CONVERGE 2014 Program by NADP

nadp conference 2014

September 15, 2014 Dear Attendees: Welcome! We are pleased you’ve joined us for CONVERGE 2014, the National Association of Dental Plans’ annual conference. We look forward to sharing the next two and half days of professional development and connection opportunities with you all. The dental benefits industry has entered a new frontier – one filled with opportunities and endless questions. Challenges range from Affordable Care Act implementation issues, shifts in the marketplace and provider concerns. Over the next two and a half days, CONVERGE 2014 will broaden your industry perspective and knowledge through stimulating general sessions, in-depth breakout presentations and informative exhibits. The breakout sessions explore industry challenges through three educational tracks: Government Relations, Professional Relations and Business Development. Session locations will be published on the pocket schedule. And as an added bonus, the Discovery Zone will offer DZ Demos to enhance your learning experience. Before we close, we’d like to thank each of you for attending our conference and bringing your expertise to our gathering. You, as industry leaders, have the vision, the knowledge, the wherewithal and the experience to help pave the way to an even brighter future. You are truly our greatest asset today and tomorrow, and NADP could not accomplish what we do without your support and leadership. Throughout this conference, we ask you to stay engaged, keep us proactive and help us shape the future of the dental benefits industry. Our personal respect and thanks goes out to all of you. Sincerely,

Chris Swanker NADP Board Chair

Evelyn F. Ireland, CAE NADP Executive Director

CONVERGE PUBS Event Program

CONVERGE offers professional development opportunities designed for various industry disciplines. This program book offers brief summaries of the breakout sessions, while the online version provides additional details. To help you determine which session best meets your needs, session titles are displayed in this order using the following coding system: Government Relations Professional Relations Business Development

Use your smart phone to scan the QR code to access mobile version of schedule.

Pocket Schedule

This pocket-sized schedule provides a quickglance, daily schedule including events, session names and locations, breaks, receptions and lunches.

Online Mobile Schedule

The updated online schedule at nadpconverge.org/schedule provides detailed session descriptions, speaker biographies, exhibitor and sponsor information that you can access on any tablet or smartphone. Check the online session descriptions for further details that are not included in the print edition due to space limitations. 3

CONTENTS

about the PUBS whatâ&#x20AC;&#x2122;s new?

agenda events

14 education exhibitors

50 sponsors 4

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STAY CONNECTED .org

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To access the 2014 CONVERGE Community, please visit

nadpconverge.org

This yearâ&#x20AC;&#x2122;s conference website, nadpconverge.org, is a one-stopshop for all your CONVERGE needs. Mobile-friendly online schedule Session details Speaker bios 2014 exhibitor list Discovery Zone floor plan & exhibitor booths 2014 sponsor list The CONVERGE Community Registration, travel and hotel information Real-time updates Links to handouts via the CONVERGE Community

WHAT’S NEW IN 2014?

• The Discovery Zone – an enhanced exhibit experience featuring a variety of opportunities to connect with products and services. • Informal “lounges” where you can recharge. • Small stages within The Discovery Zone designed for short exhibitor presentations and product demonstrations. • Dedicated Discovery Zone time. • Schedule appointments with exhibitors in the Discovery Zone during the hours the exhibit hall is closed. • Walk-around luncheon (there will be no speakers/presentations) which gives you the opportunity to visit with exhibitors.

monday, sept 15 Golf Tournament sponsored by Ameritas

8:00a - 4:00p

Exhibitor set-up (all booths must be set up by 4pm)

11:00a - 8:00p

Registration Open

AGENDA

7:30a - 12:30p

VOLUNTEER GROUP MEETINGS 1:00p - 2:30p

All-Volunteer Group Meeting

2:30p - 3:00p

REFRESHMENT BREAK

3:00p - 4:00p Codes Workgroup Education Commission STI Operations Workgroup 3:00p - 4:30p Communications Committee Government Relations Commission 4:00p - 5:00p STI Clinical Workgroup 4:00p - 5:00p

Discovery Zone Meeting with Exhibitors and Steven Hacker the Discovery Zone Manager

4:00p - 6:00p

Research Commission

4:30p - 6:00p

Membership Committee

4:30p - 6:00p Exchange Operations Workgroup State Exchange Task Force 5:00p - 5:30p EDI Workgroup 6:30p - 8:00p Opening Reception on Rotunda / Outdoor Patio

tuesday, sept 16 7:00a - 6:00p

Registration

8:00a - 8:30a

Breakfast sponsored by Stratose

AGENDA

8:45a - 10:15a Opening General Session Employer Coverage & Benefit Design in a Post-ACA Environment Caroline Pearson (Avalere) Sponsored by WellPoint 10:15a - 10:30a

Transition time

10:30a - 12:00p Dedicated Discovery Zone time no breakout sessions 10:45a - 10:57a 11:15a - 11:27a 11:45a - 11:57a

DZ Demos - stages 1 & 2 DZ Demos - stages 1 & 2 DZ Demos - stages 1 & 2

12:00p - 1:30p Lunch Session Consumer Purchasing Behavior in the Health Insurance Marketplaces Dr. Marko Vujicic (ADA) â&#x20AC;˘ Sponsored by UCCI 1:30p - 2:30p The Road Ahead for the FFM Mike Adelberg Rebecca Zimmerman (CCIIO) Provider Quality Assessment: Implementing Pay for Performance Tyrette Hamilton (P & R Dental Strategies) Dr. Robert Salehrabi (USC School of Dentistry) Big Data: Implications for Dental Herschel Reich (OptumInsight) Joel Reichert (OptumInsight)

2:30p - 3:00p

Break • Sponsored by Aspen Dental

3:00p - 4:00p ACO Update: Trends, Results and the Future of Accountable Care David Muhlestein (Leavitt Partners) Credentialing: Reducing the Time to Access Participating Providers • Jeanne Hensel (Humana) • Amy Marko (InterDent) • Mike Cole (Dental Care Alliance) • Shannon Reynolds (GEHA) Channel Management: Are You Ready for the Surge in Online Marketplaces and Private Exchanges? Jeff Yaniga (Connecture) 4:00p - 4:15p

Transition time

4:15p - 5:15p Medical Loss Ratio Implementation Issues For Dental Plans Joanne Fontana and Scott Jones (Milliman) Promoting Accountability for Long Term Health and Cost Control - a Goal for Payers Dr. Fred Ferguson (About Smiles) Dental Carriers and Private Exchanges Alan Cohen (Liazon) 5:15p - 6:15p

Cocktail Hour in Discovery Zone

wednesday, sept 17 6:30a - 7:30a Dental Dash sponsored by Pacific Dental Services 8:00a - 8:30a Breakfast sponsored by Heartland Dental

AGENDA

8:00a - 6:00p

Registration

8:45a - 10:15a General Session Mastering Disneyâ&#x20AC;&#x2122;s Management Methods! Mark David Jones (Small World Alliance, Inc.) 10:15a - 10:30a Transition Time 10:30a - 11:45a

The Emergence of Dental Benefit Strategic Partnerships, the New Normal Steve McCarty (The Concept Group)

Forensics to Improve Data Analytics in Fraud Detection Dr. Franklin Din (FraudLens)

Solving the Individual Puzzle: Empowering Transformation to a B2C Model Will Hinde and Kristin Irving (West Monroe Partners)

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12:00p - 1:15p

Lunch in the Discovery Zone

1:15p - 1:30p

Transition Time

1:30p - 2:30p

Trends and Best Practices for Public Affairs Sheree Anne Kelly (Public Affairs Council and Foundation for Public Affairs)

Medicaid Expansion and Dental Fraud Abuse Craig Kasten (Wonderbox Technologies)

Tools and Topics for Improvement Initiatives Mark David Jones (Small World Alliance, Inc.) 2:30p - 3:15p Break â&#x20AC;˘ Sponsored by Assurant Health Exhibitor Giveaways (must be present to win) 3:15p - 3:30p

Transition Time

3:30p - 4:30p The Future of Childrenâ&#x20AC;&#x2122;s Coverage: CHIP and Medicaid Joe Touschner (Georgetown University Center for Children and Families)

Dental Networks and Healthcare Exchanges Aaron Groffman (The Ignition Group) Using Population Oral Health Data to Optimize Your Dental Wellness Program Craig Lesley (Lesley Consulting Services) Dr. Carl Loeb (PreViser)

4:45p - 5:45p NADP Business Meeting Open to all members 6:00p - 10:00p

Evening on your own

thursday, sept 18 8:00a - 8:30a

Breakfast

AGENDA

8:30a - 9:45a Issues Ahead with Pediatric Dental Implementation Andrew Snyder (National Academy for State Health Policy) Colin Reusch (Childrenâ&#x20AC;&#x2122;s Dental Health Project) Tom Spangler (American Dental Association) 9:45a - 10:00a

Transition Time

10:00a - 11:30a Closing General Session Future Visions for Dental Benefits Gary Radine (Delta Dental CA) Erich Sternberg (Starmount) Phil Kaufman (UnitedHealthcare) Sponsored by Delta Dental of CA

#connect nadp.org

nadpconverge.org mynadp.org

acebook

facebook.com/nadp.org facebook.com/nadpconverge

Linked in tinyurl.com/LinkedIn_NADP 12 12

You Tube youtube.com/nadporg

twitter @nadpCONVERGE @nadp_consumers @nadp_members @nadp_research @nadpgov #nadpconverge14

EVENTS GOLF TOURNAMENT

sponsored by:

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LUNCHEON SESSION

EDUCATION

Consumer Purchasing Behavior in the Health Insurance Marketplaces presented by Dr. Marko Vujicic Room: National A & B Tuesday, September 16 During lunch, 12:00p â&#x20AC;&#x201C; 1:30p The Affordable Care Act is changing the health care landscape. With the launch of health insurance marketplaces and the mandate for purchasing coverage now passed, key information is becoming available on dental benefits coverage purchases. Moreover, other aspects of the Affordable Care Act, namely Medicaid expansion, will have a significant impact on the dental benefits coverage, access to care, and how dental care is paid for. A new wave of health care consumerism will also reshape the type of dental benefit products in the marketplaces. This presentation will summarize what we have learned so far about consumer behavior regarding dental benefits purchases within the health insurance marketplaces drawing heavily on new research from the American Dental Association Health Policy Institute. About the Speaker Dr. Marko Vujicic is Managing Vice President, Health Policy Resources Center at the American Dental Association where he is responsible for overseeing all of the Associationâ&#x20AC;&#x2122;s policy research activities. Prior to joining the American Dental Association (ADA), he was Senior Economist with The World Bank in Washington D.C. where he directed the global health workforce policy program, which focuses on addressing the numerous human resources for health challenges in developing countries. Previously, he was Health Economist with the World Health Organization in Geneva, Switzerland. Dr. Vujicic is the lead author of the book, Working in Health, which examines the effect of fiscal policy on the health workforce. sponsored by:

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The Road Ahead for the FFM! presented by Mike Adelberg and Rebecca Zimmerman

EDUCATION

Room: National C & D

Center for Consumer Information and Insurance Oversight (CCIIO) staff, Mike Adelberg, Director, Insurance Program Group and Deputy Director, Exchange Policy and Operations Group, and Rebecca Zimmerman, dental policy lead, will lead an interactive session related to dental offerings through the Federally Facilitated Marketplace (FFM). Lessons learned from 2014 and the path toward open enrollment for 2015 will be discussed.

Michael (Mike) Adelberg is the Director of the Insurance Programs Group and concurrently the Deputy Director of the Exchange Policy and Operations Group in Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight. Rebecca Zimmerman is a Health Insurance Specialist in the Issuer and Plan Policy Branch in the Division of Plan Management, Exchange Policy and Operations Group, in Centers for Medicare & Medicaid Service (CMS) Center for Consumer Information and Insurance Oversight.

Provider Quality Assessment: Implementing Pay for Performance presented by Dr. Robert Salehrabi & Tyrette Hamilton

Room: Royal Dublin

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With the introduction of the Affordable Care Act, the emphasis on reimbursement is shifting from a service based system to a value based system. Pay-forperformance has been used by medical carriers for some time; the question is whether the model can be migrated to dental. Are the days of signing just any dentist into your network and paying a fee based on services provided numbered? If so, how can payers determine which dentists provide better quality of care? The application of data analytics with a large claims database can provide the mechanism to differentiate quality dental care. By developing algorithms tied to standard quality measures developed by the DQA, CAMBRA, AAPD, etc., dentists can be segmented based on quality of care. Areas of potential measurement include 1) profiling, 2) adherence to protocols, 3) clinical competency, 4) customer satisfaction, and 5) utilization. Each of these areas can be scored for every dentist and a weighted average can be calculated to provide an overall quality score. This presentation examines how dentists can be scored on a variety of measures and presents how you can implement the system in your organization.

september 16 • 1:30p – 2:30p Dr. Robert Salehrabi received his dental degree from the State University of New York at Buffalo in 1992 with a minor in Oral Medicine. He practiced as a restorative dentist for 10 years prior to his Advanced Endodontic Residency at the University Of Southern California School Of Dentistry. He is currently an Assistant Clinical Professor at USC and his research articles have been published in the Journal of Endodontics, American Journal of Dentistry, and other peer reviewed dental journals. Tyrette (Ty) Hamilton is responsible for the day-to-day oversight of P&R Dental Strategy’s corporate activities. With more than 25 years in medical, dental, vision, and other specialized insurance program operations, she has developed comprehensive practical experience in successful management of commercial and public dental programs using data driven solutions for quality assurance, quality improvement, and key performance measurement, including National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS) and program-specific performance measurement.

Big Data: Implications for Dental presented by Herschel Reich and Joel Reichert

Room: Royal Melbourne The promise of Big Data has netted some significant advancement in analytics, providing new insights and capabilities, particularly in its ability to help organizations understand their unstructured data. But early adopters are finding challenges in turning those insights into repeatable processes in the context of highly regulated industries. The continuing marketplace shift towards the more highly skilled analytics worker is pushing information technology departments to equip knowledgeable personnel with access to the data required to make informed decisions. Herschel Reich is a Vice President in the Payer Consulting practice of OptumInsight. He joined the company in 2005 and has helped significantly grow the New York and Northeastern markets as the Office Manager. He has worked in the actuarial health care and managed care arena for more than 25 years with experience in specialization in commercial and Medicare strategy assessments, performance improvement, pricing, underwriting, reserving, product development, alliance development and vendor management for health and ancillary products. Joel Reichert is a technology champion for of the Optum Data Management team, accountable for defining the big data strategy for the organization. As such, Joel is responsible for the delivery of UnitedHealth Group’s largest data integration effort, including a shift away from traditional technologies toward the emerging capabilities of big data. Joel brings more than 13 years of experience in Healthcare and Information Technology. He brings a wealth of technical experience to deliver innovative business intelligence solutions in the payer, provider and government markets.

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EDUCATION

ACO Update: Trends, Results and the Future of Accountable Care presented by David Muhlestein, PhD

Room: Royal Dublin Health care providers in all 50 states have formed more than 600 Accountable Care Organizations (ACOs). This presentation will provide an overview of the broader accountable care movement with a focus on regional growth of ACOs, variations in approaches to managing populations, early results and the future of the movement. Dr. David Muhlestein is Director of Research at Leavitt Partners, a health care intelligence business, where he oversees the firm’s quantitative and qualitative evaluation of the changing health care landscape. He has extensively studied the growth of accountable care organizations with the Center for Accountable Care Intelligence and leads the firm’s study of geographic variation in health care markets. His general research interests focus on applying a legal and legislative lens to quantify and evaluate health policies for the benefit of government and private policy makers. Dr. Muhlestein earned his doctorate in Health Services Management and Policy, JD, MHA and MS from The Ohio State University and a BA from Brigham Young University.

Credentialing: Reducing the Time to Access Participating Providers

• Jeanne Hensel (Humana) • Amy Marko (InterDent) • Mike Cole (Dental Care Alliance) • Shannon Reynolds (GEHA)

Room: National C & D

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Join the NADP Credentialing Sub Work Group (SWG) panelists as they present their initial findings on the minimum common core data elements to credential, the payer process flow and timing to credential, the state and federal regulations, and the cost involved with potential savings to be realized. Attendees will be encouraged to offer feedback during the question-and-answer section of the presentation. Based on NADP member input, the SWG was formed early in 2014 to discuss provider credentialing issues. Credentialing is the systematic approach to the collection, verification and re-verification of a provider’s professional qualifications and experience. In March, the SWG met in-person followed by monthly meetings and non-stop committee work along with the Operations Workgroup calls.

september 16 • 3:00p – 4:00p Jeanne Hensel has more than 29 years of experience in the health benefits field, 27 of which are devoted to the dental insurance segment. In her current position as National Director Specialty Benefits with Humana Insurance Company, she leads and directs dental network growth and retention. Jeanne attended Milwaukee Area Technical College with concentration on English and Psychology. Amy Marko is Vice President, Insurance Operations for InterDent. She leads insurance relations, revenue cycle management, credentialing and business development efforts for the organization. She is the key leader focused on business growth through insurance and employer relations. Mike Cole has served as Vice President of Insurance Plan Management at Dental Care Alliance since April 1999. Prior to DCA, he worked as a Network Manager for Prudential and then UCCI from 1991-1999. Mike graduated from the University of Missouri with a BA in 1977 in Industrial Psychology. Shannon Reynolds has more than 20 years of experience in the health care industry. As the Provider Network Manager for GEHA’s propriety network, Connection Dental, Shannon has been responsible for the management of the dental network.

Channel Management: Are you ready for the surge in online marketplaces and private exchanges? presented by Jeff Yaniga

Room: Royal Melbourne With enrollment on private exchanges skyrocketing, dental plans are no longer debating “if” and instead are wondering “how” to participate in private exchanges. While there are a variety of private exchange models, many dental plans are trying to understand what the pros and cons are to participating in each and how to effectively manage the private exchange relationships and connectivity to maximize enrollments. Please join us as Jeff Yaniga, Connecture’s Vice President of Private Exchanges, discusses the private exchange opportunity and recommendations for effective channel management. Jeff Yaniga is Vice President, Private Exchanges at Connecture. In his role, Jeff develops solutions to best fit his clients’ needs by leveraging Connecture’s experience powering Medicare.gov, three public exchanges and private exchanges for active employees, early retirees and Medicare eligible individuals. He has spent most of the last two decades leading delivery teams and account teams serving Fortune 500 health plans, benefit consultants and the most innovative insurance agencies and brokers.

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EDUCATION

Medical Loss Ratio Implementation Issues for Dental Plans presented by Joanne Fontana and Scott Jones

Room: National C & D The application of minimum loss ratio requirements to health insurers under the Affordable Care Act has affected how health insurers price their plans, as well as significantly increased requirements on managing and reporting plan finances. Interest in extending minimum loss ratio rules to dental insurers has picked up, particularly with bill AB1692 in California. In this session we will discuss the minimum loss ratio regulations under the ACA and their impact on medical insurers and considerations for their potential extension to dental insurers. Joanne Fontana, FSA, MAAA is a consulting actuary in Milliman’s healthcare practice in Hartford, Connecticut, and has been with the firm since 2006. During that time her clients have included 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. Scott Jones is a consulting actuary with the Seattle office of Milliman. He joined the firm in 2002. Scott’s actuarial experience includes pricing, rating, reserving, medical underwriting, hospital contract analysis, and regulatory filings. Recent projects include: Medicare Advantage bid development and consulting, commercial exchange filings. He was part of a team developing the Department of Veterans Affairs Enrollee Health Care Projection Model, and contributed to actuarial analysis and recommendations in the development of health reform regulations.

Promoting Accountability for Long Term Health and Cost Control – a Goal for Payers presented by Dr. Fred Ferguson

Room: Royal Dublin

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A significant symptom that highlights the problems with our chronically ill healthcare system is escalating costs. This fatal flaw is the result of consumers, providers and payers not working effectively together. This lack of synergy among the key players is understandable when one realizes that

september 16 • 4:15p – 5:15p two key components of the system are unavailable to payers. Payers have neither access to timely data about consumer health related behaviors nor the provider examination data that corroborates these findings. The most effective way to understand consumer health habits, life style choices, diet, self-care, etc. is to inquire about them and authenticate the responses with their dental health record. This knowledge is critical to the entire healthcare system in order to improve overall health and reduce costs. Dr. Fred Ferguson is president and CEO of About Smiles, Inc. and creator of MySmileGuide.com. Since starting About Smiles, Inc. in 1999, Dr. Ferguson has consulted with insurance companies and organizations with the goal of increasing awareness about the value of oral health to overall health promotion and reduction of costs and claims. He has a long history of providing continuing education for insurance companies to their medical and dental health provider groups.

Dental Carriers and Private Exchanges presented by Alan Cohen

Room: Royal Melbourne News on development of private exchanges and increasing enrollment abound. It seems that private exchanges are formed every day by consultants, brokers, business organizations and even carriers. Given consumer interest in dental as the most requested additional benefit to medical coverage, most private exchanges include the offer of separate dental coverage for individuals and families. Are there opportunities for dental carriers of all sizes to participate in private exchanges? What do these exchanges need from the dental carrier to offer their coverage? Do all private exchanges take basically the same approach that public exchange take with on-line display of limited, key comparison points on products? This presentation will explore the explosion of private exchanges and what they mean to dental carriers—small and large. Alan Cohen is an insurance industry professional with more than 20 years of experience. At Liazon he leads the development of the award-winning Bright Choices® Exchange, a pioneering solution in consumer-focused benefits and insurance exchanges. Prior to Liazon, Alan was the CEO and Co-Founder of Online Benefits, the nation’s leading benefits management and communication technology firm. He led Online Benefits through its sale to A.D.A.M., and then served as President of A.D.A.M. Prior to Online Benefits, he worked in the insurance industry for Prudential, Mass Mutual, Cigna, and managed an insurance brokerage. Alan is a graduate of Cornell University (BA), Columbia Business School (MBA) and London Business School (MBA), where he won the Award for Academic Excellence.

GENERAL SESSION Master Disney’s Management Methods! presented by Mark David Jones

EDUCATION

Room: National C & D

Wednesday, September 17 8:45a – 10:15a What if Disney was to enter the dental insurance industry? Do you think that would be a game-changer? What would Disney do differently and better – even if entering a completely new arena? Creating breakthroughs always happens through change – and world-class companies like Disney have a proven track record of success when it comes to making it happen effectively. World-class companies aren’t perfect, but they consistently do the right things. Learn what the best are renowned for, the experience (service & quality) they create for their customers – and the innovation that creates both. Mark David Jones is an acclaimed consultant in the public sector as well as the private sector – having worked with dozens of Fortune 500 companies and numerous international corporations in six of the seven continents of the world. Mark joined the Walt Disney World Resort® in 1978, working in a variety of leadership roles in Operations, Entertainment, Guest Relations, Transportation, Retail, Resorts, and Human Resources. In 1992, during his doctoral studies at the University of Florida, Mark began working with leaders and teams at the Federal Aviation Administration’s national training headquarters.

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EDUCATION

The Emergence of Dental Benefit Strategic Partnerships, the New Normal presented by Steve McCarty

Room: National C & D

Standalone dental benefits companies are no longer able to rely solely on their medium and large group commercial core business and are therefore looking for new strategic business opportunities. This presentation will be based on The Concept Group’s experiences assisting our medical payer clients with identifying, selecting and implementing Strategic Partnerships with standalone dental benefit enterprises. It will focus on the evolution of this new business development and the “how-to’s” of developing Strategic Partnerships. Steve McCarty is the President and founder of The Concept Group and brings more than 25 years of strategic and operating experience leading large corporate functions, subsidiary business units, strategy development and deployment, executive team performance, organization restructuring, acquisition and integration, performance management and business transformation. Steve has held executive and management positions at Tier, Technologies Inc., GenRad, Inc., Arthur D. Little and Renaissance Worldwide, General Dynamics. Steve holds a Masters of Science degree in Industrial/Organizational Psychology from Rensselaer Polytechnic Institute in New York and a BA in Psychology from Plattsburg State University of New York.

Forensics to Improve Data Analytics in Fraud Detection presented by Dr. Franklin Din

Room: Royal Dublin

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The Economist published an article on May 29, 2014, that put the price tag for Healthcare fraud at $272 billion. That was not the worst item in the article. Even worse was the comment that healthcare fraud was becoming the criminal career of choice. The ROI of healthcare fraud was undeniably favorable to the bad guys. Clearly a better approach is needed. In an NADP webinar in June 2014, FraudLens introduced the idea and advantages of using an informatics approach to fraud detection. In this session FraudLens expands on this new approach by introducing and discussing the methods and tools of forensic science to compliment informatics. Almost all crimes exhibit patterns. FraudLens uses this knowledge to help focus and improve the detection of fraud.

september 17 â&#x20AC;˘ 10:30a â&#x20AC;&#x201C; 11:45a Dr. Franklin Din is Chief Medical Information Officer for FraudLens, Inc. and is responsible for developing advanced healthcare data analytic and business intelligence solutions. He brings experience, expertise, and knowledge in clinical care, healthcare policy, forensics, and biomedical Informatics, to lead a team of software engineers, HIT experts, visualization and user interface developers to provide a unique approach to data analytic solutions. Prior to joining FraudLens, Inc., Frank worked for HP Enterprise Service as Executive Director of the Medical Informatics Center of Excellence (MICOE) and as the Medical Informaticist for the Global eHealth Strategy team.

Solving the Individual Puzzle: Empowering Transformation to a B2C Model presented by Will Hinde and Kristin Irving

Room: Royal Melbourne As the movement to a Business to Consumer (B2C) business model continues, payors still struggle to put the complex pieces of serving the individual market together. Dental insurers are experiencing challenges as their core systems were not created to service individual members; from front office processes to back office platforms transforming to a consumer based business is proving to be a difficult task. Will Hinde is a senior director in the West Monroe Partnerâ&#x20AC;&#x2122;s healthcare practice and primarily focuses on health Insurance organizations. Will has more than 15 years of experience in management and technology consulting and is currently responsible for strategy and delivery our healthcare insurance clients. Will is an accomplished healthcare consultant and industry expert with extensive experience across multiple disciplines including healthcare reform, business and IT strategy formation, customer experience, operational assessment and improvement, mergers and acquisitions, and systems integration and consolidation. Kristin Irving is a director for West Monroe Partners in Chicago. She has more than 16 years of experience in consulting and solution development, focused primarily in the healthcare industry. Kristin has led many successful client projects in the areas of IT strategy and planning, Health Insurance Exchange Plan Management (HIX) strategy development and execution, customer experience enhancements to support business-to-consumer (B2C) transactions, software selections and implementations, application development and other disciplines, including change management.

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Trends and Best Practices for Public Affairs presented by Sheree Anne Kelly

EDUCATION

Room: National C & D Whether communicating about your brand or key public policy issues, public affairs can raise your profile. In many cases, strong public affairs efforts can even help turn passive stakeholders into engaged activists on behalf of your organization. Sheree Anne Kelly, Vice President of the Public Affairs Council (the worldwide association for the public affairs profession) will share best practices, trends and practical tools you can apply immediately to your own work. Learn new ways to educate, engage and leverage relationships with your employees, customers, community and government leaders and the general public. Sheree Anne Kelly is Vice President of the Public Affairs Council and Executive Director of the Foundation for Public Affairs. She serves on the senior management team as chief public affairs expert and deputy for the organization. Sheree Anne directs the Council’s public affairs experts who are responsible for consulting, thought leadership and training on best practices and ethical considerations worldwide. In her role with the foundation, she manages operations and oversees its research agenda. Sheree Anne is integrally involved in strategic planning for the association. Nearly a decade ago, she launched the international practice for the Public Affairs Council. Under Sheree Anne’s leadership, the Council opened its first international office in Brussels, which launched in 2013. Since joining the group 14 years ago, she’s counseled hundreds of corporate and association executives on six continents and helped craft and tailor strategic plans for their outreach programs. She’s a frequent keynote speaker and guest lecturer, having delivered presentations across North America, Europe, Asia and Australia.

Medicaid Expansion & Dental Fraud Abuse presented by Craig Kasten

Room: Royal Dublin

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As a result of the Affordable Care Act’s expansion of Medicaid coverage, the number of pediatric patients eligible for dental benefits will grow dramatically over the next several years. The importance of appropriate oversight of the delivery of necessary and appropriate dental services to this highly vulnerable population will grow in conjunction with coverage. Through establishment of the Scion Dental Protecting Children Foundation, Mr. Kasten and industry professionals continue to collaborate on the disturbing trend of pediatric dental fraud and abuse.

september 17 • 1:30p – 2:30p Craig Kasten is an accomplished leader whose career in the managed healthcare industry spans 30 years. He is the co-founder of Doral Dental USA (sold to DentaQuest Ventures in 2004) and Scion Dental. Today, these two entities are combined for the delivery of dental benefits to over 22 million Medicaid beneficiaries nationwide. Kasten also founded Wonderbox Technologies in 1995 and continues to serve as its Chief Executive Officer. In this capacity, he provides vision, strategic direction and creative support for functional design innovations to the Enterprise System, Wonderbox Technologies’ proprietary benefit administration software platform, and maintains regular contact with company clients. Kasten is also the founder of American Therapy Administrators, a company that specializes in managing the delivery of physical therapy benefits. Prior to launching his entrepreneurial career in 1992, Kasten served concurrently as the Chief Operating Officer and Chief Financial Officer of CareNetwork, Inc., a publicly traded regional health plan based in Wisconsin that was subsequently acquired by Humana. In 2005, Kasten was named a Distinguished Alumnus by the Marquette University School of Business Administration. He earned a Bachelor of Science degree from Marquette University in 1975 and an MBA from the University of WisconsinMilwaukee in 1982. He has been licensed as a Certified Public Accountant in the State of Wisconsin. Kasten and his partner, Gregory Borca, were honored as Entrepreneurs of the Year by Ernst & Young in 2003.

Tools and Topics for Improvement Initiatives presented by Mark David Jones

Room: Royal Melbourne In Mark David Jones’ experience of implementing dozens of improvement initiatives in numerous different industries, some common truths have emerged. Get the tools and tactics that result in improvement from this former Disney Executive. From establishing non-negotiables to every employee’s connection with your customer experience, you will take away information you can use in your company every day. Mark David Jones is an acclaimed consultant in the public sector as well as the private sector – having worked with dozens of Fortune 500 companies and numerous international corporations in six of the seven continents of the world. Mark joined the Walt Disney World Resort® in 1978, working in a variety of leadership roles in Operations, Entertainment, Guest Relations, Transportation, Retail, Resorts, and Human Resources. In 1992, during his doctoral studies at the University of Florida, Mark began working with leaders and teams at the Federal Aviation Administration’s national training headquarters.

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BREAKOUT SESSIONS • wed

The Future of Children’s Coverage: CHIP and Medicaid presented by Joe Touschner

EDUCATION

Room: Royal Melbourne

Together, Medicaid and Children’s Health Insurance Program (CHIP) have successfully led to the lowest rate of uninsured children in U.S. history. Without Congressional Action, funding for CHIP will expire in September 2015, risking disrupted coverage for millions of children and potentially leaving as many as two million children uninsured. This session will discuss the evolving role of CHIP in the children’s coverage landscape, the financial and coverage impacts of failure to extend CHIP funding, and national efforts to extend funding for the program and ensure children can continue to receive affordable health coverage that is tailored to meet their unique needs. Joe Touschner is a Senior Health Policy Analyst for the Center for Children and Families (CCF). In this capacity, he analyzes, researches, and responds to federal policies that impact coverage for children and families. He also supports the efforts of state level advocates to improve health care coverage. His expertise lies in Medicaid, the Children’s Health Insurance Program (CHIP), and Affordable Care Act topics including essential health benefits, health insurance marketplaces, and coverage subsidies

Dental Networks and Healthcare Exchanges presented by Aaron Groffman

Room: Royal Dublin The ACA and exchanges are a big part of the healthcare landscape. This session will help you gain a better understanding of how these external influences are shaping provider networks. We will explore dental and medical network trends including a state-by-state analysis of dental networks.

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Aaron Groffman is a 20-year veteran of the employee benefits industry. He is currently President of The Ignition Group, a business intelligence firm he founded in 2004. The Ignition Group specializes in providing competitive intelligence about provider networks to health care companies via its innovative NetMinder web-based platform. The Ignition Group’s clients include the leading national healthcare companies as well as many regional and local players.

september 17 â&#x20AC;˘ 3:30p - 4:30p

Using Population Oral Health Data to Optimize your Dental Wellness Program presented by Craig Lesley and Carl Loeb

Room: National C & D Employers are looking for ways to make employees more responsible for their own health and consultants are helping them. Medical plans are well into these discussions, and dental plans need to be as well. More and more scientific evidence is emerging on how important oral health is to overall wellness, particularly in terms of its impact on chronic diseases that cost employers a lot both in terms of claims as well as in lost productivity. Using population oral health data coupled with clinically validated risk assessments and patient engagement tools can assist dental benefit companies to customize plan designs so individuals can get the preventive services, information and treatment they need to improve their oral and overall health. The Concepts Group and PreViser will describe a data driven, full package approach that companies can use to take the offensive in this important market discussion. Craig Lesley has over 35 years of successful sales, marketing and general management experience in the health insurance industry. During Craigâ&#x20AC;&#x2122;s 32 years at Delta Dental Plan of Michigan, Ohio and Indiana he was a member of the executive management group and led the sales team as the organization grew from $3 million to $1.7 billion in annual revenue. His responsibilities included strategic planning, claims system and e-tool implementation, product design and national account sales during a time of rapid industry growth and change. A life and health insurance subsidiary company was built under his leadership to allow national expansion of the regional parent. Craig served in a variety of roles in the national Delta Plans Association, including Chairman of the National Marketing Committee and coordinator of sales training. Over the last three years he has served as Vice President, Sales and Marketing for a regional medical HMO. During this time the organization successfully installed a new claims system, introduced new products and, most recently, set new business records while retaining existing clients. He has both a bachelors and MBA from Michigan State University and is an accomplished public speaker and board presenter. Carl Loeb has been involved in the founding, operation and sale of a number of companies in more than 30 years of professional experience. Introduced in 2002 to Dr. Roy Page, Professor Emeritus of Periodontics at the University of Washington and one of the founders of PreViser, Mr. Loeb was subsequently engaged to commercialize the companyâ&#x20AC;&#x2122;s dental disease risk and severity analytic software. Patents and clinical validation on core PreViser technology have been acquired in the U.S., and additional patents are pending in Japan and the EU. Mr. Loeb has lectured on the clinical and practice implications of bio-informatic systems in India, the United States and Japan, and is a coauthor on a number of scientific papers on Periodontics.

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BREAKOUT SESSION

EDUCATION

thursday, september 18 8:30a - 9:45a

Issues Ahead with Pediatric Dental Implementation

• Andrew Snyder • Colin Reusch • Tom Spangler

Room: National C & D The ACA is reshaping large segments of the dental benefits industry, but are there impacts to our colleagues within the oral health community as well: And, what should our expectations be for the future? Should we anticipate that changes will be made to the ACA? Join representatives from the provider, consumer and state policymaker organizations to discuss the implementation fallout from the inclusion of pediatric dental within the ACA’s Essential Health Benefit Package and what’s ahead. Discussions will include cost sharing, benefit and plans design, Exchanges, and embedded 10.0 QHPs versus 9.5 SADPs (and what those acronyms mean.) Learn what changes could be on the horizon for oral health from new regulations to provider impacts and adaptive business models. Audience participation and questions are encouraged during this interactive panel session. Andrew Snyder joined National Academy for State Health Policy (NASHP) in 2011 as a Policy Specialist and is responsible for analyzing state policies related to eligibility, enrollment, and benefit design in Medicaid and Children’s Health Insurance Program (CHIP) programs. He has worked on issues relating to data systems, public health, the healthcare safety net, and particularly on issues related to oral health. Previously a program manager at the Pew Children’s Dental Campaign, Andy oversaw large research projects, including an extensive 50-state comparison of policies related to children’s dental care. From 2002 to 2006, Andy was a policy analyst at the Wisconsin Medicaid program, where he staffed a Governor’s Task Force on Access to Oral Health Care. He holds a master’s degree in public affairs from the University of WisconsinMadison.

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Colin Reusch is the Senior Policy Analyst of the Children’s Dental Health Project (CDHP). He is a recognized expert in the Affordable Care Act’s (ACA) pediatric dental benefit. He has advised policymakers and advocates in more than 20 states on how to implement the law’s dental provisions. In addition to tracking implementation of the ACA, Mr. Reusch researches and analyzes Medicaid, Children’s Health Insurance Program (CHIP) and other public policy initiatives aimed at improving the oral health of children and teens. State policymakers and advocates turn to him for technical assistance in identifying and assessing policy options. Prior to joining CDHP, Mr. Reusch worked on government policy issues at the Kentucky League of Cities, and in young alumni programs at Eastern Kentucky University. He earned both his bachelor’s degree and a Master’s of Public Administration from Eastern Kentucky University. Tom Spangler is the Senior Director, Legislative and Regulatory Policy, for the American Dental Association. Tom also serves as the director of the ADA’s Council on Government Affairs. He began employment with the ADA in 1991 as Legislative Counsel, serving as the Association’s chief lobbyist on matters before the House Committee on Ways and Means and the Senate Committee on Finance. Tom has been a member of the District of Columbia bar since 1983. Mr. Spangler received his Juris Doctor degree from the University of Toledo, a Masters in Labor and Industrial Relations degree from Michigan State University, and his B.A. from Ohio State University.

CLOSING GENERAL SESSION

EDUCATION

thursday, september 18 10:00a - 11:30a Future Visions for Dental Benefits • Gary Radine • Erich Sternberg • Phil Kaufman