Pennsylvania startup takes the middleman out of dental costs | Crain's Philadelphia

Pennsylvania startup takes the middleman out of dental costs

Dr. Michael Jefferson, right, works on a patient at the Smile Exchange in Turnersville, N.J. The Smile Exchange is working with Kleer, a startup that allows dentists to offer their own dental care plans directly to patients. | Photo courtesy of Smile Exchange

Dr. Morrie Rosen has been looking for a new way to offer his dental patients a reason to stick with his practice, whether or not they have dental insurance.

Rosen, who has been practicing in northeast Philadelphia for 25 years, is one of the first 70 dentists in the country involved with Kleer. Launched in late September, the platform allows dentists to offer a subscription service that provides many of the benefits of traditional insurance at lower cost by cutting out the middleman—the insurance company.

“This is something different than what’s on the market,” Rosen said. “It’s not just a discount plan. From the dentist’s standpoint, it’s a way to market toward companies and help companies reduce their HR [human resources] costs.”

Kleer, a Wayne, Pa., startup is not just a way for companies to reduce the cost of providing dental coverage for their employees. It’s also a way for people without insurance coverage to cut the cost of getting care.

It’s common knowledge that most people just don’t like going to the dentist—and lack of insurance coverage is just one more excuse. The Centers for Disease Control and Prevention estimates that 31.6 percent of adults ages 20 to 44 had untreated tooth decay between 2011 and 2014. Research indicates fewer than half of U.S. consumers visit a dentist annually, an October 2017 study in the journal Health Affairs found.

Kleer provides a platform for dentists to connect with patients directly. Patients subscribe to various levels of care for an average $20 to $30 a month—less than half the average figure quoted by two major nonemployer-provided plans—and the dentist sets the discounts for such services as fillings and crowns. The subscription price includes routine cleanings, exams and X-rays, along with emergency exams.

Kleer CEO Dave Monahan said dentists will be able to keep 90 percent of all payments made by patients and free up the time it takes to process insurance claim forms, giving them more time to focus on patients. In larger practices, at least one full-time employee handles insurance claims, he noted.

Rosen said he spends “way too much time” on insurance issues.

“It increases the costs of dental care,” he said. “You need to have auxiliary staff to file the claim, track the claim, make sure the payment comes in, make sure the payment matches the claim—all this costs.”

Rosen describes his practice as medium-sized. He has one partner, a specialist who comes in once a week, three hygienists and auxiliary staff members.

“When you see all these people walking around in a dental office, that’s what they’re doing, handling insurance,” he said.

Reducing the paperwork could mean lower prices for consumers.

“What’s going to happen over time, as more dentists offer plans, I think there will be dentists who say, ‘I can do better and start lowering prices,’ going to lower prices to push volume, and the other model will hold or increase [prices] because quality of care is higher,” Monahan said.

Dental insurance plans are very complicated and expensive, Monahan said, and have numerous limitations on what can be covered, as well as caps on what insurance will pay in a given year. Twenty percent of all claims get rejected, he said, and reimbursement rates for dentists haven’t been raised in years despite increasing costs for materials and wages.

“The product doesn’t work,” he said. “This [Kleer] is a better way.”

In addition to simplifying coverage, Kleer also is designed to take the mystery out of dental pricing, drawing statistics from Fairhealthconsumer.org, which breaks down pricing by ZIP code. For example, a one-surface white filling in a back tooth costs $206 in Philadelphia, as compared to $220 in Chicago, $350 in New York and $172 in Omaha.

“Consumers have no idea how much to pay for dental procedures,” Monahan said. “We will provide more transparency in pricing.”

Monahan said Kleer is just the next industry disrupter.

“The middleman, in this case insurance companies, is not so valuable anymore. People don’t want middlemen. They’d rather go direct. You see it in Uber. You see it in Airbnb. It’s happening everywhere. This is just one more market,” he said.

So far, Monahan said the reception among dentists has been positive and he has a waiting list of 200 who want to get into the pilot program. Before expanding, though, he said he wants to gauge patient reaction and hopes to launch nationwide by the first of the year.

Dr. Dave Preble, vice president of the American Dental Association’s Practice Institute, said he sees a future for what he described as “in-office discount plans” like Kleer, which he compared to concierge plans adopted by medical doctors who offer better access and other benefits in return for a retainer fee.

Preble said the obvious advantage of employer-offered dental insurance is the subsidy that reduces the costs to individuals, but for those without employer-subsidized insurance, these in-office plans might be the way to go.

Of course, that doesn’t guarantee people will actually see a dentist.

“There are a number of reasons people don’t go to the dentist,” he said, estimating a third of individuals don’t. “The two top reasons [in our surveys] are costs [even with insurance] and ‘My mouth is healthy.’”

 

October 10, 2017 - 4:14pm