SCALE Case Study:

Payer Strategy – Dental (DSO)

Client Profile

Services Deployed

Consulting

Payer Strategy

Financial Analysis

Regulatory Research

Overview

SCALE was engaged by a Dental Services Organization (DSO) participating with a Managed Care Organization (MCO) providing dental services to Medicaid recipients for which a rate reduction was imminent. The engagement included providing financial analyses to quantify service line impact, payer contract review and strategy development to improve their rate position.

The Client is a comprehensive provider of dental services in the US operating in Medicaid-focused clinics.
The Client has multiple providers who perform oral surgery in addition to pediatric and adult dental hygiene services, setting them apart from other provider groups.
They serve a mix of Medicaid and commercial patients with a large population of childrenat 43 clinics across the entire state.

Execution

SCALE Payer Strategy and Consulting business segments conducted a thorough financial analysis
of proposed rate reductions supported by contract review, a regulatory assessment, and research
on the Medicaid network in the state.

SCALE developed a comprehensive strategy to counteract proposed rate cuts:

Financial analysis of all clinic locations, revenue, profits, and risk of potential reductions.
Contract review of terms regarding rate change notifications, dispute resolution, and termination of contract.
Review of the current dental MCO contract.
Research on legislative and regulatory requirements e.g., Medicaid funding obligations.
Market data on the size of the provider group relative to the entire Medicaid market and network adequacy requirements.

SCALE recommended strategic contractual and service line scenarios to improvement to improved rates.
Additionally, leveraged stakeholder relationships through multiple meetings to advance to the client’s objectives.
Initiated and progressed with prompt payer communication throughout the negotiation process.

Results

As a result of discussions with the MCO, both groups agreed to mutually understandable financial
terms as well as a Memorandum of Understanding to solidify non-contractual terms and strengthen their continued partnership.

SCALE Case Study:

Payer Strategy – Dental (DSO)

Client Profile

Services Deployed

Consulting

Payer Strategy

Financial Analysis

Regulatory Research

Overview

Execution

Results

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