants to implement on their plan in general. But our plans cover 100% of all the different classes. So you have on a traditional dental plan, diagnostic and preventative services, basic, major, ortho, all those things are covered at 100%. And it covers 100% up to the annual cap that is designed by the employer. So the beautiful thing about what we're doing is we could design, we actually are expanding access to dental care because now we're making it so much more affordable because an employer, let's just say a very, very small shop that never even considered about offering dental benefits in the first place, they could roll out a plan that you know provides their employees with $200 a year just to get their cleanings and x-rays and exams. Likewise, you could have a let's just say a law firm, more white-collar industries that wants to design a very, very rich benefit, $5,000 cap, covers 100% of everything. So everything that we're rolling out is really designed to be around flexibility of how the employer wants to implement a dental program to hit their retention and hiring goals.

David 5:12

So explain to me, as if I were an employer, how this ends up costing me less money, or does it?

SPEAKER_02 5:19

So it depends on your goals. So you could design a self-funded dental program that is relatively looks very similar to you the normal dental plan you have today. Let's just say the caps are the same. I have a plan with Delta Dental, for example, has a $1,000 maximum. I could roll out a plan with a thousand dollar maximum with Promptus, and the actual expenses from the plan and plus the administration will actually look relatively the same. So it depends on the goals of the employer when you're matching it up. There can be an opportunity as you get based on the plan design to actually just offer a better benefits package in general. So it definitely varies on the particular goal at hand.

David 6:08

So is part of the attraction that you're removing some of the friction points that exist in the current fully insured dental universe?

SPEAKER_02 6:16

Absolutely. So traditional fully insured plans, you have this in, you have this out of network, you have UCR, you have Mac, all different types of reimbursement schedules, exclusions, limitations. All these things are put in the dental plan to protect the carrier from exceeding their plan expense projections or their expense on claims. And what we are doing is we're removing a lot of that friction and making it easier for the members to use because now they don't have to suddenly deal with deductibles or co-payments. They just have a plan with, say, a thousand to two thousand dollars. And how that looks from the member standpoint is we the beautiful thing about what we're doing is we're providing a debit card. And I'm actually, before I go into this, rolling out debit cards is typically seen with a lot of FSA, HSA, HRA programs are employing this type of technology on the ground to encourage better consumerism, make it easier for people to use their benefits. So we're taking that application from a technology standpoint and applying it to dental to make it easy for the members to use. So what this looks like on the ground is that our members, they could go to any dentist they want. We're not directing them to in or in network dentists, they go to any dentist they want, but we do provide a network if they want to take advantage of that and save. They get their work done, and all they have to do is literally just swipe their debit card. And that's just what makes it easy. That's what makes it simple for the member to be able to use their benefits. And the plan is also self-funded. So, again, based off that plan design, it could either the target could be to provide a better benefits package, or it could be on the cost containment side to save the company some money.

David 7:58

So does that not increase utilization?

SPEAKER_02 8:02

I would say that it definitely could increase utilization if the plan is, you know, open and covering all different types of services. But, you know, I think that it depends on your mindset when going into this. I think that if you are going to be more on the cost containment side, there are things, like I said, when you're going to self-funded in general, there are things that you could cost containment measures you could add into the plan to be able to save some more dollars at the end of the day. You could actually build a plan that only utilizes a network and nobody goes to out of network providers to decrease the cost. Or you could actually open something up and you could have this more flexible benefits package that Promptist is bringing to the industry that actually is now covering more cosmetic services. There's no waiting periods. So, yes, it could increase utilization, but I would say that like we as employers, we provide benefits to our team as a great incentive, right? To show them that we care about them at the end of the day. We care about their individual needs. And we don't want them to have to potentially be absent one day because of a having to need a tooth extraction or major implant work and they're anxious about that or they're not confident in the workplace. So, you know, providing this more holistic benefits package is a way to help them get the treatment they need while helping reduce their out-of-pocket costs.

David 9:30

You know, we hear frequently that dental health and regular dental visits are a great way to keep problems from happening or to spot problems early on. Do you find that and do you price for that in your model?

SPEAKER_02 9:43

I would say that preventative dental care is very important. There's a correlation between obviously your oral health and your overall health in terms of the diseases that could come from neglecting to get your routine cleanings, x-rays, exams, all the preventative work that would, you know, the diseases that could be able to come from that are heart disease, osteoporosis, and there's also many other very, very bad diseases. So we don't factor it into our pricing model, but it's certainly consideration. I mean, it's definitely a part of our larger goal to keep our members healthy. And I would also just say, going back to the big problem in this industry, you know, folks don't know today really what their plans are going to reimburse, what they're going to cover. They actually may forego dental treatment. The biggest reason people forego dental treatment is because of cost. That is definitely the biggest reason today. People don't want to go to the dentist because they're worried they're going to get a $500 bill that they may not be able to afford. And the consequences of that, if you're not going to the dentist and if you're not getting that cleaning twice a year, which is what dentists recommend, then you are more at risk for those larger health complications. And I think that what we're trying to do and make benefits easy to use and transparent upfront, clear up front to the member, is that they're more likely to, they know they're like, okay, I have, you know, $500 on my promptist debit card. I could go to my dentist. The cost if the money is going to be there, and I don't have to worry about the bill at the end of the day. And I think that's a great thing.

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David 12:26

So from the provider side, are there advantages for the providers? Do they get paid faster? Do they have a different kind of a relationship? Do they pens spend less time treating and chasing?

SPEAKER_02 12:36

So actually it's funny because I worked at a dental practice for around seven years. So I know the ins and outs of uh provider of billing with insurance companies and how that all works. But absolutely, they get paid right on the spot. They are not chasing down a check that's overdue from insurance company for over a month for a long period of time. From an administration standpoint, accounts receivable are simplified. They are not having to call 1-800 number to rectify payment. And it's just a big headache that's taken off their plate when members come in with promptists and actually use the benefits themselves. So it is great for dentists overall, and you know, and also their staff and their practices and helps them grow. And traditionally today, they have a terrible relationship with insurance companies, and insurance companies actually get in the way between patients and providers and prevent that success from happening. Because with the fee schedules involved, the dentists have to prioritize their billing structure at the end of the day with their staff. And they're not able to give patients the right amount of time and the quality needed because the insurance reimbursements are just so low at the end of the day.

David 14:00

I want to be clear, first of all, this is not something that needs to be attached to a self-funded medical plan. I just started there as an analogy. Is that correct? That is correct. Okay. So again, if I'm a broker and I'm talking to a prospect or a client, what's that conversation like? Because this is different. And sometimes employers, especially in the small and mid-market size, they're not really keen on different. They're a little different averse. What's that conversation like with an employer? Where do you start? How do you take them through the hoops to get them comfortable?

SPEAKER_02 14:30

Yeah. So where to typically start? So what are you using today? What type of plan are you on? How does it work? How are the mechanics explaining that? And what I mean by that are just explaining fully insured. Fully insured at the end of the day is it's insurance with a lot of different layers. You can think of it about it as an onion, right? And with self-funding, we're peeling back the onion. We're peeling back the layers. So just explain to your client where you are today. What is this idea of self-funding? Because self-funding, it's a big jump for a client to be able to walk through. There's a lot of things that you're gonna have to know. And the biggest thing is, you know, when people hear about self-funding, they think that they're gonna go bankrupt or something like that. It's a very scary concept. So just getting people comfortable, like, okay, why does dental make sense for self-funding? Well, it's because you have a cap involved, right? The cap uh protects the maximum exposure on the plan. So you could actually be able to point to them and say, hey, here, this is the number, this is the worst, worst case scenario, which really isn't that bad at the end of the day. So just getting that comfortable them comfortable with that endpoint. And then also just you have to work with the right TPA to put together the actuarial analysis on the potential plan expenses and just giving them an idea. This is what is expected from a plan expense standpoint. And hopefully that should run lower than what they're spending collectively in premium. And that's really what the delta is in terms of the savings you could be looking at. And I guess I just covered a few different conversations in one, but this would be a process of getting them comfortable, like understanding of what the process is like to self-fund and how it works. And then the next logical step is all right, well, let's see what the numbers look like. Let's take in a census, let's, you know, work with the TPA to do a lot of that actuarial analysis. And I would say that, you know, the best thing that we could do, which is very hard today, and this is the challenge in the industry that every advisor is coming across and they know, and is that it's hard to get claims data, right? With the self-insured medical plan, it's even hard to get claims data on a lot of groups because I think the proof is in the pudding. And it's the same case for dental. So typically you get the claims data for groups over the size of 100. And over time, we would like to see claims data being available for any group. So if we can get our hands on that claims data, that is really the proof at the end of the day. If we're looking to build a more cost-effective dental plan, and that is our goal, let's get our hands on the claims data. That's gonna be the proof right there. And preferably over three years, a three-year period would be a pretty sensible idea of how much this group is spending on premium and whether self-funding makes sense. And let me just kind of go back it. And if the numbers don't add up, and maybe that's not even what the group is looking for at the end of the day. Maybe, maybe their goal is not cost containment. Self-funding is just an application to build a better dental package that people are gonna love, that your employees at the end of the day are gonna be very, you know, they're gonna be thankful for and they're gonna be grateful for that benefit. So I would just encourage any advisor out there that it's it, the conversation, it may not be about cost containment. I work with a lot of advisors that the story is actually about filling in the gaps on the traditional dental plan, right? Like, so what are those gaps? Well, members, the out-of-network coverage is is very poor, right? There's no ortho coverage, there's no coverage for implants, things like that that the members need. So self-funding gives you that opportunity to fill in and remediate a lot of those gaps in the benefits package. And that's good for the client overall. And that's what I would say.

David 18:16

And you can build as an employer, you can build anything, if I understand you correctly, from just a pool of money to a plan with kind of more traditional gates and limits and and categories, correct?

SPEAKER_02 18:26

Yeah, absolutely. We who we are is like I said, we start on the radical end of, hey, this is what it looks like if we're gonna provide the best benefits package that your employees are gonna love. But we'll back it into a more custom approach to say, hey, this is if your employees got this dental plan, it's gonna look relatively the same in terms of the classes that are involved, the coverage. It's gonna be obviously better because there's gonna be better coinsurance, there's gonna be no deductible, there's gonna be the fine print that you see on your dental policy of where the exclusions are, all that is gone. So, but yes, you're correct in your assessment there.

David 19:04

I mean, on the other hand, a guy like me who's about to go get two crowns wouldn't have to out-of-pocket 800 bucks if I just had a pool of money. And the employer said, Hey, here's two grand a year, use it for your dental care, have fun. Yep, that's correct. And that's possible with a self-funded plan, where it's not possible with a more traditional type of plan. A great place to end our conversation today. Josh Jackson, founder of Promptist Josh. Thanks so much and continued good luck in building out your new model.

SPEAKER_02 19:30

Hey, David, thank you so much for having me on the show. This has been great. My pleasure.

Announcer 19:36

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