2021 CONVERGE - All Sessions

2021 CONVERGE - All Sessions

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This package includes all recorded educational sessions from 2021 CONVERGE.

 

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  • Contains 1 Component(s) Recorded On: 10/06/2021

    A review of dental actuarial hot topics presented by actuaries from around the industry.

    A review of dental actuarial hot topics presented by actuaries from around the industry.

    Joanne Fontana, FSA, MAAA

    Principal and Consulting Actuary

    Milliman

    Joanne Fontana is a consulting actuary in the Health Practice of Milliman’s Hartford office. She has been with the firm since 2006. During that time she has served insurance companies including several major dental carriers, employers, government entities, and other organizations. Joanne’s focus has been largely on managed care and dental, with experience in premium rate development, provider contract analysis, valuation of post-retirement health benefits, and health care reform. Over the past several years she has worked closely with the National Association of Dental Plans, the California Association of Dental Plans, the American Dental Association, and other dental clients to assess the impact of health care reform on the dental industry. She has worked with carriers and employer groups on the dental insurance procurement process, worked on Medicaid dental procurements with both state entities and bidders, and has done core actuarial dental pricing and underwriting work for many dental carriers. Joanne is considered an industry expert in dental product and pricing, and has presented on dental-related topics at multiple industry forums.Prior to joining Milliman, Joanne spent more than ten years as an actuary with Cigna, where she held various healthcare financial leadership roles including Chief Actuary of CIGNA’s dental insurance business

    Adam Barnhart, FSA, MAAA

    Consulting actuary

    Milliman

    Adam is an actuary with the Milwaukee office of Milliman. He joined the firm in 2007. Adam's expertise is in both managed and traditional healthcare programs, with more than eight years of experience in these areas. He has assisted various entities, including health plans, employers, and health care providers. He has helped clients with product development and pricing, experience analysis, valuation of reserves, and financial reporting.

    Adam is considered a firm-wide leader in Medicare Advantage and Part D consulting. He has completed bid development for many clients.

    April Furlong, MBA

    Compliance Consultant

    Milliman

    April Furlong is a compliance consultant with the Tampa office of Milliman. She joined the firm in 2014 bringing with her 10 years of prior experience in the insurance industry.

    April has experience in compliance consulting, policy form drafting, and other compliance-related services for health products. April has been involved in numerous research and product development projects, focusing heavily on dental and vision products. April also assists health insurers with network filings and research on network adequacy and oversight rules. She has worked closely with supplemental products such as hospital indemnity, critical illness, and accident insurance. She also has experience with the various filing requirements for the Affordable Care Act. She has worked closely with regulators to secure approval on many filings.

    April also has served as client and project manager, overseeing each step of the project and adhering to strict deadlines. She has worked closely with clients to understand their needs during the development, drafting, and filing of a product.

    Prior to joining Milliman, April spent 10 years working in managed care, analyzing data on risk, profits and trends applicable to health plans, and overseeing state filings.

    Tom Murawski, FSA, MAAA

    Consulting Actuary

    Milliman

    Tom provides consulting services to a wide variety of clients in the U.S. healthcare system including insurance companies, stop loss carriers, employers, provider groups, government entities, and advocacy groups.

    Tom’s focus has been on advising clients in understanding the impact and strategic implications of the ACA. His experience includes pricing health benefits, estimating reserves, and projecting financial results. Tom has led projects to assist clients in these activities for many different health products including individual plans, small and large group plans, and stop loss products.

    Tom also has significant experience with dental plan pricing for both commercial and Medicaid populations. He has been involved in studies and analyses of the impact of the ACA on dental insurance, experience analysis studies for large employers and insurers, and review of provider fee schedules.

    Tom frequently presents at industry conferences and regional actuarial meetings on dental and other health benefits topics. Tom has also authored several research reports on the potential impact and implications of proposed healthcare law and regulations. As a result of his research, Tom has met with and advised members of Congress, Congressional Budget Office leadership, and Senior White House Policy Officials on healthcare reform proposals.

  • Contains 1 Component(s) Recorded On: 10/06/2021

    Learn more about best practices in delegated credentialing from the perspectives of both plans and DSOs. Panelists will discuss ways to streamline processes and foster positive relationships for both plan to plan, as well as plan to DSO credentialing delegation.

    Learn more about best practices in delegated credentialing from the perspectives of both plans and DSOs. Panelists will discuss ways to streamline processes and foster positive relationships for both plan to plan, as well as plan to DSO credentialing delegation.

    Theresa Bacon

    Director Provider Relations

    Aspen Dental Management

    Theresa Bacon joined Aspen Dental Management Inc. (ADMI) in 2012 as the manager carrier relations and has served as director of insurance operations since March 2019.  Leading provider credentialing and plan enrollment for more than 900 Aspen Dental branded practices in 44 States.   Theresa currently serves as the chair of the DSO Advisory Council and has been a member of the NADP Operations and Codes Workgroups since 2015. Past volunteer experience includes Provider Directory Validation, CAQH and Delegated Credentialing Sub-WorkGroups.

    With more than 20 years in the dental industry, prior professional experience includes leadership roles at Coast Dental Services and roles with general dentistry and endodontic private practices.

    Mike Cole

    Vice President of Insurance Plan Management

    Dental Care Alliance

    In April 1999, Mike Cole joined Dental Care Alliance (DCA), an NADP Associate member and one of the largest dental service organizations in the country. As vice president of Insurance Plan Management, Mike oversees the teams responsible for insurance relations, revenue cycling and the credentialing departments. Prior to joining DCA, he was a network manager for both Prudential Healthcare and United Concordia. With more than 30 years in the dental healthcare industry, he was instrumental in fostering partnerships between DCA and the insurance plans. Working together to achieve the best outcomes has led to creation of the NADP credentialing application, NADP-supported directory validation process and innovations with the patient experience. My received the Don Mayes Award at CONVERGE 2019.

    Mike has been active in the NADP for the last eight years and has served on the Operations Workgroup, where he is currently the vice chair. Mike is a graduate of the University of Missouri – Columbia and is also a Certified Employee Assistance Professional (CEAP).

    Andrea Braykovich Garrett

    Provider Network Management

    Guardian Life

    Andrea Braykovich Garrett has more than 20 years of experience in all facets of provider network management, including responsibility for credentialing and Dental Support Organization relationship management. While employed by DenteMax and Dental Network of America from 2000-2017, Andrea established delegated credentialing programs for both DSOs and network leasing plan partners. She also co-authored the NADP 2015 update to the Dental Plan Accreditation Standards for credentialing and credentialing delegation. Andrea is currently the director of Dental Networks for the Guardian Life Insurance Company of America.

    Kristen Smith

    Director, Provider Network Operations

    United Concordia Dental

    Kristen S. Smith is the director, Dental Network Operations at United Concordia.  She has overall leadership responsibility for all credentialing, delegated credentialing, provider data management and support functions.  

    Kristen has more than 32 years of clinical and administrative dental experience.  She has worked for United Concordia for 30 years where she has held positions in professional relations, claims operations and audit, provider data management, quality/process improvement and project management. Prior to United Concordia she worked as a dental office manager and clinical dental assistant. 

    Kristen has her Bachelor of Science from East Stroudsburg University, a PA Teaching Certificate, and is a Juran certified Six Sigma Black Belt.

  • Contains 1 Component(s) Recorded On: 10/06/2021

    Inaccurate and out-of-date dental provider data can negatively impact all stakeholders across the industry, including sub-optimal experiences for members, lost revenue for care providers, and the need for extra costs and resources for health plans. Please join our round table discussion featuring DSO, payer, network and solution providers, each with their unique perspectives on market challenges, data management, and juggling increasing directory requirements. Bring your questions as we explore how to make the patient experience better.

    Inaccurate and out-of-date dental provider data can negatively impact all stakeholders across the industry, including sub-optimal experiences for members, lost revenue for care providers, and the need for extra costs and resources for health plans. Please join our round table discussion featuring DSO, payer, network and solution providers, each with their unique perspectives on market challenges, data management, and juggling increasing directory requirements. Bring your questions as we explore how to make the patient experience better.

    Valerie DeBruin

    Vice President of Network Operations

    Careington International

    Valerie DeBruin began her career with Careington International Corporation in 2008 and currently serves the company as vice president of Network Operations. During her tenure, she has held leadership roles in Sales, Account Management, Product Development and Network Operations. Valerie was instrumental in the successful launch of the London office for Careington’s affiliate, Munroe Sutton. During her time abroad, Valerie helped build the foundation for a discount dental and optical network, the first of its kind, throughout the United Kingdom. She has extensive experience working with brokers and employers to define needs in the marketplace. Today, Valerie oversees the recruiting, credentialing, quality assurance, DSO relations and analytics divisions of Careington’s Dental Network, which has maintained discount fee-for-service and PPO lease networks for more than 40 years. Valerie works with the primary goal of helping provide an avenue for consumers to receive access to affordable dental care throughout the U.S. and U.K. She and her team are constantly looking for ways to improve the provider and customer experience, as well as the accuracy and adequacy of Careington’s nationwide dental networks.

    Rinku Goldberg

    Vice President of Strategic Relation Management

    UnitedHealthcare

    Rinku Goldberg is the Vice President of Strategic Relation Management in UnitedHealthcare’s Dental Network team. In her position Rinku oversees all strategic provider network relations including Leased Network partnership and National DSO management. She also has a key role in supporting the Private Label and National Account Sales teams.

    Rinku has 20 years of experience in the Dental industry specifically in the provider space. She started her career at PacifiCare Health Systems which was later acquired by UHC in 2008. During her tenure, she has held various leadership roles in provider operations, provider relations, sales support, data management, credentialing, government programs, and now provider network management.

    Rinku holds a Master’s degree in Health Administration from the University of LaVerne and a Bachelor’s degree in Biological Sciences from California State University, Fullerton.

    Michaela Muniz

    Director, Insurance Plan Management

    Dental Care Alliance

    Michaela Muniz joined Dental Care Alliance (DCA) in September 2017 and is currently the Director of Insurance Plan Management.  Michaela works closely with the Insurance plan partners to foster a relationship and works to increase Dental Care Alliance’s plan participation and revenue.  In addition, Michaela leads the credentialing department and oversees the delegated credentialing team. Michaela has been involved in the medical and dental provider network marketplace for more than 30 years, working in a variety of positions.  Prior to joining DCA, Michaela was the Vice President of Provider & Network Management at Argus Dental & Vision and the National Director of Provider Networks at Ameritas Group Dental. Michaela currently serves as the co vice-chair of the DSO Advisory Council and has been a member of the NADP Operations workgroup since 2012 and was a member of the Delegated Credentialing sub work group. Michaela is a graduate of the University of Florida.

    John Schaak

    Chief Innovation & Growth Officer

    SKYGEN

    As Chief Innovation & Growth Officer, John Schaak is responsible for driving profitable growth through the acquisition of new customers and sales of new products and services. John leads company efforts to solve industry problems by identifying new opportunities and markets, as well as innovative new products and services. With his strong commitment to exemplary client service and collaborative approach to both internal and external relationships, he has a demonstrated ability to help players in the healthcare continuum grow their businesses while reducing costs, improving operations, and serving their members more effectively.

    John brings extensive leadership experience to his position. He was previously the president of Scion Dental and SKYGEN USA’s chief operating officer. Before that, John was a partner with the national law firm Quarles & Brady.

    John has been listed on the Wisconsin Super Lawyers, Rising Stars list multiple times. He holds a Juris Doctorate from Marquette University Law School. He earned a Bachelor of Science Degree in Political Science and Criminal Justice with a minor in Sociology from the University of Wisconsin Oshkosh.

  • Contains 1 Component(s) Recorded On: 10/06/2021

    Regional representatives will sit down for a discussion moderated by an NADP Government Relations staff person. Attendees will get insight into biggest threats, challenges and opportunities facing dental plans in the legislatures of all 50 states.

    Regional representatives will sit down for a discussion moderated by an NADP Government Relations staff person. Attendees will get insight into biggest threats, challenges and opportunities facing dental plans in the legislatures of all 50 states.

    Jeff Album

    Vice President of Public & Government Affairs

    Delta Dental of CA, NY, PA, & affiliates

    Jeff Album is vice president of Public and Government Affairs for Delta Dental of California, New York, Pennsylvania, and affiliates, which serve 40 million enrollees.  His responsibilities include managing a team of 16 lobbyists, as well as staff who engage in reputation/issues management for all affiliates. Jeff is widely regarded as one of the nation’s foremost experts on the dental industry generally, and on health care reform’s impacts on that industry. His impact on state and federal legislation and rule making occurs through his advocacy on the boards of the California Dental Plans Association (CADP), the National Association of Dental Plans (NADP), and as a member of the Delta Dental Plans Association (DDPA) Public Policy Committee.) In 2014, Jeff was recognized for his contributions by NADP with the Gabryl Award, that association’s highest honor for lifetime service to the dental benefits industry. Jeff holds a Master of Arts degree in communication from Stanford University, and a Bachelor of Arts degree in planning and public policy from the University of California, Santa Cruz. He is a current board director with the San Francisco Chamber of Commerce.

    Richard Jones

    Vice President, State Affairs

    Guardian Life

    As vice president for State Affairs, Richard manages a multi-state legislative and regulatory agenda primarily in support of Guardian’s Group Benefits business unit. He joined Guardian as its chief communications Officer in 2008 and prior to that held executive positions at GE Capital, Mastercard and several global public relations consultancies. Richard is board chair of the Association of California Life & Health Insurance Companies. He is on the Board of Directors of the California Association of Dental Plans, the Utah Life & Health Guaranty Association, and a member of the Wooster School (Danbury, CT) Board of Trustees. He co-chairs the California Association of Dental Plan’s Legislative and Regulatory Committee and chairs the National Association of Dental Plans’ Government Relations WorkGroup. Richard holds a master's degree in journalism and a bachelor's degree in communications, both from Ohio University.

    Crystal McElroy

    Vice President, Group Benefits Contracts and Compliance

    MetLife

    Crystal McElroy is the vice president over the Group Benefits Contracts and Compliance team at Metropolitan Life Insurance Company in Irvine, CA. She currently oversees all contracts, compliance and regulatory issues as it relates to MetLife’s Group Benefits business. Crystal currently is the vice chair of the NADP Commission on Advocacy Policy and volunteers on the NADP Government Relations Workgroup. She also serves as the co-chair of the CADP Legislative and Regulatory Committee and is the secretary/treasurer on the CADP Board of Directors and a member of the NADP Board of Directors. Prior to joining MetLife in October 2013, she served as a senior attorney with the California Department of Managed Health Care in the Office of Plan Licensing for seven years. She was responsible for reviewing dental plan and health plan licensing documents as it relates to plan benefits, disclosure documents, networks, and mergers and acquisitions. Crystal graduated from the University of California, Los Angeles, with a major in Biochemistry and a minor in Political Science in 2003 and obtained her Juris Doctor from the University of the Pacific, McGeorge School of Law in 2006.

    Mike Trebold

    Compliance Manager, Group Division

    Ameritas Life

    Mike Trebold is a Compliance Manager for the Group Division of Ameritas Life Insurance Corp., which he joined in 2014.  His responsibilities include advocacy and oversight of legislative and regulatory review and implementation.  He has nearly 20 years of compliance and regulatory experience in the insurance industry.  Mike is currently the vice chair of the NADP Government Relations Workgroup, and was recently awarded an NADP Evelyn Ireland Volunteer Award in 2020.  He earned a B.S.B.A. from the University of Nebraska – Lincoln and a Juris Doctor from the University of Nebraska College of Law.

  • Contains 1 Component(s) Recorded On: 10/06/2021

    In today’s increasingly complex dental landscape, payers and providers are looking for a better way. Traditionally, payers and providers have operated with independent and sometimes conflicting goals and objectives, often causing lost opportunities for efficiency, savings, and positive member experiences.

    In today’s increasingly complex dental landscape, payers and providers are looking for a better way. Traditionally, payers and providers have operated with independent and sometimes conflicting goals and objectives, often causing lost opportunities for efficiency, savings, and positive member experiences. The current dental ecosystem is starting to evolve - Payers are trying to find the right providers; dentists want to deliver the best care; and members are looking for affordable, high-quality care. Join NADP and Zelis to understand key market trends and explore strategies you can employ to improve your part of achieving efficiency, savings, and positive experiences for all parties involved.   

    Zelis will cover:   

    • Perspectives on the dental market trends that can impact your current business and future planning   
    • Understanding where DSOs fit into the picture 
    • The benefits of electronic payment adoption for providers and payers   
    • Discussion on the future of member payment integration as well as why payment and responsibility transparency, is important  

    Matthew Lungen

    VP of Sales

    Zelis

    Matthew Lungen, vice president of Sales at Zelis, provides thought leadership, market intelligence and sales strategy across the organization. Matthew is an accomplished sales leader and one of Zelis’ longest standing employees from one of the original four pillar companies that ultimately formed Zelis in 2016.  

    Matthew has more than 24 years of sales leadership experience and was pivotal in Zelis’ launch into the Dental, Workers’ Compensation, and Auto verticals. Matthew has a deep understanding of the entire healthcare landscape and focuses on strategy and growth initiatives.

    Aaron Shumate

    Executive VP of Product and Strategy

    Zelis

    With more than 15 years of healthcare technology experience, Aaron has guided Zelis Network Analytics' growth as the industry standard in provider network analytics for health and dental plans nationwide. First as chief revenue and strategy officer during the startup and early scale-up stages, and now as EVP of product and strategy, he directs Zelis Network Analytics' priorities in delivering enterprise solutions to our clients. Aaron believes in the power of the right data as the foundation for delivering cost, time and process efficiencies via an advanced provider network performance platform.

    Leah Silver

    Senior Director of Business Solutions

    Zelis

    Leah is a healthcare payments subject matter expert with over 7 years of cross-functional payment experience. Leah has held key roles in implementation and account management, and has helped independent TPAs, regional Health plans, Fortune 500 healthcare payers both in Medical and Dental industries optimize their payment processes. In addition to helping payer clients directly, Leah helps drive strategy and innovation initiatives for Zelis.

  • Contains 1 Component(s) Recorded On: 10/06/2021

    As Artificial Intelligence (AI) systems, capable of accurate radiographic diagnosis, begin to penetrate the dental industry, carriers have emerged among the earliest adopters of the technology.

    As Artificial Intelligence (AI) systems, capable of accurate radiographic diagnosis, begin to penetrate the dental industry, carriers have emerged among the earliest adopters of the technology. The benefits of computer vision-powered utilization management and review – efficiency, automation, comprehensive claim examination, fraud detection and, of course, real-time adjudication – have been extolled by every dental AI startup bringing utilization management/utilization review (UM/UR) solutions.  Though real-world application of the technology too limited and nascent to have produced clear evidence of those benefits, most insurers – even those who have yet to see the technology in action – seem willing to grant that, at least in principle, AI holds considerable promise for the future of claim adjudication. The question is: Could that promising future actually include real-time claims adjudication? The Dental AI Council (DAIC) would like to try to answer that question with the help of members of the DAIC leadership committee, who will bring their dental care, insurance carrier, and AI experience to bear. They will address:  

    • Benefits of real-time adjudication for providers, patients and carriers  
    • Why AI holds promise for real-time adjudication  
    • Logistical impediments to real-time adjudication  
    • Regulatory impediments to real-time adjudication  
    • How to overcome impediments  
    • Steps that can be taken to facilitate a real-time reality

    Dr. Kyle Stanley

    CCO

    Pearl

    Dr. Kyle Stanely, DDS, is an award-winning dentist and the chiefclinical officer at Pearl, an AI company specializing in diagnostic andbusiness analytics solutions for the dental industry. A graduate and formerfaculty member of USC’s Herman Ostrow School of Dentistry, Dr. Stanley’sesthetics, dental implant, and smile design research has been published in thetop international dental journals. He has been honored with the AAED’s CharlesL. Pincus Award for outstanding achievement in esthetic dentistry and named tothe AACD’s "The Next Generation of Cosmetic Dentistry" and SeattleStudy Club’s "Top 10 Young Educators in Dentistry" lists. As a keyopinion leader and public speaker, Dr. Stanley has become the dental industry’sleading advocate for mental health awareness. His private practice is locatedin Beverly Hills, CA.

    Linda Vidone, DMD

    Chief Clinical Officer/V.P. Clinical Management

    Delta Dental of Massachusetts

    Dr. Linda Vidone is the chief clinical office and vice president of Clinical Management at Delta Dental of Massachusetts. She has 20 years of dental experience in clinical private practice, as dental school faculty, and in the dental benefits industry. Dr. Vidone, a board-certified dental consultant, is a hands-on leader in the dental insurance industry, setting clinical policies and performing routine claim review while staying abreast of innovations in oral health care. She shares her unique knowledge of being on both sides of the claim form while lecturing nationwide on all aspects of dental benefits, dental coding, claim accuracy, utilization management and utilization review. A graduate of Boston University School of Dental Medicine, Dr. Vidone holds a D.M.D. and C.A.G.S. in General Dentistry and Periodontology. She is currently a member of the Delta Dental Plan Association Policy Committee. She is immediate past president of the American Association of Dental Consultants and also serves as chair of the Certification Committee. She is on National Association of Dental Plans Code workgroup and is a voting member of the American Dental Association’s Code Maintenance Committee, where she represents American Health Insurance Plans. She also maintains a private practice in periodontology in Brookline, Massachusetts.

  • Contains 1 Component(s) Recorded On: 10/05/2021

    This session will feature a panel discussion covering the progress made in the NADP Carrier/Consultant Member Interest Group. Topics will include carrier requirements to "qualify" consultants, creation of a Dental Consultant Association focused on representing provider needs and interests and how carriers can work with consultants to achieve their goals.

    This session will feature a panel discussion covering the progress made in the NADP Carrier/Consultant Member Interest Group. Topics will include carrier requirements to "qualify" consultants, creation of a Dental Consultant Association focused on representing provider needs and interests and how carriers can work with consultants to achieve their goals.

    Chris Falk

    AVP of Network Recruitment

    Careington

    Chris Falk, assistant vice president of Network Recruitment, has been a dental industry leader for more than 15 years. His career has primarily focused on network recruiting, but he has also been responsible for the growth and development of Careington and its affiliate dental networks for the US and the UK. Throughout Chris’ professional career, he has been integral in establishing new recruitment team structures and incentive programs, achieving 10% growth year-over-year. In his current role, he also oversees the Provider Retention team while promoting programs and revenue-driven enhancements for our dentists.

    Michelle Hart, RDH, MBA

    Associate VP, Strategy Advancement

    Michelle has been in the Dental Industry for over 30 years, working in a variety of practice settings as a registered dental hygienist for more than 10 years before expanding her education and experience onto the Payor side and receiving an MBA in Health Care Administration from Bryant College. She served in many different capacities at Delta Dental of Massachusetts including UR/UM and Provider Relations before moving to Guardian for 22 years in Dental Networks and started a new opportunity 2 years ago with Humana. In her current role at Humana as associate vice president, Strategy Advancement, Michelle is responsible for network expansion and retention for all lines of business ensuring that all Humana members have access to participating dental providers in order to maximize their dental benefit.

    Chad Hendricks

    CEO

    Clear Choice Consulting

    Chad has worked in the Dental Industry for over 17 years. He spent my first 16 years working at two large DSOs, American Dental Partners (ADPI) and Midwest Dental. Chad spent 13 years at ADPI, heading up their payer relations department for much of that time. He also oversaw ADPI’s revenue cycle and credentialing teams. At Midwest Dental, Chad took a similar path, leading their payer relations team, credentialing and eventually revenue cycle too. Chad was with Midwest Dental for three years before he started Clear Choice Consulting. Clear Choice Consulting was formed to support dental groups both large and small and to support solo offices as well. His primary support focus areas are payer relations, credentialing and revenue cycle. Chad has always been a big advocate of the payer/provider partnership and tries to continue that as a consultant. Chad has been a member of the NADP for over ten years. He is a graduate of the University of Minnesota.

    Amy Marko

    CEO

    Amy Marko & Associates

    Amy Marko joined Unum in April of 2017 as senior vice president, Dental/Vision Products and Professional Relations where she was responsible for dental products including adding DHMO in California to their dental portfolio. Amy has served in leadership roles with InterDent Services Corporation and Aspen Dental Management, both of which are large Dental Service Organizations (DSO).  Prior to these roles, Amy spent more than 30 years overseeing substantive dental insurance operations for Kaiser Permanente, Aetna, Prudential and Safeguard. In 2021, Amy formed her own consulting company, Amy Marko & Associates working with insurance carriers as well as DSO and large group practices.   She is actively involved with the National Association of Dental Plans where she is a former two-time board member and is the recipient of the 2017 Gabryl Award, the dental industry’s highest honor. Amy currently serves on the Board of California Association of Dental Plans (CADP).

  • Contains 1 Component(s)

    The COVID-19 pandemic has had a profound impact on the US healthcare system, and the dental industry is no exception. When the pandemic rapidly escalated in March and April 2020, many states banned elective dental procedures, including routine examinations and preventive care.

    The COVID-19 pandemic has had a profound impact on the US healthcare system, and the dental industry is no exception. When the pandemic rapidly escalated in March and April 2020, many states banned elective dental procedures, including routine examinations and preventive care. This was part of a broader effort to slow the spread of the novel coronavirus and preserve personal protective equipment (PPE) for use in fighting COVID-19. In May, many of these state prohibitions expired and dental practices began to reopen for elective care, albeit with a variety of restrictions. As of January 2021, however, only 43 percent of practices reported “business as usual” in terms of patient volume, according to a poll conducted by the Health Policy Institute of the American Dental Association. This decreased volume is likely a result of patient reluctance to visit the dentist combined with reduced operating capacity to prepare the office between appointments. It is also indicative of the decline in US dental care spending during the pandemic and suggests that patients are continuing to postpone routine dental services, putting their overall health at risk. Drawing on the nation’s largest repository of private healthcare claims data, this session will present a claims-based analysis of utilization of dental services to explore how dental care has rebounded, or failed to rebound, after the beginning of the pandemic.  

     

    The analysis will: 

    • Compare trends in dental service utilization before, during and after the peak months of the COVID-19 pandemic,  
    • Identify trends in oral health issues, such as dental caries and periodontal infections, resulting from deferred preventive dental services,  
    • Examine trends in US dental care spending throughout the pandemic.  

     

    Specific data inquiries will include top procedure codes and diagnoses, reduction in elective service utilization (e.g., implants, periodontal bone surgery), changes in the number of root canals performed, growing requests for mouth guards, efficiency within dental visits (i.e., multiple services for one claim for one patient), PPE costs for dental visits, and the rise of teledentistry, among others. The information presented in this session will be useful to stakeholders throughout the healthcare sector, particularly dentists and other oral healthcare providers, as well as payors, policy makers and researchers. 

    Ali Russo

    Chief Information Officer

    FAIRHealth

    Ali Russo is national healthcare non profit FAIR Health’s chief information officer. She has over 25 years of experience in information technology, including over 20 years in healthcare data, analytics and product development. Previously, Ali was with McKesson, where she had many roles, including responsibility for the Analytics Services team under the Health Solutions division. As Director of Analytics Services, she focused on bringing actionable analytics to the healthcare sector based on allocated claims data.

  • Contains 1 Component(s) Recorded On: 10/05/2021

    Discover how Artificial Intelligence (AI) enhanced with Big Data is unlocking exciting new possibilities in the dental market.

    Discover how Artificial Intelligence (AI) enhanced with Big Data is unlocking exciting new possibilities in the dental market.  

    The future of dental is bright with data and analytics that incorporate exciting new advancements in artificial intelligence — everything from A.I.-powered dental image analysis to uses in maintaining accurate, cost-effective and efficient dental claim review operations. These advancements can help payers serve members more effectively while managing costs. However, A.I. is only as effective as the underlying data powering it. A.I.-powered image analysis can only operate on the fraction of claims that contain accompanying x-rays of acceptable quality. Plus, the current regulatory environment requires experienced human dental consultants to be in the loop. In this session, presenters will discuss how A.I.-enhanced image analysis, algorithmically derived claims analysis and highly trained human dental consultants complement each other to provide opportunities for the ultimate in utilization review effectiveness. In addition, this session will explore the latest progress on the artificial intelligence initiatives developed with  P&R Dental’s strategic partner, Denti.AI Technology Inc.

    Michael Urbach

    EVP

    P&R Dental Strategies

    Mike is executive vice president, Strategic Sales & Business Development for P&R Dental Strategies and is responsible for overseeing all aspects of driving revenue growth for our dental analytics business solutions. Mike has over 20 years’ experience in the health care informatics space and has developed and successfully sold a variety of informatics solutions to all stakeholders in the health care marketplace including payers, providers, suppliers and consumers. Mike has worked at informatics companies large and small, public and private, including: HCIA, Solucient, Pharmetrics and IMS Health. Mike has a BA from Syracuse University and an MBA and an MHA from the University of Pittsburgh.

  • Contains 1 Component(s) Recorded On: 10/05/2021

    Objectives of this session include: To foster communication and collaboration among grant makers and others To help strengthen the grant-making community’s knowledge, skills, and effectiveness To achieve better health through better philanthropy

    Objectives of this session include: 

    • To foster communication and collaboration among grant makers and others 
    • To help strengthen the grant-making community’s knowledge, skills, and effectiveness 
    • To achieve better health through better philanthropy 

    Cara V. James, PhD

    President and CEO

    Grantmakers In Health (GIH)

    Dr. Cara James is president and CEO at Grantmakers In Health (GIH). Prior to joining GIH, she served as -director of the Office of Minority Health at the Centers for Medicare & Medicaid Services (CMS) where she provided leadership, vision, and direction to advance the U.S. Department of Health and Human Services and CMS goals related to reducing disparities and achieving health equity for vulnerable populations, including racial and ethnic populations, persons with disabilities, sexual and gender minorities, and persons living in rural communities. Under her guidance, CMS: 

    • Developed its first CMS Equity Plan to Improve Quality in Medicare, its first Rural Health Strategy;
    • Created an ongoing initiative to help individuals understand their coverage and connect to care; Increased the collection and reporting of demographic data; and
    • Developed numerous resources to help stakeholders in their efforts to reduce disparities.

    Before joining CMS, Dr. James served as director of the Disparities Policy Project and director of the Barbara Jordan Health Policy Scholars Program at the Henry J. Kaiser Family Foundation, where she was responsible for addressing a broad array of health and access-to-care issues for people of color and other underserved populations, including the potential impact of the Affordable Care Act, analyses of state-level disparities in health and access to care, and disparities in access to care among individuals living in health professional shortage areas. Prior to joining the foundation, she worked at Harvard University and The Picker Institute. She is a past member of the National Academies of Sciences, Engineering and Medicine’s Health and Medicine (NASEM) Roundtable on the Promotion of Health Equity and has served on several NASEM committees. She has published a number of peer-reviewed articles. Dr. James holds her doctorate in health policy and her bachelor’s degree in psychology from Harvard University.