Investing in the Smiles of the Future

Cavities are the most chronic childhood disease, five times more common than asthma. In an effort to give kids a chance for a brighter future, Delta Dental of Colorado began offering Right Start 4 Kids^® (RS4K) in 2017. Two years in, all small groups (and 75% of all of our covered businesses) now have this benefit enhancement.

Because of the addition of the Right Start 4 Kids benefit, we are seeing positive trends in benefit utilization, with a 5% increase in preventive visits in children under 13. We hope to continue to be able to add this benefit to all of our groups—large and small—and continue leading the way in helping to create healthier smiles in all Colorado kids!

Innovating by Listening to the Voice of our Customers

One of the hallmarks of Delta Dental of Colorado has always been the world-class service we provide to our members, employer groups, and dental offices. We've always been committed to high service standards. With that in mind, our Voice of the Customer program measures and monitors our performance monthly and keeps our ear to the ground on what our important stakeholder groups have to say about us.

In 2018, we saw improved overall satisfaction with Delta Dental of Colorado within our three stakeholder audiences (employer, member, and provider). The Voice of the Customer program has provided us with the ability to learn first-hand of opportunities for continuous improvement, which we have transformed into actionable change and transformation. After all, feedback is a gift.

Driving Change Through the Customer Journey

Delta Dental of Colorado is committed to delivering world-class service to our customers. In order to meet their needs, we must look at the customer experience from their point of view. In 2018, we kicked off the first Customer Experience Council. It was composed of nine employee volunteers representing a cross-section of the organization. These individuals went through several training sessions to learn about human-centered design thinking, which involves interviewing and listening to real customer experiences, understanding the functional and emotional needs of customers, identifying pain points in the customer journey, and creating solutions that are in alignment with the customers' perspective.

This leads to innovative products and services, and helps us view things from the customer perspective to come up with solutions for the real-world problems facing them. As we look to the future, having the customer at the center of the conversation also helps to break down silos because there is a common goal of having the best interest of the customer in mind.

Forging the Path Through Catalyst

Delta Dental of Colorado joined the Catalyst Health Tech Innovation (HTI) community in the fall of 2018. Located in Denver's River North District (RiNo), Catalyst HTI is bringing together private enterprise (startups to Fortune 100), government, academic, and nonprofit organizations with health care providers and payers to accelerate innovation and drive real, lasting change. Oral health is an integral part of overall health, and we want to make sure that it also becomes an integral part of the health care conversation.

It's thanks to the collaborative spirit that Catalyst brings to its community, that a partnership has already formed with two other tenants: CORHIO and the University of Colorado/UC Health. The three partners have come together to tackle one of the more persistent problems in oral health care: people getting oral health care in emergency room settings when they should be getting regular preventive care in a dental setting. By using CORHIO's data services and health information exchange technology to analyze clinical and claims data for a certain segment of Delta Dental's membership, the partners are attempting to identify opportunities to identify proactive care to:

• Improve the patient experience
• Improve population health
• Reduce the cost of health care

Word of Mouth

There's an important connection between oral health and overall health. More than 90% of all systemic diseases are linked to oral health. Poor oral health can lead to and escalate serious overall health issues and can also be pricey. An untreated cavity can cost you more than $6,000 over the course of a lifetime.

Through the years, we've worked to help spread the word of this important connection while aligning to our mission to improve the oral health of the communities we serve. It's by serving in our communities and partnering with various organizations that we've gathered important first-hand stories of people who have experienced the important connection between oral and overall health. We encourage you to view the videos and stories included on the Words of Wellness webpage and share your stories with us by sending them to communications@ddpco.com.

Using Technology to Make Connections Between Oral Health and Overall Health

Technology has come a long way in 60 years. Who would've thought when we first opened our doors that we'd be able to communicate directly with our members through various online platforms and media. Delta Dental of Colorado's social media team has spent the past year in the trenches of Facebook, Twitter, Instagram, LinkedIn, Pinterest, and our very own blog, ensuring that Coloradans have information on oral health, dental insurance, and much more, literally at their fingertips.

Thanks to information gathered in 2017 through our Customer Experience (CX) Council, we were able to find that one of the biggest reasons people don't go to the dentist is fear (80% of Americans have some anxiety regarding dental treatment). Our social media team was able to craft a campaign aimed at targeting those who fear the dentist with the hope that:

• Members could overcome dentist-related fear by using simple techniques.
• Providers would understand the widespread commonality of dental anxiety and ensure their staff understands and is able to help anxious patients.

The campaign launched in the fall of 2018 with a video aimed at shattering the stigma around dental phobia.

In addition to helping clear the stigma of dentist-related fear, our social media team also takes on the daily task of ensuring our members receive the customer service they deserve with direct messaging functions through Facebook, Twitter, and Instagram. We received more than 400 questions, comments, and concerns through direct messaging on these platforms and were able to respond to them directly in less than an hour.

A New Mission Brings Opportunities for a Lifetime of Care

For more than 20 years, Delta Dental of Colorado Foundation (DDCOF) has worked to improve Colorado's oral health by eradicating childhood tooth decay. We're proud of our work toward that mission and the efforts of our grantees and the partnerships we've formed.

However, oral health impacts Coloradans of all ages. In 2018, DDCOF celebrated the completion of a strategic planning effort and launched a new mission: to elevate the well-being of all Coloradans by improving oral health equity.

Our expanded mission inspired new opportunities for grant-making to help reach historically overlooked communities. A fresh approach was needed to connect with organizations that aligned with our strategic focus areas:

• Access to care.
• Prevention of tooth decay.
• Connections to overall health.

A Listening Approach to Improving Oral Health in Colorado

As part of our new strategic direction in 2018, we refocused our efforts to listen more to community needs and priorities, and collaborate with communities to inform our work.

We proudly partnered with 29 Colorado nonprofits through our inaugural open funding opportunity. By providing $3.4 million over three years, we are supporting projects that advance oral health equity with a focus on accessing oral health care or preventing tooth decay. "The 62 applications submitted for our inaugural round of open funding revealed a significant need for dedicated oral health funding statewide," said Allison Cusick, executive director of Delta Dental of Colorado Foundation. "According to the Colorado Health Institute, just 63 percent of low-income Coloradans report good physical and oral health. Thousands of Coloradans live in dental health professional shortage areas. Disparities like these result in oral health inequities. By funding innovative projects designed to improve community oral health, we will better understand what Coloradans need to be healthy."

Partnering on community-driven solutions has become imperative to the foundation's role in advancing our mission. This perspective will inform how we deepen our focus and strengthen our partnerships with local communities to improve oral health in 2019.

Strategically Partnering to Change Systems and Policy

In 2018, Delta Dental of Colorado and Delta Dental of Colorado Foundation partnered with several organizations, such as the Children's Campaign of Colorado, to advance oral health policy and strengthen the future oral health workforce. Over the past 14 years, more than 5,000 medical, pharmacy, nursing, and other health-profession students, residents, and practitioners have participated in interprofessional training opportunities through the University of Colorado School of Dental Medicine's Frontier Center 4 Health.

Colorado Medical-Dental Integration (CO MDI) Project Launches Wave II

CO MDI is the first project of its kind in the country. In 2015, the CO MDI project awarded funding to 16 medical practices to add a dental hygienist into the health care team. This is significant because it integrates preventive dental services into medical practices. By encouraging grantees to partner with dental professionals, there is increased access to care in rural and urban locations.

In spring 2018, we launched the second phase of the project. This time we partnered with the Colorado Health Foundation to provide $3.3 million in CO MDI funding over four years for 10 additional medical practices. In total, 26 organizations serve 27 communities in 39 CO MDI locations across Colorado.

"While the state's average dentist-to-patient ratio is one to 1,350, Phillips County sits at one to 4,363," said Trampas Hutches, chief executive officer of Melissa Memorial Hospital, in Holyoke, Colorado. "According to data from the Colorado Health Institute and Centers for Disease Control and Prevention, the people of Holyoke and surrounding areas have 70 percent less access to care than their urban counterparts. Melissa Memorial's selection as a CO MDI grantee means that more people in our community will now have the opportunity to improve their oral health."

Teaching Healthy Habits Through Laughter

Land of Smiles, Delta Dental of Colorado Foundation's school-based theater program for K-3 students, is a fun interactive show that helps young kids learn about good oral health habits. After the show, each student receives a smile bag containing a toothbrush, toothpaste, and floss. In 2018, the program focused on reaching schools with a high population of students eligible for free and reduced lunch. Through the year, the program distributed 25,511 smile bags to students across the state!

Feedback from teachers who have participated in the program continues to be very positive. "I have been a health tech in the schools for 11 years and this was the best dental program I have seen. The actors were awesome. The play was very engaging with the students. I look forward to scheduling another one and have already told people about it."

• 100% of teachers rated the show excellent overall.
• 95% believe Land of Smiles increased kids' oral health knowledge.

Experiencing the Journey to Oral Health of the Communities where we Live, Work, and Play

At Delta Dental of Colorado, we foster a culture of generosity and giving back to our community. Our community engagement program connects our team members with causes that impact Coloradans and strengthen our partnerships with local nonprofits. We do this in three ways:

1. Team member engagement through volunteerism, financial donations, and board participation.
2. Community outreach through supporting the work of other nonprofits via programs, events, and sponsorships.
3. Strategic community partnerships by including oral health as part of overall health conversations and activities.

In 2018, our employee-driven iGive program contributed $120,000 to 10 Colorado-based organizations. iGive allows each Delta Dental of Colorado team member and board member to select one out of 10 team member—nominated organizations. In honor of the company's 60th anniversary, each team member was given $600 to donate to the charity they aligned with best.

We celebrate when our business relationships grow into ways to support the community. When one of our brokerage partners invited us to be a gala sponsor for Food for Thought, a nonprofit that provides a weekend supply of food for kids in need, we welcomed the opportunity. At the gala, one of our sales team members was so moved by Food for Thought's work that she nominated them for iGive. They were selected, and our team members then granted the nonprofit $16,500, which went to feeding students for almost three-quarters of a school year.

Later, our sales team volunteered at Food for Thought with our brokerage partner to assemble PowerSacks for an upcoming food distribution. Encouraging our team members to get involved with causes they care about is important to us, and it's even better when we can partner up to do good.

Our community engagement program focuses on mission-building activities for the company that complement Delta Dental of Colorado Foundation's philanthropic work to advance oral health equity. Our efforts together will make the greatest social impact and improve the well-being and oral health of Coloradans across the state.

Creating Educational Opportunities for our Providers

Since day one, our providers have been our partners and allies in our mission to improve oral health in Colorado. With that in mind, our network and clinical management teams are highly focused on ensuring that our network providers receive the support they deserve in a timely manner.

"Through the past few years, we've developed a series of workshops across the state to give providers and their office staff an opportunity to meet face-to-face with Delta Dental of Colorado staff. In addition, our team has made more than 1,000 visits through out the year, as well as provided information about new tools to help them."

In 2018, more than 100 providers and/or office staff across Colorado took advantage of our Empower Your Practice workshops, and we're hopeful that many more continue to do so.

In addition to the workshop, we also conduct CPR sessions where we give our office staff and providers the opportunity to get certified at no cost. More than 400 participated in our free CPR class in 2018.

Saving Lives Through Blood Pressure Screenings

Our Hypertension Identification Program developed for the University of Colorado Health Plan and UC Health, is still going strong after more than a year! The program was developed to track blood pressure readings taken during routine dental office visits.

Since the program's inception, 137 participating providers have screened more than 2,000 patients for high blood pressure, and, out of those, eight patients identified to be in a hypertensive crisis and referred to their primary care physician for further evaluation, potentially saving a life. There is an important connection between oral and overall health and dental providers can help to identify systemic diseases during routine office visits.

The financial results presented above combine the operations of Delta Dental of Colorado, the Delta Dental of Colorado Foundation, and SpringRock Dental. Included in those financial results are contributions made from Delta Dental of Colorado to the Delta Dental of Colorado Foundation of $6.44 million and $5.75 million for 2018 and 2017, respectively. With these contributions, the Delta Dental of Colorado Foundation sponsors programs to elevate the well-being of all Coloradans by advancing oral health equity.