Final Thoughts When Selecting a Plan

Participants insured with a dental PPO insurance plan are responsible for paying their deductible before receiving any reimbursement.  One of the key differences between dental HMO insurance and dental PPO insurance is that DPPOs usually allow dentists to spend more time with insured patients.  Dentists in dental HMO insurance plans are expected to see a certain number of patients, so some dentists have been known to rush through dental appointments.  A PPO dental insurance plan consists of numerous dentists that sign up to join a network insurance system or group with hopes that they will have many patients to service.  When subscribers join a PPO dental plan, they benefit from lower out-of-pocket costs when they see one of the network dentists.

Considerations

Similar to the HMO dentist, a dentist that accepts PPO dental insurance members will do so in an attempt to establish a patient base.  Before choosing a PPO dental insurance plan, make sure that there are dentists available in your area that accept the plan.  Typically, PPO dental insurance plans are said to offer better service and have less limitations than HMO dental insurance plans, but the premiums are usually more costly.  The rates are usually lower if the insured member selects a primary dentist and/or dental specialists from the dental PPO network, but the insured individual still has the freedom to choose a dental care provider outside of the established network.

In 2007 the US Congress created the priority review voucher program to encourage the development of drugs for neglected diseases. Under the program, the developer of a drug that treats a neglected disease receives both a faster review of the drug by the Food and Drug Administration and a voucher for a faster review of a different drug. The developer can sell the voucher. We estimated the commercial value of the voucher using US sales of new treatments approved in the period 2007–09. A third of the commercial value of a voucher comes from capturing market share from competitors, nearly half from the value of earlier sales because of the expedited review, and less than a quarter from lengthening the time between approval and the launch of a generic competitor. We estimate that if only one priority review voucher is available in a year, it will be worth more than $200 million, but if four vouchers are available, the value could fall below $100 million. Congress should be cautious about expanding the voucher program, because increasing the number of vouchers sharply decreases the expected price. Lower voucher prices could undermine the incentive to develop new medicines for neglected diseases.

Deductibles and Coinsurance – Typical with a PPO Dental Insurance Plan

With a PPO dental insurance plan you will usually have a deductible and a coinsurance amount.  In some cases, PPO dental plans will give you an option to seek dental treatment outside of the directory of dentists.  If your PPO dental plan provides this option, you will most likely be required to pay a higher coinsurance and your maximum payable benefits amount may also be greatly reduced for treatments outside of the network.

Integrated care aims to organize care around the patient instead of the provider. It is therefore crucial to understand differences across patients and their needs. Segmentation analysis that uses big data can help divide a patient population into distinct groups, which can then be targeted with care models and intervention programs tailored to their needs. In this article we explore the potential applications of patient segmentation in integrated care. We propose a framework for population strategies in integrated care—whole populations, subpopulations, and high-risk populations—and show how patient segmentation can support these strategies.

Through international case examples, we illustrate practical considerations such as choosing a segmentation logic, accessing data, and tailoring care models. Important issues for policy makers to consider are trade-offs between simplicity and precision, trade-offs between customized and off-the-shelf solutions, and the availability of linked data sets. We conclude that segmentation can provide many benefits to integrated care, and we encourage policy makers to support its use.

Learn about Dental PPO’s Preferred Provider Organizations:

Another true insurance plan, a preferred provider organizations ( PPO) falls somewhere between an indemnity plan and a dental HMO.  A PPO dental insurance plan will provide you with more freedom to choose your dentist than an HMO dental plan.  You will be able to seek dental services from a wider selection of dentists and may visit any dentist or specialist within the PPO network.

Preferred Provider Organizations

Another true dental insurance plan, a Preferred provider organizations ( PPO) falls somewhere between an indemnity plan and a dental HMO. This plan allows a particular group of patients to receive dental care from a defined panel of individual dental insurance dentists. This type could be used to provide dental gap insurance.

The participating individual or family office agrees to charge less than usual fees to this specific patient base, providing savings for the plan purchaser. If the patient chooses to see one who is not designated as a “preferred provider,” that patient may be required to pay a greater share of the fee-for-service.

A group of individual or family dentistry providers agrees to provide services at a deeply discounted rate, giving you substantial savings — as long as you stay in their network. Unlike the more restrictive DHMO, though, you can go out of network and still receive some benefits.

Although spending rates on health care and social services vary substantially across the states, little is known about the possible association between variation in state-level health outcomes and the allocation of state spending between health care and social services. To estimate that association, we used state-level repeated measures multivariable modeling for the period 2000–09, with region and time fixed effects adjusted for total spending and state demographic and economic characteristics and with one- and two-year lags. We found that states with a higher ratio of social to health spending (calculated as the sum of social service spending and public health spending divided by the sum of Medicare spending and Medicaid spending) had significantly better subsequent health outcomes for the following seven measures: adult obesity; asthma; mentally unhealthy days; days with activity limitations; and mortality rates for lung cancer, acute myocardial infarction, and type 2 diabetes. Our study suggests that broadening the debate beyond what should be spent on health care to include what should be invested in health—not only in health care but also in social services and public health—is warranted.