Dental
Metropolitan Health Risk Management offers a comprehensive managed care dental programme that not only focuses on managing the end stages of oral disease, but also puts emphasis on evidence-based, preventative care plans with the purpose of proactively identifying, managing and eliminating the risk factors for oral diseases. This is to ensure the delivery of cost effective, quality, accessible and long-lasting oral healthcare solutions to members.
The programme provides the following services:
- Proactive rules-based claims processing management system. The rules are based on different parameters, clinical guidelines and evidence-based dentistry.
- Dental care plans that are designed to identify and eliminate dental risk factors, thereby reducing the need for specialised and surgical dental procedures. The focus is on early identification of caries and periodontal disease, followed by the management thereof.
- Pre-authorisation of certain dental procedures and in-hospital procedures according to clinical rules, accepted industry standards, evidence-based dentistry, clinical protocols and guidelines.
- Clinical advisory services from qualified dentists and dental specialists.
- Input into the relevant scheme's benefit design.
- Proactive wellness and targeted member education programmes on oral health conditions, causes and treatment options, home care and preventative measures. This is delivered for targeted members, through online articles or dental screening during health days.
- Nationwide provider network, customised for a specific scheme and products.
This programme is strictly managed according to standard operating procedures, and strict protocols and formularies, to ensure that appropriate treatment is rendered to members in a cost-effective manner.
The dental programme interacts with other internal managed care programmes to ensure a holistic and integrated approach, namely in-hospital dental procedures with hospital risk management and disease risk management for identification of members at risk of certain oral disease.