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Analytics: Key to Managing Medicaid Dental Benefits in Uncertain Times

by Marcel Tetzlaff

SKYGENUSA Powering Healthcare for the Digital Age

AUTHOR: MARCEL TETZLAFF, VICE PRESIDENT OF DENTAL BENEFITS MANAGEMENT

To say these are uncertain times for Medicaid dental is like saying the sun is hot at the equator.

Yet while that makes for good headlines, the reality is Medicaid dental has always had its challenges, even when it hasn’t been under intense scrutiny and political pressure. 

The only real certainty around Medicaid dental is that health plans need to be much more efficient if they are going to continue to be good stewards of taxpayer dollars. Here are some of the ways technology-enabled solutions can make that happen.

Use analytics to improve benefit designs

Benefit offerings and provider reimbursement schedules have a tendency to become bloated over time. Analytics help payers address the spend on both. They can determine the services that should be included as part of standard benefit offerings based on what is already available within specific markets. They can also take a high volume of data and organize it into reports to show where reimbursement schedules can potentially be consolidated or eliminated – a task that is often impossible with manual reviews. By bringing the variables down to a manageable number, payers can avoid waste, making more total dollars available without any increases in funding. This approach can also help reduce the impact of funding cuts, if they occur.

Recognize good providers and remediate the bad

Analytics can again surface the providers who are excelling when compared to their peers. Technology can then be used to provide additional perks, such as placing them at the top of location-based “find a provider” lists. These same analytics can also be used to uncover instances of fraud, waste, and abuse (FWA) by comparing claims and highlighting the outliers. Once they are visible, the payer can take the appropriate remediation steps, such as provider education. Minimizing FWA means more money available for necessary care.

Drive preventive services

It is almost always far less expensive to prevent a problem than to fix one. Analytics can help uncover low instances of preventive care coupled with high instances of more costly care to help payers drive providers toward delivering more appropriate preventive services.

Move analytics to the cloud

Rather than building (or adding to) internal software and hardware infrastructure, you should partner with a Software as a Service (SaaS) organization to add analytics capabilities. This eliminates many of the up-front costs as well as ongoing expenses for maintenance, security, training, etc. If you work with a SaaS provider that has achieved HITRUST certification, you will dramatically reduce concerns about data security.

Manage smart

Medicaid dental is constantly changing, and is currently facing unprecedented potential upheavals. By understanding how to create efficiency to deliver more benefits out of whatever dollars are available, states, payers, and managed care organizations will bring the greatest level of quality care to more members.

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Marcel Tetzlaff

About
Marcel Tetzlaff

Vice President of Dental Benefits Management, Marcel Tetzlaff leads SKYGEN USA’s continuing commitment to helping its clients provide superior dental program stewardship. He and his team are responsible for developing and executing the company’s Enhanced Benefit Management program that is designed to ensure delivery of the most appropriate and efficient care possible. By leveraging SKYGEN USA’s technology, clinical, analytical and administrative expertise, the appropriate intervention can be initiated to achieve optimum performance, including recognizing and rewarding high-performing providers.

Mr. Tetzlaff comes to SKYGEN USA with more than 20 years of experience in managing government and commercial healthcare and dental plans. He was previously Director, Program Implementation at Integrated Health Network of Wisconsin, a multi-system, clinically integrated accountable care network. During his tenure, he oversaw all aspects of their Medicare Advantage program with payers and health systems, implemented best practices and operational standards across all health systems, and developed workflows, reports, education, training, and documentation for the Medicare Shared Savings Program (MSSP), Risk Adjustment Factor (RAF), Healthcare Effectiveness Data Information Set (HEDIS) and other quality and efficiency measures. Prior to that position, he was Regional Vice President, Provider Networks at DentaQuest, where he oversaw provider networks in 12 states and new network development efforts nationally. Among his accomplishments was managing the risk business that improved loss ratios with millions of dollars in claims expense reduction. He also implemented pay-for-performance reimbursement models for providers.

Mr. Tetzlaff earned his MBA at the University of Wisconsin-Milwaukee with a major in healthcare management. He also holds a Bachelor of Business Administration Degree from the University of Wisconsin-Whitewater.  

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