Budget Season Alert: How SKYGEN’s Solutions Help Payers Control Costs

The 2025 budget season is upon us, and payers face the critical task of balancing cost control with maintaining high standards of care for their members. At SKYGEN, we understand the unique challenges payers encounter and offer a suite of flexible, cost-effective solutions designed to help you maximize efficiency, eliminate waste, and enhance care quality. Whether you need a comprehensive solution or specific tools to address targeted needs, we’ve got you covered.

SKYGEN’s Flexible Cost Control Solutions
Our range of solutions is crafted to help dental payers achieve significant savings, minimize fraud, waste, and abuse (FWA), and ultimately improve the quality of care members receive. You can implement our solutions in their entirety or select individual components that best address your specific needs.

Enhanced Benefit Management (EBM)
SKYGEN’s Enhanced Benefit Management (EBM) is your comprehensive approach to uncovering savings across benefit design, reimbursement strategies, and network performance. Our team of expert consultants, armed with deep clinical, technological, and industry expertise, use advanced analytics to create custom strategies tailored to your organization’s specific requirements. Beyond cost savings, EBM enhances fraud detection and improves member and provider experiences by identifying outliers who deviate from community standards. These outliers are referred to your in-house FWA department, or if you lack an internal FWA team, SKYGEN’s FWA department can manage this process for you.

Key Components of EBM:

• Market Analysis: A thorough evaluation of all factors impacting your program's performance across each market.
• Provider Analysis: Identification of top-performing providers who deliver appropriate and efficient care, as well as those who deviate from community standards.
• Benefit Analysis: A data-driven assessment of your benefit plans, comparing them to industry standards to uncover opportunities for improvement.
• Reimbursement Analysis: Evaluation of reimbursement schedules and methodologies to ensure efficient and effective use of your program dollars.

Fraud, Waste, and Abuse (FWA) Solutions
For clients who lack an internal FWA team, SKYGEN’s Fraud, Waste, and Abuse (FWA) department offers specialized expertise. Our dedicated professionals leverage advanced tools and deep industry knowledge to identify, investigate, and mitigate instances of fraud, waste, and abuse within your dental benefit programs. Partnering with SKYGEN means you have a robust FWA solution that ensures compliance with regulatory standards, protects financial resources, and safeguards the integrity of care. Whether you require full FWA services or need support to complement your existing efforts, SKYGEN delivers the necessary expertise and protection to maintain a healthy and efficient dental benefits program.

Provider Select Suite
SKYGEN’s Provider Select Suite is designed to help dental payers identify and reward high-performing providers, driving enhanced member experiences. With flexibility at its core, the Provider Select Suite can be tailored to your specific needs—whether your focus is on quality, cost, efficiency, or a customized balance.

The Provider Select Suite Includes:

• Ratings Tool: This tool identifies high-performing providers by evaluating care appropriateness, cost, electronic adoption, and other custom criteria. Fully customizable, it helps reduce provider variances and prevent inappropriate care, aligning with your quality, cost, or efficiency goals.
• Recognition Program: Recognize and reward providers who deliver high-quality, cost-effective care. This program helps you identify top performers who can be considered for enhanced reimbursement opportunities.
• Enhanced Find-A-Provider: This feature uses provider ratings and proximity to direct members to the best nearby providers, optimizing both member satisfaction and cost savings.

Customizable Solutions 
At SKYGEN, we recognize your unique needs. That’s why our solutions are customizable, allowing you to leverage services that address your specific challenges. This flexibility ensures that you can tailor how you work with SKYGEN to maximize efficiency and achieve your cost-saving goals.