Altus Dental Confronts Challenging Landscape with Resolve

Biting Comments

 

 

Jim Kinney acknowledged that it will certainly take some time before the full impact of changes to the dental-insurance landscape in the Bay State — specifically a successful ballot initiative requiring insurers to dedicate 83% of revenue from premiums to patient care — is known.

But already, that landscape is changing, and in profound ways, said Kinney, vice president of Sales and Business Relations for Rhode Island-based Altus Dental, noting that several insurers have announced their intention to withdraw from the small-plan market in Massachusetts as a result of the measure, and more will likely do so in the months to come.

Altus isn’t one of them, he said, adding that the company is committed to staying in Massachusetts and continuing to provide small-plan coverage, despite the many challenges inherent with doing so.

“There’s been some contraction — five carriers have notified the Commonwealth that they’ll be exiting the market,” he told BusinessWest. “So right now, small group is really … turbulent. That’s the word I would choose to use; there’s going to be a lot of change.

“But we’re really committed to staying in the market,” he went on, adding that Altus prefers to look at these companies exiting the small-business market as an opportunity, one that will require an even greater emphasis on efficiency, something the company has always made a priority, and creating more volume — assignments we’ll hear more about later.

Meanwhile, beyond the turbulence, the companies exiting the small-market segment will be “doubling down,” as Kinney put it, on the large-market component, creating more competition and more challenges in the segment.

But Altus sees opportunities there as well, he said, adding that 2024 will certainly be an intriguing year, to say the least, as it looks to continue growing its membership in Massachusetts, which is currently about 230,000.

“We’ve been on a good growth trajectory, and with the market changes coming next year and going forward, we’re really expecting to see new sales in small group,” he said, adding that, in this environment, there is even more strength in numbers.

For this issue and its focus on insurance, BusinessWest talked at length with Kinney about how Altus, which has been steadily growing market share in Massachusetts, intends to continue its pattern of growth amid the tumultuous changes in the market.

 

Some Things to Chew On

In the run-up to the November 2022 election, insurers issued not-so-subtle warnings to Bay State residents that, if the ballot question passed, carriers would likely flee the state, leaving fewer options, especially in the small-plan market, and, more alarmingly, more people without dental insurance.

But, backed by the American Dental Assoc. and local dentists, the referendum question passed with ease, bringing dental insurers in line with healthcare insurers that are required by Obamacare to allocate 83% from premiums to patient care.

Now, some of those warnings are coming to pass.

Ameritas Dental Network and Principal dental insurance recently notified the National Assoc. of Health Plans, of which they are members, of their intention to abandon the Massachusetts small market. Those moves follow the announcement in August that Guardian Life Insurance, one of the country’s largest mutual insurance companies, had notified small businesses in Massachusetts that it would no longer provide dental insurance as a result of the ballot question.

And others will likely follow suit, said Kinney, who, when asked if the market was done shaking out, said simply, “there’s more to come.”

“The legislation goes into effect Jan. 1, but it’s going to be delayed, at least with some aspects of it,” he told BusinessWest. “We’re going to see more companies exiting the market, and unfortunately, that’s not a good thing for the health of the market.”

The small-business component comprises roughly 80% of the market in Massachusetts, with about 46,000 client companies, said Kinney, adding that this is a very large slice of the dental-insurance pie in the Bay State.

Now, there will be fewer players contending for slices of that pie, a scenario that, as noted, comes with opportunities and challenges, and probably more of the latter than the former, which is why companies are exiting the small-business market here.

“The numbers are very difficult; it’s difficult to make it work for carriers — they’re being really restricted,” he said of what’s known as the medical-loss ratio that is now being applied to dental insurers. “We have a bit of a different model — we’re more efficient, and we run a lot of new business on a much tighter margin than many can.”

And this efficiency, this ability to thrive on much tighter margins, will be ever-more important, said Kinney, who used some simple math to get his points across about this new regulation and why so many companies have decided to exit the small-business market.

He said a commercial market medical-insurance premium runs about $600 per month on average; this contrasts with $35 for a dental PPO and $20 for a dental HMO. Despite this huge monetary gap, dental and medical plans perform most of the same administrative tasks. That’s why most of the industry has long held that dental insurers should not be subject to the same medical loss ratio, in this case more than 80%.

Such numbers explain why, in this environment, there will be a premium on efficiency and providing value, he said, and with fewer competing players, on top of the new regulation, there will be added pressure on premium costs.

“We’re committed to being fiscally responsible, keeping premiums affordable, and focusing on high value for the premium,” he said. “But I do have concerns that less competition will erode some of that for the market. But our commitment is to remain affordable, with a good focus on value for our members.”

And one of the keys to keeping premiums affordable will be efficiency, Kinney noted.

“We’ve gotten down to a process with our technology where we get a lot done in a simple way,” he said. “I think we’ve just done a really good job of using technology to focus on getting the right things done in the most efficient way. Also, many of our employees have been here for 20 years, so they really understand our systems very well, and they can make things happen quickly.”

Elaborating, he said this emphasis on technology, such as electronic data files, enables Altus to sped up the approval process on many procedures and process claims more quickly, thus improving overall customer satisfaction.

 

Bottom Line

As noted earlier, this changing environment puts additional emphasis on both size and efficiency, Kinney said, adding that Altus, which, unlike some carriers, focuses exclusively on dental, is better-positioned to thrive in this climate than its smaller and larger competitors.

“We’re small enough that we’re nimble and able to make changes and really meet the demands of the market very quickly,” he explained. “But our infrastructure is large enough to handle the administration and be able to actually support all the things that go into this.

“We understand that this legislation is going to impact us financially, there will some challenges, and the policy is going to bring some negative consequences for Massachusetts,” he went on. “But with our 20 years of experience focused on dental and our position as one of the fastest-growing companies, we really think we’re well-positioned to navigate this market and the changes and challenges that are going on.”