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 MINNEAPOLIS, Nov. 23 /PRNewswire/ -- A new group of Twin Cities dentists has embarked on an effort to do what has long eluded the dental industry -- establish treatment protocols that will be widely practiced by dentists across Minnesota, thus reining in dental care costs.
 The effort, spearheaded by the recently formed Delta Associates LTD, differs from previous protocol-development endeavors in that it is a ground-up effort by practicing dentists who will be using the guidelines.
 Delta Associates is a new metro-area group practice. Delta Dental Plan of Minnesota sponsored the formation of this non-profit professional corporation to answer the growing demand for managed dental care under health care reform. Together with a contracted affiliated group of independent dentists across Minnesota, Delta Associates will serve the state's emerging Integrated Service Networks (ISNs). Both groups -- Delta Associates employees and their affiliated dentists -- will follow the protocols that are being established.
 At present no set of universally accepted practice protocols exists for general dentistry, according to Thomas Ireland, D.D.S., dental director for Delta Dental Plan of Minnesota. "This means if we sent a patient to a number of different dentists, that patient may be presented with a number of different treatment plans, which could all be considered professionally acceptable," he said. "Variations such as this may signal overtreatment or undertreatment, both of which are inappropriate and result in unnecessary expense.
 "In addition, the care patients receive is often based on the provisions of their dental benefit package rather than by protocols that represent the appropriate care for a particular situation," he added.
 Standardized protocols are a key factor in Delta's strategy for achieving cost effectiveness and quality, two of the main goals of health care reform, Ireland said. "If we're going to provide managed care, we have to have a baseline against which to decide what's appropriate," he said. "That's what the protocols will provide for us.
 "Also, we want to make sure patients are getting appropriate care that's cost-effective. That, in a nutshell, is the definition of value."
 Protocols are intended to be a starting point in standardizing dental care. "Any treatment protocol should be modified by factors such as the patient's age and medical condition," Ireland said. "But protocols are helpful in spelling out appropriate treatment, given an average situation."
 The protocol-setting panel will examine current dental practice patterns in the state, aided by statistics Delta Dental Plan gathers from its provider networks, which include nearly all the state's 3,000 dentists. The panel will also consider guidelines that have been used by other professional groups, such as the California Dental Association.
 The protocols will only address issues related to general dentistry, since some organizations of dental specialists have agreed-upon guidelines, according to Ireland.
 "We will subject any protocol to three questions: 'What is most commonly done?', 'Is is appropriate?', and 'If the panel agrees it isn't appropriate, what better protocol can be put in place?'," Ireland said.
 The panel currently consists of the following members:
 -- Dentists from Delta Associates and their affiliated independent providers
 -- A dentist representing the providers participating in Delta's Dental Outcomes Research Study with Honeywell employees
 -- A representative of the University of Minnesota School of Dentistry
 -- A representative of the Minnesota Department of Health
 -- A representative of the State Board of Dentistry
 -- A representative of NQA, Inc., an independent professional review organization
 -- Ireland, who chairs the panel and acts as an ex-officio member.
 Many types of organizations -- including the American Dental Association, HMOs and other third-party payers, and universities -- have attempted to establish usable protocols, according to Ireland. The work of the Delta Associates panel will avoid some of the problems that have hampered these efforts, Ireland said, through these important differences in process:
 -- The panel developing the protocols is made up primarily of practicing dentists, not academicians or representatives of insurance companies.
 -- The protocols will be developed and used by independent dentists across the state, as well as by employees of Delta Associates, the organization that is leading the development effort.
 -- The protocols will be reviewed by experts from an independent review board and the state's board of dentistry, health department and dental school.
 -- Dentists formulating and using the protocols will have some financial stake in putting them into practice.
 -- The panel will be working with a reliable set of statistics reflecting practice patterns in the state, provided by Delta Dental.
 The panel, which had its initial meeting in September, plans to have a baseline book of protocols to present to the entire Delta Associates group and their affiliated independent providers by April 1994. However, the process of developing protocols will be ongoing.
 "Technology improves continually in dentistry," Ireland said. "We'll never be completely done developing and fine-tuning protocols." An ongoing review process conducted by Delta Dental and Delta Associates will ensure continuous improvement of the protocols, he added.
 Delta Dental will assess providers' adherence to protocols by analyzing care patterns and periodically reviewing patients' charts. "If we find variations from a protocol, we will review the factors that led to the deviation, and we will review the protocol to see if it is valid," Ireland said.
 Delta Dental Plan of Minnesota is the state's largest provider of dental coverage. Nearly one million Minnesotans are covered by Delta's managed-care and fee-for-service plans.
 Questions and Answers About
 Q. What is Delta Associates LTD?
 A. A group dental practice with offices in the Twin Cities metro
 area. This non-profit professional corporation was recently
 established under the sponsorship of Delta Dental Plan of Minnesota.
 Q. Who are the employees of Delta Associates?
 A. Delta Associates are established Twin Cities metro area dentists
 invited by Delta Dental Plan of Minnesota to join because of their
 reputation for providing high-quality dental care and their desire
 to form a group practice.
 Q. Why did Delta Dental Plan of Minnesota decide to sponsor Delta
 A. Delta Dental Plan brought together Delta Associates to function
 as the core of a provider network Delta Dental will offer to
 developing purchasing coalitions and Integrated Service Networks
 (ISNs). The MinnesotaCare legislation of 1992 authorized the
 formation of ISNs, new health care delivery mechanisms designed to
 be accountable for the costs and outcomes associated with delivering
 a continuum of health care services to a defined population.
 Q. What about access to Delta dentists for persons in Greater
 A. Delta is also inviting independent providers throughout the
 state to be contractually affiliated with Delta Associates. These
 independent dentists are being organized into regional and statewide
 networks to provide access in both Greater Minnesota and the Twin
 Q. How will the protocols the panel is developing affect these
 provider groups?
 A. To standardize the delivery of quality care through ISNs, all
 Delta Associates employees and contracted affiliated providers will
 follow the treatment protocols.
 -0- 11/23/93
 /CONTACT: Thomas Ireland, D.D.S., of Delta Dental, 612-944-5252, ext. 280; or Kristi Fuller, of Colle & McVoy, 612-851-2635, for Delta Dental/

CO: Delta Dental; Dental Associates ST: Minnesota IN: HEA SU:

CP-DB -- MN001 -- 7154 11/23/93 09:18 EST
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Publication:PR Newswire
Date:Nov 23, 1993

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