The Great Crossover - Leveraging Coretech to be the Dental Plan of the Future

Tuesday, September 20 

4:15 PM - 5:00 PM

The Great Crossover not only applies to the growing trend of sharing data to inform risks that are starting to become a reality but product portfolios also, the sort that benefits insurers are now having to build. With the fallout of the pandemic and other dynamic factors still driving impact, trends like the great resignation and significant shifts in working practices like hybrid workforces are continuing to propel changes in benefits packages. During this panel discussion, you will hear from industry experts on where dental benefits fit in The Great Crossover and how ambitious insurers can leverage technology to take advantage of the trend. 

Judy Ambrose 
Insurance Transformation Leader and Managing Director  
Ernst & Young LLC 

Judy Ambrose is a managing director in the insurance technology consulting practice focused on life, employee benefits, and health markets currently based out of Ernst & Young LLC’s (EY) Chicago office. She has over 20 years of business and technology transformation experience focusing on modernizing core platforms and leveraging data analytics to bring a “customer-first” experience. Judy also has extensive experience working with package software such as FINEOS, Unqork and Guidewire and leads the EY alliance with FINEOS. In working closely with her clients and understanding today’s market needs, she can lead global teams to help her clients deliver on their market strategies. Judy is also an active member of EY’s Women in Technology group and works closely with teams to promote and create opportunities for women in technology. 

Dan Galdenzi 
General Manager, EVP Healthcare  
EIS Group 

Dan brings nearly 25 years of progressive technology, business, and innovation experience in healthcare IT. He joins EIS with a deep understanding of the market and a fundamental belief in the disruptive nature of a modern technology platform like EIS. Before joining EIS in October 2020, Dan served as the CIO at Blue Cross Blue Shield of Vermont and, using his expertise in healthcare consumerism, led their journey into a member-first culture. He also led their four-year core administrative system migration onto NASCO. Most recently, Dan was the chief growth officer at NASCO. He led the company's transformation toward a cultural, technical, and innovative product company by forging new relationships with contemporary partners and orchestrating a new provider management product in partnership with Salesforce. Dan has a degree in geography with a focus on urban planning. He resides in Vermont and is active in environmental and wildlife advocacy causes. 

Bob Meier 
Product Solutions Manager, Healthcare and Benefits 
EIS Group 

Bob brings a unique people-centric approach, a wealth of industry expertise from his ventures, and lessons learned in the healthcare insurance and benefits technology space. He joined EIS in early 2022 with over 20 years of experience developing innovative strategic marketing and communication programs that helped retain customers and engage employees, resulting in dramatic brand equity and growth increases. Bob began his insurance journey with Metlife, supporting systems development and implementations for dental, vision and healthcare products. He also led both technical and process innovations for many Blue Cross and Blue Shield companies nationwide in both IT and strategic marketing and communication roles.

Diana Steinhoff
Senior Vice President, Dental and Vision
Aflac Group

Diana Steinhoff, senior vice president of Dental and Vision for Aflac Group, is responsible for the business's strategic, operational and financial oversight. She also serves as the president of Argus, an Aflac subsidiary. Diana designed a dynamic business model with innovative capabilities of the insurer’s dental product, the consumers' second most requested health benefit. In 2021, she launched Aflac Group's nationally dental and vision benefit solutions. With nearly two decades of experience driving business strategies to optimize operational practices and revenue while delivering an exceptional customer experience, Diana has a proven record of building diverse, high-performing teams with a passion for innovation and service. Before joining Aflac, Diana was part of the executive team that built Zurich North America's group insurance business with a $285 million capital investment, successfully launching in 2017. Subsequently, she was on the merger and acquisition leadership team that developed the strategy to sell the Zurich Group assets to Aflac. Previously, she held leadership positions of increasing responsibility at Aetna. Diana holds a bachelor's degree in psychology, a minor in criminal justice from Florida International University, and a master's degree in mental health counseling from Nova Southeastern University. She is licensed in Florida as a mental health counselor. She lives in Florida with her husband of 19 years and three beautiful rescue dogs.

Value-based Care: Shifting the Industry’s Focus from Volume to Outcomes 

Wednesday, September 21 
2:15 PM – 3:15 PM 

While there are many benefits to transitioning to a value-based care system, there are also many challenges. This panel discussion will include a variety of industry perspectives to provide an honest look at the role provider reimbursements play in its success, its overall benefits and challenges, as well as the crucial role of technology.

Michael Cole 
Vice President of Insurance Plan Management 
Dental Care Alliance 

Mike Cole joined Dental Care Alliance (DCA) in April 1999 and is currently the insurance plan management vice president. He oversees insurance relations, DCA’s Membership Plan, and the credentialing and delegated credentialing departments.  Before joining DCA, Mike was a network manager for Prudential Healthcare and United Concordia Companies, Inc. Mike has over 30 years of working in the dental industry on both the plan side and for Dental Care Alliance. Mike has been instrumental in fostering partnerships between the plans and dental support organizations (DSOs). Working together to achieve the best outcomes has led to the creation of the NADP credentialing application, NADP-supported directory validation process and innovations for patient satisfaction. Mike has been active with NADP for the last 11 years and has served on the Operations Workgroup, where he is currently the vice-chair and the DSO Advisory Council since inception. Mike received a Star Award from NADP in 2015 for his work on a standardized dental application. He received the prestigious Don Mayes Leadership Award in 2019 from NADP and was the first DSO designee to be recognized. Mike served as co-chair of the Insurance Committee with ADSO from 2020-2022. The committee was formed in response to COVID-19, and it met biweekly to stay current with topics relevant to DSOs. Mike also serves on several advisory councils, including Aetna, UnitedHealthCare, Liberty and DentaQuest. Mike graduated from the University of Missouri – Columbia and is a Certified Employee Assistance Professional (CEAP). 

Cherag D. Sarkari, DDS 
California Dental Director 
LIBERTY Dental Plan 

Dr. Sarkari joined the team at LIBERTY Dental Plan of California in the spring of 2020 as the dental director responsible for the clinical oversight, policy and quality management. He brings a collective experience of 27 years in the dental industry, ranging from the provider, academics, administration and c-suite leadership. Dr. Sarkari has a proven track record of stakeholder engagement and business development, leveraging his past experiences as a provider and in the benefits industry, lending a unique, balanced viewpoint to his current role. Before this position, he was the chief clinical officer of a multi-state DSO with 65 locations, in addition to heading the DSO-affiliated Professional Corporation in CA since 2014. This responsibility afforded him the clinical oversight of more than 175 providers in all matters related to policy and the delivery of oral health care, in addition to driving the agenda for the development of the providers.  Dr. Sarkari served as the dental director of a Knox Keene stand-alone dental plan and has been intimately involved in a range of quality management activities by participating on the Quality Management Committee both within the organization and externally as a member of the California Association of Dental Plans (CADP) Quality Management Committee (QMC). Dr. Sarkari is an active member of the National Association of Dental Plans (NADP), where he has volunteered his time on the Codes Sub-WorkGroup (developing CDT procedure codes), Clinical Sub-Workgroup (development of clinical protocols), and the DSO Advisory Committee (which serves to establish representation for DSO's with different payer groups). He received a Star Award from the NADP for his contributions to the SNOMED / ICD Sub Work Group. His experience in Medicaid and commercial spaces of the dental benefits industry supports his current role in California. Dr. Sarkari earned a Bachelor of Dental Surgery (BDS) and a Master of Dental Surgery (M.D.S.) in Prosthodontics. In 2003, he earned a Doctor of Dental Surgery (D.D.S.) from the Dental Board of California.  In addition, the University of Vienna also conferred a Master in Oral Laser Applications in 2015. As a practicing clinician since 1993, he served as a provider and clinical supervisor as a managing and senior regional dentist at multiple locations. Dr. Sarkari also instructs at the University De LaSalle in Mexico as visiting faculty teaching law and ethics and the Dental Practice Act and previously served as an associate professor of prosthodontics. As a member of the American Dental Association, California Dental Association, and the Sacramento District Dental Society, Dr. Sarkari chairs the Peer Review Committee and serves on the Ethics Committee and the Oral Health Task Force.  

 

Betty Gilbert, RDH
Vice President of Value-Based Care Programs
LIBERTY Dental Plan 

Betty Gilbert, R.D.H. is the vice president of value-based care programs and has been with LIBERTY Dental Plan for 10 years. She brings a collective experience of over 30 years in the dental industry, ranging from a practicing dental hygienist, dental office management, provider network development and leading Value-Based Programs.  Betty has over 25 years of experience in developing networks for government-funded managed care programs.  Before her current role, Betty was the vice president of Provider Relations for LIBERTY Dental Plan of Florida. Her leadership was instrumental in developing the LIBERTY Dental Plan Statewide Medicaid Network. She previously served as a Regional Director at DentaQuest, managing network expansion in multiple states. She has an extensive background in provider fee negotiations, having directed numerous national provider recruitment initiatives in Medicaid and Medicare lines of business. Betty has a proven track record of building accessible, quality networks and creating successful market expansion. Betty continues to maintain her active license as a registered dental hygienist in Florida. She has participated in several oral health initiatives in Florida and is currently on the Oral Health Florida School Action Team. Betty’s goal is to continue to work with dental offices to promote improved oral health outcomes.

James Shade 
Senior Vice President, Dental Network Operations, Services and Solutions 
United Concordia Dental 

James Shade oversees United Concordia Dental’s provider relations area, including provider network operations and services, credentialing and network partnerships. Since joining United Concordia in 1995, he has served in many areas of network development. Jim has helped the company develop a national dental network for government and commercial businesses, positioning United Concordia to deliver access to high-quality, affordable dental care across the country. Jim has more than 40 years of experience in the healthcare industry, including working in administration with Harrisburg Hospital, financial consulting for a comprehensive outpatient rehabilitation facility, and as assistant executive director for the Pennsylvania Dental Association. 

Separating the Meat from the Sizzle of AI: A case study of practical considerations for integrating artificial intelligence technology into a utilization review workflow

Wednesday, September 21
2:15 PM – 3:15 PM

From better serving members and improving relationships with providers to discovering operational efficiency gains, there’s good reason for industrywide excitement around the potential impact AI-powered dental image analysis can have on dental payer operations. However, AI-assisted utilization review is not a one-size-fits-all implementation; without careful considerations, it’s easy to get burned by the sizzle of artificial intelligence. To ensure the costs of integrating AI into utilization review (UR) processes are managed and efficiency goals are met, the context of an organization’s current operations needs to be thought through, and the right expectations should be set surrounding every step of implementing AI. In this presentation, P&R Dental Strategies claim and utilization review experts will walk through a real-world case study of an AI-assisted dental utilization review process. P&R will explore cost considerations, successes, learnings around efficiency gains, and other key takeaways. As dental claim review experts, P&R aims to highlight factors that dental payers should consider when implementing AI technology into their utilization review process. In addition, P&R plans to discuss what underlying data and supplemental analytics are required for payer teams to get the most efficiency gains out of AI technology. Plus, P&R will explore the latest progress on the artificial intelligence initiatives they are developing with their strategic partner, Denti.AI Technology Inc.

Michael Urbach
President, P&R Dental Strategies

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

Building a digital dental payer: Pitfalls to avoid and essential steps to "being digital."

Wednesday, September 21
2:15 PM - 3:15 PM CT

Many traditional insurers haven’t evolved their technology strategies and this relative stasis has put them in a challenging position that compounds over time. The challenge becomes: how do you dig yourself out of old code and fragile applications but keep your business running? How do you rebuild without totally disrupting your current customers and internal stakeholders? Your customers' expectations have changed, have you? The answer is that you become a digital payer organization. This is no small task and it doesn’t happen overnight—we know firsthand, having successfully helped some of our most valued clients through this journey. But we also know that it’s imperative to build a better business that’s tech-driven and human-centered, one that’s agile and ready to participate in a more dynamic, connected health care system focused on holistic patient health. Our team will share common mistakes made by Health Plans that we think can accelerate the digital revolution. This session aims to dive into the mistakes we’ve seen in the past and the essential ingredients for building digital dental payers. 

Pablo Alejo
Managing Director Product Experience & Engineering Lab
West Monroe

Pablo constantly seeks to uncover hidden truths that prevent clients from success by using a human-centered approach to solve real challenges. He partnered with a national dental chain to improve online bookings by rethinking the in-office experience—with his work shifting most bookings online. This improved online appointment conversion by over 20% annually for over five years and drove $300 million in revenue from digitally sourced new patients. As a veteran of the innovation age, Pablo has seen every major digital trend come and go and considers himself fortunate to have been a part of all of them. From the first websites to immersive mobile experiences and beyond-screen experiences, he has been there and led that. He joined West Monroe in 2022 from Accenture, where he was a Design and Innovation leader. Previously, he spent nearly 20 years in creative and technology roles within advertising before transitioning to consultancies. He earned a bachelor’s degree from Western Carolina University.

Hugh Ma
Partner
West Monroe

Hugh has over 20 years of experience working from ground zero of startups to the c-suite at Fortune 50 companies. Hugh has a business and product acumen that shapes strategic thinking. This operational expertise drives pragmatic decision-making, a leading perspective on evolving care delivery models, and the underlying business models transforming Healthcare. His expertise is in launching innovative businesses and products, strategy development, and large-scale business transformations. His management proficiencies include innovation, entrepreneurship, strategic planning, staff leadership, and business development.

The Payoff of Living More Mindfully

Wednesday, September 21

1:15 PM – 2:00 PM

This breakout session provides up-to-date lifestyle recommendations for how to develop more meaning, peace, and strength in our daily lives. Dr. Knowles teaches mindfulness-based stress reduction techniques. It can work for everyone, and during these incredibly difficult past years, healthy coping mechanisms are much needed to help survive the daily stress attacks on our bodies. Dr. Knowles offers ways to turn our thinking around and learn to savor the moments, even during chaotic times.

Dr. Lisa Knowles
Associate Dental Consultant
Blue Cross Blue Shield of Michigan
Dr. Lisa Knowles is the associate dental consultant for Blue Cross Blue Shield of Michigan. She continues to practice in East Lansing, Michigan, in her private practice focused on overall health and family dentistry. At Blue Cross, she advises on clinical aspects of Complaints & Grievances, Provider Relations, Fraud, Waste and Abuse, and Integrated Well-Being. She has a certificate in Mindfulness-Based Stress Reduction for Healthcare Professionals from Duke University’s Integrated Medicine Program. 

Emerging Trends in Dentistry Among Patients 22 and Younger: A Claims-Based Study

Wednesday, September 21

1:15 PM – 2:00 PM

The COVID-19 pandemic has profoundly impacted dental care among patients, particularly the 22 and younger age groups. Drawing on the nation’s largest repository of private healthcare claims data, this presentation will examine trends in the dental population before and during the COVID-19 pandemic. This session will look at the growth of orthodontic claims following the initial impact of the pandemic.  It will assume this growth may be supported by “do-it-yourself” orthodontics, as more general dentists are providing orthodontic treatment to help maintain their income as they may see fewer patients per day and cover the extra cost of personal protective equipment (PPE). This session also will look at the potential increase in cavities targeting patients age 22 and younger and if this is due to patients putting off routine dental care throughout the COVID-19 pandemic. In addition, FAIR Health will look at how anxiety connected to the ongoing pandemic may have resulted in an increase in teeth grinding, identified by increased occlusal guards. This session will also explore trends in rural versus urban dental health and if the pandemic changed how dental practices operate in these areas, as measured by the number of patients per day and services per patient. The information presented in this session will be helpful for stakeholders throughout the healthcare sector, particularly dentists and other oral healthcare providers, as well as payors, policymakers and researchers.     

Donna Smith
Chief Client Officer
FAIR Health

As chief client officer, Donna Smith maintains an effort to bring value to the various stakeholders across multiple market segments in the healthcare ecosystem. Donna has over 25 years of experience in the healthcare industry, concentrating on benefits administration, managed care, payor and claims solutions. Before joining FAIR Health, she was an independent consultant to various entities in the healthcare and benefits sector, including health plans, third-party administrators and other companies serving the health insurance payor and self-funded employer markets. For these entities, her consulting services concentrated on marketing, sales and organizational strategic planning. In addition, Donna also served the provider community, working with small physician group practices to evaluate electronic medical record (EMR) solutions based on meaningful use evaluations. Earlier in her career, Donna served as senior vice president of sales and marketing for a technology company, SBPA Systems, a role she retained when the company was acquired by SunGard, a leading technology and services provider of employee benefits, healthcare claims adjudication, business process automation and reporting solutions for the health and benefits insurance industry. In addition to focusing on business development, sales and marketing, Donna developed customer service, implementation and account management teams and executive and customer advisory groups.

Donna has participated in several key industry associations—including Self-Insurance Institute of America (SIIA), Health Care Administrators Association, America's Health Insurance Plans (AHIP), Institute for Healthcare Consumerism (IHC), and Institute of Medicine (IOM)—by serving in many capacities, such as focused panels, workshops, task groups, and committees, including a board of directors’ appointment with SIIA. Donna continues to participate and speak at various industry forums representing the many sectors FAIR Health serves. She holds a Bachelor of Science in Business Management and Marketing from Louisiana Tech University.

Winning in the Digital Era – Digital Strategies to Enhance Member and Provider Experiences, Reduce Costs and Improve Care

Wednesday, September 21
1:15 PM - 2:00 PM CT

This panel discussion session will explore how dental payers can employ digital strategies and tools to improve experiences and engagement with their members and provider stakeholders, reduce costs, and improve care. Participants will gain insights from experts on how to:

• Establish stronger member connections with mobile tools
• Improve access to the care experience, and increase member satisfaction with intelligent provider rating technologies
• Dramatically streamline provider processes and reduce administrative work with digital, automated provider onboarding
• Improve patient and provider experience with a real-time treatment plan and patient responsibility information.
• Improve cost and quality of care with artificial intelligence (AI) tools.

An Incremental, Progressive Agenda: Oral Health and Dental Plan Oversight in Biden Administration Policies

Wednesday, September 21
10:15 AM - 11:15 AM CT

While the boldest plans of the Biden administration have stalled in a narrowly divided Congress, the Biden Administration's executive agenda is incrementally advancing a progressive program that impacts oral health and dental plans in several ways. This session will survey key Biden administration regulatory priorities concerning public health (including oral health), health equity, expanded healthcare access, and specific interest policies to dental plans in the Affordable Care Act, Medicare, and Medicaid markets.

Mike Adelberg
Principal, Faegre Drinker Consulting
Mike Adelberg is the leader of Faegre Drinker Consulting’s healthcare provider and plans practice. He brings unique insights into the processes, policies, and people driving insurance regulation and the major government healthcare programs—Medicare, Medicaid, and “Obamacare” (the Affordable Care Act). Before joining Faegre Drinker Consulting, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS). He was responsible for establishing the Affordable Care Act policy for pediatric dental coverage and Stand-Alone Dental Plans. Before that, he oversaw Medicare Advantage contracting and market conduct, including supplemental dental benefits. Since joining Faegre Drinker, Mike has led numerous engagements related to the regulation of dental benefits.   

Beyond Network Discounts: Assessing the Value of Your Dental Provider Networks

Wednesday, September 21

10:15 AM – 11:15 AM CT

Dental provider network strength is a critical aspect of the competitiveness of dental insurance products. The panel will discuss the various elements that are important to consider when assessing the competitiveness and financial value of a dental provider network, and how to use data to gain insights into how to improve network positioning.


Tory Carver, FSA, MAAA
Actuary at Milliman

Tory Carver is an actuary with Milliman’s Hartford, Connecticut office. She joined the firm in 2017. As a member of the Hartford health practice, Tory assists with various projects for both public and private sector clients, including insurance companies, employers, pharmaceutical manufacturers, Medicare plan sponsors, dental insurers and special interest groups. Tory has experience with dental plan pricing for both commercial and Medicaid populations. She assists in premium rate development, provider contract analysis and has done core actuarial dental pricing and underwriting work for many dental carriers. She helps with Milliman’s Dental Actuarial Analytics PPO Network Study. This product uses a vast contributor database of dental claims to provide competitive insights on dental network discounts and utilization to study participants. Tory also has experience with the individual Medicare Part D market. She assists Medicare Part D plan sponsors with plan design, formulary design, and pricing of prescription drug plans. Tory also has experience modeling changes to the parameters of the Part D program. Tory currently serves as a contact for the Hartford Health practice’s recruiting efforts. She is a fellow of the Society of Actuaries and a member of the American Academy of Actuaries. Tory earned her B.S. in Mathematics and Business Administration from Northeastern University and graduated Summa Cum Laude.

Joanne Fontana, FSA, MAAA
Principal and Consulting Actuary at Milliman 

Joanne Fontana is a principal and consulting actuary in the Health Practice of Milliman’s Hartford office. She has been with the firm since 2006. During that time, she has consulted for insurance companies, including several major dental carriers, employers, government entities, and other organizations. Joanne’s focus has been mainly 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 manages Milliman’s Dental Actuarial Analytics PPO Network Study. This product uses a vast contributor database of dental claims to provide competitive insights on dental network discounts and utilization to study participants. She has worked with carriers and employer groups on dental insurance procurement and Medicaid dental procurements with state entities and bidders. She has done core actuarial dental pricing and underwriting work for many dental carriers. Joanne is considered an industry expert in dental products and pricing; she has presented on dental-related issues at multiple industry forums and authored many topical articles. Before joining Milliman, Joanne spent more than 10 years as an actuary with Cigna, where she held various healthcare financial leadership roles, including Chief Actuary of CIGNA’s dental insurance business.

Nolan Kurtz, Ph.D., FSA, MAAA
Actuary at Milliman

Nolan Kurtz is an actuary in the Hartford office of Milliman. He joined the firm in 2016. Nolan has a research background in programming languages, statistical software and predictive analytics. Before joining Milliman full-time, he held an internship at Milliman’s Hartford Health Practice. Nolan has a strong background in data analytics with pharmacy, medical, and dental claims in commercial and Medicare markets. He has worked with medical, pharmacy, and dental claims in multiple countries with varying levels of data quality and different development environments. Nolan has worked on projects addressing marketplace-wide surveys of pharmacy benefits, the impacts of point of service rebate sharing, pharmacy claim re-adjudication, health risk adjusters in China, PBM profitability visualization dashboards, Medicare Advantage and Part D pricing, dental network analysis and pharmacy investigations. He also manages the back end of the GASBHelp.com website, which helps small government employers comply with Other than pension Post-Employment Benefits.

Tom Murawski, FSA, MAAA
Actuary at Milliman

Tom Murawski is an actuary with the Hartford, Connecticut, office of Milliman. He joined the firm in 2009. Tom provides consulting services to various 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 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 laws 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.

Ryan Swindells, ASA, MAAA
Associate Actuary at Milliman

Ryan Swindells is an associate actuary with Milliman’s Hartford, Connecticut office. He joined the firm in 2019. Ryan assists with various projects for a diverse group of clients. He provides services for insurers, employers, pharmacy benefit managers and government entities on medical, pharmacy and dental benefits. Ryan has experience in the Medicare Advantage market. He assists with benefit design, formulary analysis, and pricing of Part D prescription drug plans for individual plan sponsors. He helps insurers with Employer Group Waiver Plan pricing in the commercial market. Recently, Ryan has been working on competitive analysis of commercial dental networks, auditing employer pharmacy benefit programs, and performing profitability tests under various pharmacy benefit designs and regulatory reforms.

Dental Fraud Waste and Abuse

Tuesday, September 20
3:00 PM – 4:00 PM CT

This session will explore fraud waste and abuse and answer these questions:

• What is looked at/what is looked for?

• How can data systems help?

• How an investigation goes along?

Stewart R Balikov, DDS
National Dental Director and Director of Dental Special Investigations
Anthem
Stewart R Balikov, DDS, is a 1983 graduate of the University of Southern California, School of Dentistry.  He joined Anthem in 2017 and is currently serving as the national dental director and Director of dental special investigations, having previously held the national dental director, utilization management for Aetna. Dr. Balikov is an accredited health care fraud investigator through the National Health Care Anti-Fraud Association and a Certified Quality Assurance Consultant through the California Association of Dental Plans. Additionally, Dr. Balikov is a Certified Dental Consultant and a past president of the American Association of Dental Consultants. Dr. Balikov is a member of the National Health Care Anti-Fraud Association, the American Association of Dental Consultants, the American Dental Association, California Dental Association, San Fernando Valley Dental Society and Alpha Omega Dental Society. He maintains a limited practice in the Los Angeles, CA, area. Dr. Balikov currently holds licenses in California, Colorado and Arizona.