NADP Knowledge Center
Week 1 - CONVERGE 2020
This Week 1 CONVERGE 2020 package includes all recorded sessions from Week 1.
- NADP Members - $100
- Non Members - $150
The Fate of Standalone Dental: RevisitedContains 1 Component(s) Recorded On: 09/22/2020
$200 NADP members | $300 non members
Find out more about challenges and opportunities facing the dental benefits industry Sept. 22 at 10 AM Central when West Monroe presents The Fate of Standalone Dental: Revisited, the opening general session for Virtual CONVERGE 2020, offered live and via recording. For background information, see West Monroe’s recently published report, Convergence of Dental and Health Insurance Accelerates, which provides industry insights regarding the future of standalone dental plans.
The report contains key findings from West Monroe’s research such as:
- Updates from the 2018 research: What’s new, what’s changing, etc.
- Data and insights from health, dental, and ancillary plans
- COVID’s impact on convergence
- How all carriers can prepare and seize the opportunities from convergence
- Consumer demands and strategic market shifts
- Drivers and impediments to convergence
Meanwhile NADP research offers the following information about the current dental benefits market.
The Enrollment Survey reports:
- Less than 1% of covered individuals obtain dental benefits as part of a medical plan.
- 93% of covered individuals receive benefits from their employer or other group programs like AARP.
- An additional 7.1% buy individual coverage.
According to the Employer Survey:
- About half of all employers purchase standalone dental from a carrier different than the one providing medical coverage
- About 4 of every 10 employers purchase a standalone dental plan in conjunction with medical coverage from the same carrier
- Only 3% of employers purchased a medical plan that included dental coverage in a single policy
What does all this mean?
Presenters Benjamin Baenen and Kristin Irving of West Monroe will help you gain understanding and knowledge about these factors and how they will impact the industry when you attend Virtual CONVERGE 2020.
Director of Healthcare & Life Sciences
West Monroe Partners
Applying extensive experience gained from years of working with dental payers to transform their operations and customer experience, Kristin is responsible for expanding West Monroe Partners’ dental payer strategy and solutions. This includes solutions that deliver product road maps, build-versus-buy analyses, and multi-year system implementations. A results-focused project leader and skilled problem solver, Kristin brings a unique balance of business and technology expertise that enables her to address issues and opportunities from a holistic perspective – one that considers and incorporates people, process, strategy, and technology implications when defining a solution. By utilizing her experience managing large, complex projects on time and within budget, Kristin has helped her clients reduce operating and IT costs, optimize processes to maximize productivity, and deliver quality solutions. Kristin has worked collaboratively with her clients to deliver a wide array of successful business solutions, including IT strategy and planning, customer experience enhancements to support B2C transactions, claims platform assessments and consolidation, application development, web portals, and optimization of call center, claims, and sales-to-setup processes. Kristin also has worked with third-party administrators, dental payers, and dental providers to select and implement new platforms and software solutions. In addition, she has provided functional and IT diligence of healthcare systems and processes in conjunction with mergers and acquisitions. Prior to joining West Monroe Partners in 2006, Kristin was a manager with Hewitt Associates (now Aon Hewitt), responsible for improving claim processing and submission processes. Kristin earned a Bachelor of Science degree in Management Information Systems from the University of Illinois.
Director of Healthcare & Life Sciences
West Monroe Partners
A results-focused healthcare leader, Ben directs transformational initiatives spanning product innovation, new market entry, operational transformation, and technology disruption. He has spanned the payer value chain and launched a number of new technologies, strategic initiatives, and member engagement platforms. He has implemented consumer shopping portals, provider portals, robotics initiatives, billing engines, process changes. These projects created significant value for his clients, ranging for new member acquisition, increased provider engagement, and reduced calls to the call center. Ben has deep expertise in healthcare payer operations, supporting claims system analysis, system selections and vendor analysis, business transformation, functional requirements and design, usability testing, and operational readiness planning. Contagiously enthusiastic, Ben promotes collaboration within the firm and with clients in order to achieve the best results. He joined West Monroe in 2007 after earning a bachelor’s degree in economics from DePauw University.
New Decade, New Challenges, New Solutions: Highlighting Key Dental Data Trends and Market ProjectionsContains 1 Component(s) Recorded On: 09/22/2020
$200 NADP members | $300 non members
For the second year in a row, Managed Healthcare Executive magazine included “using big data effectively” as one of the top challenge’s healthcare executives will face this year. Big data is only getting bigger as we head into the next decade and dental is poised to experience a sea change as a result. In this presentation, P&R Dental Strategies’ dental and analytics experts will share key historical trends, market metrics and projections to provide an understanding of all the places Big Data can inform business strategy for dental payer organizations. From shifts in utilization and group practice market dynamics to rolling out value-based payment models, Big Data plays a role and P&R will discuss how.
P&R Dental Strategies
Mike is the President of P&R Dental Strategies and is responsible for overseeing all aspects of growing the business including sales, marketing and business development activities. 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.
Chief Analytics Officer
P&R Dental Strategies
Tim is the Chief Analytics Officer for P&R Dental Strategies. He is responsible for turning the vast database into actionable insights and intelligence for all our stakeholders. Tim has more than 30 years of applied statistical and analytical experience in the pharma/healthcare informatics space including over 20 years of consulting experience. He has worked at several of the nations’ leading data and analytics firms, including IMS Health, Aetna Health Information Solutions, Pharmetrics and AmeriHealth Caritas. Tim holds both a BS and MS in Statistics from the University of Delaware.
Plan - DSO Best PracticesContains 1 Component(s) Recorded On: 09/22/2020
$200 for NADP Members | $300 for non members
Learn more about administrative processes that work well for plans and DSOs. Panelists from leading dental support organizations will highlight best practices used by plans when working with DSOs. Topics covered include:
- Credentialing, both application & delegated
- Provider Directory Validation
- Claim payment and review policies
- Enhanced benefits for diabetes and other conditions
- COVID-19 responses, including teledentistry claims, PPE
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).
Sr. Manager, for Revenue Operations Projects
Pacific Dental Services
As senior manager for revenue operations projects at Pacific Dental Services, Amy Spaulding has contributed to the strategic focus of operational excellence since 2015. In this role, she oversees and manages the revenue cycle practices ensuring standardization, implementation, and utilization of top practices. Prior leadership positions at Pacific Dental Services include new market development & education manager for two years, billing operations manager for two years and orthodontic supervisor for revenue operations for one year. Additional professional experience includes service at multiple California dental practices.
VP, Insurance Products & Strategic Relations, Pacific Dental Services
Jeremy Jonckheere is vice president, Insurance Products & Strategic Relations at Pacific Dental Services. Prior to his work with Pacific Dental Services, Jeremy held numerous positions at DaVita Rx including senior director of strategy, director strategic development and government affairs, director of new markets, and director of strategic development. He holds an MBA in Finance, Marketing and Biotechnology from Northwestern University, Kellogg School of Management, an HBA in Business Administration (Honors) from the University of Western Ontario, Richard Ivey School of Business and a Bachelors in Business Administration from the University of Western Ontario.
Director Provider Relations
Aspen Dental Management
Theresa Bacon joined Aspen Dental Management Inc. (ADMI) in 2012 as the Manger Carrier Relations and has served as Director of Provider Relations since March 2019, leading provider credentialing and plan enrollment. Theresa is currently a member of the NADP Operations and Codes Workgroups and has worked on the Provider Directory Validation, CAQH and Delegated Credentialing Sub work groups
With over 20 years in the dental industry, Prior professional experience includes leadership roles at Coast Dental Services where Theresa served as associate director insurance and collections, insurance manager and insurance specialist.
Vice President of Insurance Operations, Aspen Dental Management
Art currently serves as the vice president of Insurance Operations and Revenue Cycle for Aspen Dental Management, Inc. (ADMI). ADMI is a dental support organization that provides non-clinical business support services to over 800 independently owned and operated Aspen Dental-branded practices in 41 states.
His business focus is on improving the efficiency and cost effectiveness of dental transactions so that dentists and insurance carriers can better focus on patients, subscribers, and employer groups.
Art started his career in insurance with a subsidiary of Anthem focusing on claims processing, file set-up, and system migration. He served as an officer in the U.S. Marine Corps and holds an MBA in Healthcare from Binghamton University and a BA in History and MS in Education from Canisius College. Art is currently the chair of the National Dental EDI Council (NDEDIC) and works with NADP on the EDI and Government Relations WorkGroups and DSO Advisory Council.
Dental Actuarial Round TableContains 1 Component(s) Recorded On: 09/23/2020
$200 NADP Members | $300 non members
Dental Actuarial Round Table
Joanne Fontana, FSA, MAAA
Principal and Consulting Actuary
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
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. 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.
Brenton Pyle, FSA, MAAA
Brenton is a consulting actuary with CSG Actuarial in Omaha, Nebraska. His work at CSG Actuarial includes product development, pricing, competitive analysis, financial projections, rate management, annual filing, valuation and reserving for dental, Medicare Supplement, hospital indemnity, cancer, accident, and other supplemental health products. Prior to joining CSG Actuarial in 2017, he served as assistant vice president and pricing actuary at Physicians Mutual, working on product development, pricing and product management for dental and other supplemental health products sold through a wide variety of distribution channels.
Pricing Actuary for Specialty Products
Blue Cross Blue Shield of Michigan
Martha Stubbs is the pricing actuary for Specialty Products at Blue Cross Blue Shield of Michigan (BCBSM), where she has worked since 2001. A University of Michigan graduate with an M.A. in mathematics, Martha has an extensive background in health insurance pricing (both insured and self-funded) and has supported multiple lines of business, including medical, dental, vision, disability income and limited benefit products such as hospital indemnity and accident only.
Ms. Stubbs currently supports pricing, RFP submissions, experience analysis, network evaluations and system implementations for Specialty Products at BCBSM.
Martha, who has a passion for teaching and learning, integrates both old and new concepts for ancillary product development. She has more than 40 years of experience in the individual, group and senior health insurance markets, and she has worked on compliance for small group reform, the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA) individual and group rate submissions for dental and vision products.
Anne Treankler, FSA, MAAA
Chief Risk Officer
Delta Dental of Wisconsin
Anne Treankler is the chief risk officer for Delta Dental of Wisconsin, leading the actuarial, billing and enrollment, business intelligence, group service claim operations, and underwriting teams overseeing enterprise risk management, pricing, financial projections, reserving, renewal adequacy, manual rate analysis, billing and enrollment, group claims administration, business intelligence, and analytics. She has over 20 years of actuarial experience. Since joining Delta Dental in 2012, she has also been actively involved in government relations. Anne is an actuarial consultant to numerous other Delta Dental plans.
Anne is a Fellow of the Society of Actuaries (SOA), a member of the American Academy of Actuaries, and serves on an SOA exam committee (vice-chair). She is a member of the Dental Policy Committee and the Public Policy Committee and a past member and chair of the Industry Research Advisory Group sponsored by the Delta Dental Plans Association. Anne is also active in the community, serving as Treasurer on the Girl Scouts of the Northwestern Great Lakes Board and as Vice President on the UW-Stevens Point Foundation Board.
Increasing Member Retention and Improving Member Experiences with Incentive BenefitsContains 1 Component(s) Recorded On: 09/23/2020
$200 NADP Members | $300 Non Members
Attracting new members year-after-year is expensive. When members move to a new plan every year or skip enrollment for a year this is costly for members and can jeopardize their oral health. Incentive benefits allow dental insurers to reward members for long-term membership and regular preventive care. These plan designs can drive increased member loyalty and motivate members to maintain good oral health. Automating these incentive benefit designs, including decreasing annual deductibles, increasing benefit maximums, and decreasing coinsurance, helps ensure the program meets member and employer expectations.
In this session you will learn:
- How incentive benefit plan designs benefit the member and drive better oral health
- Best practices from insurers who offer this benefit option
- Best practices for administration and automation of incentive benefits
Chief Sales and Marketing Officer
Delta Dental of Missouri
Jim Barone is the chief sales and marketing officer at Delta Dental of Missouri. He joined the organization in 2020, and currently directs all aspects of sales, marketing, account management, charitable giving and product development, and provides executive leadership for strategic goal setting, brand development and ongoing business plan metrics.
Jim has more than 30 years of sales and marketing experience. He previously served in a variety of roles at Ameritas, including as senior vice president of business development and wholesale distribution, senior vice president of group distribution, senior vice president of group business development and MGA distribution, and as national vice president of group business development. He has also held other executive positions, including as vice president/partner at Curtis Visual Communications, chief sales officer at ARAG North America, vice president of marketing and sales at Luxottica/Eyemed and vice president of marketing and sales at Anthem Blue Cross and Blue Shield.
Jim earned a Bachelor of Arts degree in philosophy from the University of Cincinnati and a Juris Doctorate degree from the University of Toledo College of Law. He was named “40 under 40” Top Business Leader by the Denver Business Journal.
Mark Krum, LLIF
Senior Vice President
Association Member Benefits Advisors (AMBA)
Mark Krum is a senior vice president responsible for the growth strategy at Association Member Benefit Advisors (AMBA) based in Austin, Texas. In his present role, one of his many responsibilities is setting business strategy for managing risk and sales growth of dental and vision products for AMBA members.
Prior to coming to AMBA he was the national dental & vision practice lead at WTW, responsible for consulting with employers on cost-effective and efficient dental and vision program strategy, design, vendor selection and ongoing plan management.
Mark brings over 30 years of broad strategic dental and vision industry experience, in the areas of distribution, consulting, strategic planning, product development, underwriting, account management, communication and network analysis. He has led the development and implementation of new dental and vision products for carriers/vendors, consulted on strategic distribution partnerships, private exchange development and single/multi-employer dental and vision block arrangements.
Mark’s broad vendor experience, diverse consulting projects and association program strategy bridges all market segments within the dental and vision space.
Education and Credentials
Mark is a graduate of Lawrence Technological University where he earned a B.S. degree in Civil Engineering, with a concentration in construction management. He earned a LIMRA Leadership Institute Fellow (LLIF) designation from Wharton School of Business and LIMRA.
Chief Innovation & Growth Officer
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.
Artificial Intelligence Transforming Dental Claim ProcessingContains 1 Component(s) Recorded On: 09/23/2020
$200 for NADP Members | $300 for Non Members
This presentation will cover how Artificial Intelligence (AI) is going to transform dental benefit organizations. Using AI, payers will be able to automate claim processing (utilization management, fraud, waste and abuse detection, claim analytics etc.) to reduce costs, increase accuracy and improve provider relationships. They will also be able to extract actionable insights to improve policies and patient care.
Wardah Inam, PhD
Chief Executive Officer
Dr. Inam is the CEO of Overjet. Overjet is the leading provider of AI solutions for the dental industry to help improve patient care. She has been ranked among the 32 most influential people in dentistry by Incisal Edge. Prior to founding Overjet, she was the lead product manager at a Silicon Valley based healthcare startup, Q Bio, working on biomedical imaging. Before that, she was a Postdoctoral Fellow at MIT Computer Science and Artificial Intelligence Lab where she worked on remote biomedical sensing using machine learning on wireless signals. Dr. Inam received a PhD from MIT, where she developed AI-powered autonomous microgrid technology. This work received widespread recognition including National Geographic covering it as a breakthrough that could transform the way we power the world. She has also worked on imaging technology at GE Healthcare and at Apple. She is the recipient of the MIT Graduate Women of Excellence Award, and the GIKI University and Presidential Gold Medals.
Chief Operating Officer
Shaju is the chief operating officer at Overjet, the leading provider of AI solutions for the dental industry. He is an experienced insurance industry executive previously serving as the chief analytics officer for DentaQuest, one of the largest dental insurance providers. He also served as chief information officer for P&R Dental Strategies, a dental insurance informatics company, after his startup was acquired by P&R. He has served as the board of Trustee for Mount Ida college and received his Master’s degree from Boston College.
Dental Trends in MedicareContains 1 Component(s) Recorded On: 09/23/2020
$200 NADP Members | $300 Non Members
This session will explore case studies from Dominion’s dental experience in Medicare Advantage programs in different states, including:
- How offering dental benefits with Medicare programs improves retention and reduces medical costs
- How dental and medical carriers approach Medicare dental plan designs
- The future regulatory landscape
Vice President, Ancillary Services
Chris Davis joined Capital BlueCross in February 2016 as Vice President, Ancillary Services. He is responsible for leading the continued growth of Capital BlueCross’ blue-branded dental and vision products, as well as ancillary business lines through its diversified family of companies. They include Dominion National, Avalon Insurance, and Consolidated Benefits, Inc. Chris sits on numerous committees, ranging from ensuring compliance and assessing risk, to process improvement and growth strategy. He is also a Board of Directors member for several healthcare-related companies. Prior to joining Capital BlueCross, Chris was part of the Senior Management team at Dominion National. He was responsible for group sales and retention, and served as Vice President, Sales and Service. He introduced new concepts to his sales and service team, as well as other departmental leads at Dominion, that increased productivity, strengthened distribution channels and ultimately lead to record commercial growth for Dominion National. Prior to serving Dominion National, Chris spent more than a decade with a national dental carrier in a large group sales role. He successfully grew (doubled) the book of business he was responsible for. He was one of an elite group in sales to achieve the “hall of fame” status for exceptional sales performance, and was one of the youngest to reach this milestone. Chris earned his Bachelor of Science degree in Marketing from King’s College in Wilkes-Barre, PA. He received his Master’s Degree in Business Administration, graduating with honors, from Shippensburg University, Shippensburg, PA. He also completed Breakthrough Leadership, a top internationally ranked leadership development program, as well as executive leadership training at Northwestern University’s Kellogg School of Management. Chris is a member of the United Way Tocqueville Society and serves as a member of the Board of Directors for the United Way of Central Pennsylvania. He was the top fundraiser for the Central Pennsylvania “Real Men Wear Pink” 2017 campaign which benefitted Making Strides Against Breast Cancer (American Cancer Society). He also served as the Leadership Chair in 2019 and the Tocqueville Chair in 2019 for the United Way campaign at Capital BlueCross. Chris maintains a Producers Accident and Health License in Pennsylvania. In 2017, he was a Central Penn Business Journal “Forty under 40” award recipient.
Vice President, Marketing
Jeff Schwab is Vice President of Marketing for Dominion National, a leading dental and vision insurer and administrator that serves over 900,000 members. He has nearly 20 years of experience in marketing, public relations and corporate communications. Schwab is responsible for leading Dominion’s marketing, public relations and advertising efforts, as well as overseeing the company’s new product launches and individual product lines both on and off the health insurance exchanges. He has led the development and execution of Dominion’s teledentistry pilot program with the goal of improving member engagement, satisfaction and access to dental care. He has also helped spearhead studies that reinforce how integrating dental and medical coverage and care can be associated with improved health and lower costs for those dealing with chronic medical issues. As Chair of Dominion’s Corporate Giving Committee, Schwab works to increase oral health awareness in Dominion’s communities through annual donations including dental health kits for children to local clinics and other charitable efforts. Schwab serves on the Board of Directors for the National Association of Dental Plans (NADP) to support NADP's mission to promote and advance the dental benefits industry to improve consumer access to affordable, quality dental care. This includes advocacy efforts on Capitol Hill. He is also a guest speaker at national industry conferences to discuss teledentistry trends and the importance of preventive dental care. Schwab holds a Master of Business Administration from the University of Maryland Global Campus and a Bachelor of Arts in Journalism from the University of Maryland. In 2019, he was a Leadership Center for Excellence “40 Under 40” award recipient.
President and Chief Operating Officer
Mike Davis is a founder of Dominion National and has overall responsibility for the company. Davis has nearly 30 years of experience in dental benefits and had served in various executive positions with MIDA Dental Plans, a successful DHMO in the Mid-Atlantic region, prior to establishing Dominion. Davis has been instrumental in driving the innovation of Dominion’s systems, services and plans since its inception in 1996. Most recently he has led the company’s pursuit into teledentistry to improve outcomes, member satisfaction and experience. Under Davis’ leadership, Dominion has grown to serve over 900,000 members, offer access to over 350,000 national dentist listings and employ a staff of over 200. Dominion’s expansion offering benefits to commercial groups, individuals and health plans resulted in the company’s 2016 re-brand to Dominion National. Davis helped Dominion become one of the first dental benefits providers in its region to introduce interactive, online benefit administration and other groundbreaking models and technologies to improve the client experience. Over the past decade, Dominion also became known for its innovative online dental programs for individuals and associations. Davis participates on several boards, including Dominion National and a regional DSO. He earned a bachelor’s degree from Radford University.
A Medicare Dental Benefit: No Longer a Just a Pipe DreamContains 1 Component(s) Recorded On: 09/24/2020
$200 for NADP Members | $300 for Non Members
The COVID-19 emergency and recession is forcing Americans to again focus on healthcare reform, and the odds of a major healthcare reform push in 2021 are growing. Speaker Pelosi advocates adding dental and vision benefits to Medicare, and four recent bills include a Medicare dental benefit. For the first time, a Medicare dental benefit is not a pipe dream. But will this benefit leverage leading private sector practices to deliver the best and most cost effective dental coverage for seniors?
Faegre Drinker Consulting
Mike Adelberg is the leader of Faegre Drinker Consulting’s health care strategy practice. He brings unique insights into the processes, policies and people driving the major government health care 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 Affordable Care Act policy for pediatric dental coverage and Stand Alone Dental Plans and, prior to that, oversaw Medicare Advantage contracting and market conduct, including with regard to dental supplemental benefits. Since joining Faegre Drinker, Mike has led numerous engagements related to the regulation of dental plans and helping dental plans pursue new opportunities within government programs.
The need to modernize Network and Provider Management Capabilities in a Post Pandemic WorldContains 1 Component(s) Recorded On: 09/24/2020
$200 - NADP Members | $300 - Non Members
Context COVID-19’s impact on our country’s medical infrastructure is without precedent. In no small part, the impact can be attributed to unheeded calls to adequately plan and prepare for a pandemic. And while providers on the front lines risk their lives to save lives, another battle may be underway to ensure enough qualified providers are deployed when and where they are needed. Therefore, a discussion topicworth consideration is what challenges is this pandemic surfacing or magnifying for payer and provider organizations as related to provider and network management (onboarding, credentialing, payer enrollment, network management, provider directory management etc.). The objective is to identify and raise awareness as to what are the challenges that payor and provider organizations may now need to address within provider enrollment and provider enrollment operations that were introduced or exacerbated by the COVID-19 pandemic. This session will share challenges, lessons learned and the implications of COVID 19 from different perspectives on key provider related operations. This session will also explore short- and long-term impacts of COVID-19 on regulatory compliance and the need to modernize out-of-date processes and solutions as well as opportunities to increase collaboration between providers, payors and solution providers.
Assoc. Director Dental and Vision Quality Improvement
Corinne Hanson is the assoc. director Dental and Vision Quality Improvement for Sun Life. She has responsibilities for provider credentialing, member complaints, dental fraud investigation, provider access and accessibility, directory validation and prepaid compliance as it relates to the company’s quality improvement initiatives.
Corinne began her career as an ICU nurse and created a hospital-wide compliance program, awarding the hospital its first accreditation with the Joint Commission. She was a consultant for the Texas Department of Insurance for its development and implementation of their HMO triennial audit tools. For the past 20 years, she has devoted her knowledge and experience to the dental/vision industry, creating compliance programs to address regulatory and legislatives changes affecting both carriers and networks. She has been an active volunteer of NADP’s Operations WorkGroup and was instrumental in the development of the uniform provider directory validation spreadsheet.
Vice President of Strategy and Sales
Bert Fajardo joined Santéch Solution in 2011 as vice president of Strategy and Sales where he is entrusted with ensuring Santech’s vision is aligned with the needs of its clients and the healthcare industry. An accomplished executive with more than -25- years of experience, Bert’s a hands-on leader who guides organizations in ensuring their technology investments are appropriately leveraged to achieve business aligned objectives. Prior to Santéch, Bert served as a management consultant advising C-Level executives on IT Strategy and Risk. He also served as CIO for One Call Medical, a recognized leader in the delivery of various Healthcare services. Bert has also served as a senior IT executive at several Fortune 100 firms including UBS, Citigroup, and JP Morgan Chase.
Bert earned a B.S. degree at Pace University where he majored in Computer Science.
DE Practice Group
Jeannine partners with regional management and their teams to create growth in dental practices and systematize the operations that create success. After spending nearly three decades in dentistry and calling anything from large group offices to small boutique practices her dental home, Jeannine knows what truly drives and motivates dental teams, strong relationships, and nurtured leadership. It's how well you can connect with people you support, and watch grow and communicate your experiences and knowledge back to them so that they can be leaders as well. Jeannine is from a beautiful small town in Missouri where the stars are brighter than the lights in town, and while she misses her home town, she loves where she has resided in Atlanta for the past 26 years with her husband, family, grandkids, and dog, “George.” It does not matter which state she is in this week; you can see Jeannine embracing what she believes in, which is serving others.
Vice President of Network Operations
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.