SKYGEN Helps Payers Leverage Data to Improve Oral Health Equity

The quest to optimize Medicaid budgets will never end for state programs and managed care organizations (MCOs), but now, programs are pulling more data into the equation. As Medicaid administrators seek strategies that go beyond the day-to-day work of fixing teeth to genuinely enhancing the oral healthcare of all patient members, data is being used to supercharge strategy adjustments to influence outcomes. 

The question of how to accomplish this is one SKYGEN’s Dr. Shirley Spater, DMD, MPH, FADPD, DABSCD, Clinical Director, Benefits Management is helping insurers answer. In this interview, Dr. Spater talks about SKYGEN’s use of data in collaborating with Medicaid clients to increase preventive care and continuity of care, especially among the most vulnerable. 

Q: What types of data does SKYGEN analyze to help Medicaid programs improve outcomes?
Dr. Spater: We can look at any number of data sources depending on what the program wants to achieve, from coding and utilization to provider profiles and outlier behavior to patterns of member behavior.  We aggregate all this information, analyze it and then work with our client to decide how best to move forward with strategies developed to improve outcomes. 

Q: How does SKYGEN help Medicaid programs encourage the shift toward more preventive care?
Dr. Spater: It’s a multi-pronged strategy. First, it’s critical to acknowledge and appreciate the history of the plan as well as the current provider and member environments. By reviewing fee schedules, code ratios, utilization patterns, and authorization requirements, we focus on the goals of the program, including a strong concentration on preventive care. We can help curtail duplication of services, and identify areas for enhanced rule application. Second, by doing some outreach and light-touch education with providers, we help them succeed. When we are delegated to provide outreach, we have the resources to reach out to them directly, efficiently and effectively.  

Based on what we see in the analysis, there could be an opportunity to update provider manuals that may be missing information or need to give better guidance to the providers. We may need to ask providers to refer to their current provider manuals and CDT books more often than they do to align their billing with best practices. At the same time, we appreciate the sensitivities of the network, and pay close attention to network integrity. We are firmly committed to continually improving access to care. 

SKYGEN can also help Medicaid programs develop a recognition program to recognize and reward providers for delivering high-quality, cost-effective care. In all of these ways, we can influence change in terms of both preventive care and quality of care in the program.  

Q: How does SKYGEN help Medicaid programs work toward continuity of care goals?
Dr. Spater: Continuity of care, which is members returning to the same dentist, or what’s called a dental home, is absolutely essential to increasing oral health equity and delivery of preventive care. Being able to go to a dentist in their own community and being served by multilingual, multicultural staff may help members be much more comfortable visiting the dentist and so more likely to return. We provide education so members understand they can contact SKYGEN directly and request another dentist as warranted. 

We also have an Enhanced Find-A-Provider tool Medicaid programs are offering. With this smart tool, members may find not only the providers close to them but providers who also offer appropriate and efficient dental care. By using both proximity and provider ratings to direct members to quality care, we can help improve member satisfaction, and hopefully, their willingness to see their dentist for preventive care. 

When you think about the taxpayer-supported, finite budgets Medicaid programs are working with, gaining visibility into who is or isn’t utilizing their benefits and how providers are delivering care can enable programs to manage their programs at a deeper level. That’s really foundational to improving program performance in areas that contribute to oral health equity. 

Have questions about using data to target spending and benefits more effectively in your Medicaid program? Find out more on our Medicaid solutions page, or contact SKYGEN’s Medicaid program experts to get answers.