NADP Knowledge Center
Sept. 21 - Value-based Care: Shifting the Industry’s Focus from Volume to Outcomes
Recorded On: 09/21/2022
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.
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.
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.