learning & informatics summit 2017
TRANSCRIPT
Confidential and Proprietary
Learning & Informatics Summit 2017
©2017 P&R Dental Strategies, LLC – Confidential and Proprietary
Learning & Informatics Summit 20
17
Welcome & Overview PAUL T. SHEILS, CEO
Confidential and Proprietary
Learning & Informatics Summit 2017
P&R Overview
Founded 1995
The industry ‘gold standard’ for Utilization Review
Over 100 employees and consultants;; offices in Nashua, NH and Hamilton, NJ
40130,000
45 million 1.7 billion
Our Mission:
To transform the dental benefits industry by
deploying data-‐driven analytics and services
to contain costs, reduce fraud, improve
efficiencies, increase transparency and
improve outcomes.
Confidential and Proprietary
Learning & Informatics Summit 2017
Our Utilization Review Solutions Suite
Professional Claim Review
• Utilization review by credentialed, licensed dentists• URAC accredited – 100% score on re-accreditation• 100% compliant with all federal and state laws and regulations
Claim Review Management System
• Highly efficient utilization review workflow application for payer in-house utilization review programs
v.1.0e
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Learning & Informatics Summit 2017
Our Multi-payer Claims Database
Founded 1995
The industry ‘gold standard’ for Utilization Review
Now owned by New Capital PartnersStatistically valid
data set on over
U.S.
dentists within the
last 12 months
Over
treated patients
within the last
12 months
154,00064 million records in the
database, adding
75 million per quarter
2.1 billion
DentaBase™ Data Warehouse
Aggregated claims database
from over dental
payers across the U.S.
including large national
for-profits, not-for-profits
and regional payers
60
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Learning & Informatics Summit 2017
Payer Market - Informatics Solutions Suite
v.1.0e
Network Development Module (NDM)
Actuarial Intelligence Module (AIM)
DentaBase™ Data Warehouse
Utilization Management Module (UMM)
Fraud & Abuse Detection Module (FAD)
Dynamic Claim Review & Predictive Analytics (Pronto™)
Data Licensing and Subscription Reports;; Custom Analytics
Peer-Ranked, Claims-Based Dentist Quality Measurement (DentaQual™)
Network Directory Accuracy Service
MarketVector™ Payer Forecasting Report
Utilization Management Optimization Report
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Learning & Informatics Summit 2017
New P&R Initiatives - Leveraging Data & Analytics to Overcome the Business Challenges of 2017
• MSDA - State Medicaid Agency Association • Cost Containment Learning Collaborative
• Council on Dental Market Transformation• Best Practices RFP Project
• State Dental Society Insurance Education Program• P&R Report Card-based initiative for one state’s dental society
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Learning & Informatics Summit 2017
Our Summit Team
7
Paul SheilsCEO
Tim DowneyChief Analytics Officer
Tracy Sproule Compliance Officer
Chakra ElangovanVP, Technology
Greg MericaVP, Special Projects
Ty HamiltonChief Operating Officer
Maureen O’BrienVP, Client Relations
Michael RabhanVP, Sales
Blake BarajasVP, Sales
Greg MoralesVP, Business Development
Mike UrbachPresident
Dr. Michael FiorenzaDental Director
Joe MannVP, Marketing
Paul GolderDirector, Acct. Management
Tina MullinVP, Finance
Jose BenitezSr. Database Architect
Confidential and Proprietary
Learning & Informatics Summit 2017
Keynote Speaker
Juan F. YepesDDS, MD, MPH, MS, DrPH
Associate Professor of Pediatric Dentistry James Whitcomb Riley Hospital for ChildrenIndiana University School of Dentistry