Shifts are transforming the way dental care is provided and experienced, bringing new opportunities and challenges. To help you stay informed and ready for what lies ahead, here are five dental plan trends to keep on your radar this year.
Trend 1. Evolving Network Adequacy and Network Access Standards
The rules for dental network adequacy continue to evolve as federal and state regulators amend standards to improve access to care. For instance, certain states and the Health Insurance Exchange Marketplace now use geographic distance calculation to measure network adequacy. This type of measurement considers geographic and topographic factors to calculate access rather than traditional drive-time estimates. As states adopt similar calculations, you want to keep pace by proactively adjusting your strategies.
Advanced solutions and analytics are shaping how you can address these challenges. “Proactively adopting advanced analytics and compliance monitoring tools like Quest Enterprise Services® (QES®) for Dental will be best positioned to meet these changes head-on. Such solutions allow you to identify gaps in coverage, optimize provider recruitment strategies, and ensure compliance while minimizing disruptions to member care,” explains Kerry Martin, National Sales Director at Quest Analytics®.
What to Watch Going Forward
Anticipate more states to continue to amend their network adequacy standards. We recommend you monitor applicable regulatory updates and be ready to adjust network strategies accordingly.
💡 Read our blog post to learn about the latest network adequacy and provider directory accuracy updates.
Key Dental Plan Trends and Strategies
Explore the latest trends in dental plans and networks with Kerry Martin, National Sales Director at Quest Analytics, and Kate Deiters, Marketing Specialist at Quest Analytics.
Trend 2. Greater Focus on Provider Data Integrity
Medicaid contracts continue to represent a cornerstone of revenue generation for dental networks. However, the pathway to securing these opportunities is becoming increasingly complex. As regulators raise expectations during Medicaid Request for Proposal (RFP) evaluations, the need for provider data accuracy stands front and center. Data errors—such as outdated provider contact information, excessive listings of specialties, or providers tied to multiple unverified locations—can jeopardize your contract eligibility.
Zach Snyder, VP of Government Affairs at Quest Analytics, explains, “Regulators are using more sophisticated solutions to evaluate networks during Medicaid RFP submissions. They can identify common errors such as outdated provider contact information, providers listed with excessive specialties, or providers associated with too many locations.”
These advanced evaluation methodologies emphasize one vital truth: maintaining high-quality provider data is no longer optional—it is a non-negotiable imperative for networks looking to remain competitive. Martin underscores this point, stating, “What we’re seeing, in order to prove yourself either to a regulator or to a payer partner, is that the provider data roster must be as accurate as possible.”
What to Watch Going Forward
Expect increased enforcement of provider directory accuracy regulations at the federal and state levels. Transparency in provider data—including address listings, availability, specialties, and whether providers are accepting new patients—will play a decisive role in securing contracts and maintaining trust with regulators and consumers.
💡 We recommend you conduct an internal review to ensure your data and processes comply with the requirements.
The Focus on Provider Directory Accuracy
Eliza Hoffman, Vice President of the Regional Payer Segment at Quest Analytics, discusses the changing priorities for dental benefit providers.
Trend 3: Regulators Sharpen Focus on Consumer Protection
Consumer experience is becoming a focal point for policymakers as they seek to protect members from misleading marketing practices and network inaccuracies. Kate Deiters, Marketing Specialist at Quest Analytics, elaborates, “Policymakers are concerned about the consumer experience. Their primary goal is to protect consumers. They’re closely examining how people shop for health plans, what they’re being told during the process, and whether the final product matches those expectations.”
A mismatch between marketing claims and network realities, such as providers who are not in-network or are unable to accept new patients, can be perceived as false advertising. These discrepancies, including issues like ghost providers, excessive travel distances, or significant delays in scheduling, erode trust, invite regulatory scrutiny, and fuel member dissatisfaction.
As Martin explains, “To have a provider at the right location is great, but if they’re not accepting new patients and you are, as a member, a new patient, then it doesn’t really do you any good. You still have that abrasion from the member’s perspective.”
What to Watch Going Forward
The focus on aligning marketing claims with consumer experiences will intensify. Regulators will likely enforce standards and penalties for network misrepresentation. We encourage you to audit your marketing materials and ensure accuracy in their directories to build trust and avoid backlash from both regulators and members.
Trend 4. Integrating Marketing, Data, and Strategy Teams for Network Management
Traditionally, marketing, data management, and strategy teams have operated independently. However, the increasing focus on comprehensive care and network transparency necessitates closer collaboration.
When data analytics inform marketing strategies and operational insights influence consumer communications, networks can more effectively demonstrate their value. Metrics such as accessibility, quality, and efficiency can be utilized to create compelling stories for members. Martin highlights the advantages of this integration, stating, “Aligning data and marketing helps networks be portrayed accurately, which builds trust with consumers and regulators.”
What to Watch Going Forward
Look for deeper integration of data analytics, marketing, and strategy teams within dental benefits providers. Plans will increasingly use claims data and performance metrics to craft compelling stories about their networks. Expect transparent reporting of cost and quality measures to become a critical part of provider network differentiation efforts.
Trend 5. Performance-Based Network Differentiation
Competition in the dental benefits space is intensifying, driving networks to differentiate themselves based on measurable outcomes. Martin explains, “To market your network effectively, you must differentiate it. Increasingly, organizations are doing this by focusing on cost and quality.”
These analytics empower them to assess provider performance based on metrics of both cost efficiency and care quality. Martin further explains, “The key question is: do I have the right providers who are high-performing on cost and quality metrics, that I can confidently present my network as superior to the competition?”
What to Watch Going Forward
Performance-based differentiation will continue to shape how networks are evaluated and marketed. Expect value-driven care analytics to play an increasingly central role in contract bids, member retention, and competitive positioning.
Looking Ahead
There you have it—five trends that are the talk of the town in the dental benefits industry. Keep your eyes peeled for more news because the world of dental plans is always evolving. Until next time, may your smiles be bright, your paperwork be light, and your data be right.
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Related Network Adequacy and Provider Directory Accuracy Resources
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