Menomonee Falls, WI – January 31, 2017 – While controlling administrative costs on Medicaid dental programs is important, it still only accounts for roughly two to four percent of the total spend. Scion Dental’s Enhanced Benefit Management Program is designed to address the larger opportunity. By enhancing the management of the benefit spend, payers are able to realize significant savings of a few dollars per member per month (pmpm) rather than the few pennies they might save by managing the administrative spend.
Key to the program is Scion Dental’s use of the Medicaid dental industry’s most sophisticated big data analytics, which delve deeply into factors that affect the cost of the program such as provider performance, benefit plan design, and reimbursement strategies. These findings are then used to develop benefit management strategies that are specific to each market a payer serves. Strategies include recognizing and encouraging dentists who are doing a great job of delivering appropriate and efficient care, as well as addressing those who may not meet the payer’s standards.
“Our Enhanced Benefit Management program is all about providing unparalleled program stewardship,” said John Schaak, president, Scion Dental. “We work tirelessly to save money so that budgeted dollars can provide more and better care to more members, while also improving the provider experience through, among other things, higher reimbursement rates. Given the potential changes the Medicaid program may face over the next few years, it will be more important than ever to encourage greater provider participation while also managing precious program dollars.”
The Enhanced Benefit Management program has four components:
- Market Analysis and Strategy Implementation – Scion Dental’s team of expert analysts use big data to perform an in-depth analysis of how benefit dollars are being spent – and should be spent – in each of a client’s markets. Once the strategy is developed and approved, Scion Dental can implement it or it can be turned over to a payer’s internal team.
- Provider Analysis – Scion Dental’s analysts also use big data to identify the top-performing dental providers – those delivering the most appropriate and efficient care, and who are focused on the best interests of the program. These providers are recognized through various means, which encourages the same positive behaviors throughout their market. The analytics also easily identify outliers, i.e., dentists who may be over-treating patients (especially children) in various ways. Armed with this information, payers can initiate the appropriate intervention, such as providing education or implementing a creative reimbursement strategy. The goal is to remove needless costs, leaving more money available to deliver dental care to all who need it.
- Benefit Plan Analysis – Scion Dental’s experts perform data-driven benefit plan analysis to help optimize the overall spend on benefits. For clients in a position to shape benefit plans, the analysis looks at factors such as how reallocating dollars to expand preventive services will reduce the need for (and spend on) more expensive procedures. It also can help interested payers determine which value added services might make them more competitive in a growing market.
- Reimbursement Analysis – Scion Dental analyzes reimbursement schedules and methodologies at both the provider and program level. Reimbursement strategies are then developed to ensure a payer’s limited Medicaid dollars are being spent in the most efficient and effective manner. The recommendations leverage many of the flexible reimbursement options available in Scion Dental’s Enterprise System benefit management software.
“Medicaid is not like traditional insurance. It is really budgeted healthcare,” Schaak said. “As with any budget, you can do more with every dollar you can stretch. Our Enhanced Benefit Management program ensures that limited Medicaid dental dollars are used wisely. We see it as a real difference-maker for payers, providers, states, and most importantly the citizens they all serve.”
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