Optimizing Provider Network Performance through Enhanced Benefit Management

  • March 13, 2018
  • 2:00 PM – 3:00 PM ET
  • Online

While managing Medicaid programs effectively has never been easy, the recent expansion of the Medicaid population has made delivering access to high-quality care to all who need it more difficult than ever. With limited funding, states, payers, and MCOs must find ways to stretch budgeted dollars further by developing and implementing strategies that encourage quality providers to join and stay in the program, more effectively control spending on program elements such as reimbursement, and help eliminate sources of fraud, waste, and abuse (such as overtreatment) in order to deliver the most appropriate and efficient care. Achieving these goals is extraordinarily challenging, however, using the processes and technologies payers and MCOs typically have in place today.

This webinar will explain how dental, medical, and vision payers can ensure better Medicaid program stewardship and optimal provider network performance by replacing manual processes with an innovative approach called Enhanced Benefit Management (EBM). The webinar will demonstrate how a combination of sophisticated data analytics and education can be used to maximize program dollars and optimize provider network performance, yielding millions in savings and improving access to quality care while reducing fraud, waste, and abuse. Built on a foundation of Analytics, Access, and Automation, EBM delves deeply into factors affecting program costs, such as provider performance, benefit plan design, and reimbursement schedules. Organizations can then use these findings to develop market-specific strategies to ensure peak provider network performance, such as recognizing providers who are delivering outstanding yet cost-effective care.

Attendees will learn:

  • Recognize the challenges created when a current business model is unable to scale effectively and how it can adversely affect commercial and government-sponsored health plans 
  • Comprehend the need to use big data and sophisticated analytics to evaluate their current reimbursement schedules more effectively so they can look for opportunities to reduce or consolidate them
  • Identify criteria to use in assessing provider performance so they can recognize those who are performing well, encourage others to follow those standards, and re-mediate any issues within their networks
  • Determine what they need to do to move forward to ensure their organizations continue to thrive in the Digital Age


John Schaak, Chief Operating Officer, SKYGEN USA

As Chief Operating Officer, John Schaak leads the delivery of technology-enabled solutions that are transforming healthcare. This includes leveraging SKYGEN USA’s first-in-class, enterprise software to reduce administrative burdens for providers and bring all health payers unprecedented levels of automation. These and other improvements help the company create the most efficient and effective plans in the country. Mr. Schaak is also particularly dedicated to ensuring that SKYGEN USA and its clients are the best possible stewards of Medicaid programs – which means stretching program dollars to deliver continually better care to the greatest number of people. In service of this goal, Mr. Schaak has directed the introduction of many innovations, such as the company’s Enhanced Benefit Management program, which uses, among other things, a wealth of claims data and sophisticated analytics to recognize great providers and guide the development of targeted benefit management strategies.

In addition to his passion for protecting our most vulnerable populations, Mr. Schaak brings extensive leadership experience in matters of business. He holds a Juris Doctorate from Marquette University Law School and a Bachelor of Science Degree in Political Science and Criminal Justice from the University of Wisconsin Oshkosh.

Marcel Tetzlaff, Vice President of Provider Experience and Benefits Management, SKYGEN USA

As Vice President of Provider Experience and Benefits Management, Marcel Tetzlaff leads SKYGEN USA’s continuing commitment to helping its clients provide superior program stewardship. He and his team are responsible for developing and executing the company’s Enhanced Benefit Management program that is designed to ensure delivery of the most appropriate and efficient care possible. By leveraging SKYGEN USA’s technology, clinical, analytical and administrative expertise, the appropriate intervention can be initiated to achieve optimum performance, including recognizing and rewarding high performing providers.

Mr. Tetzlaff earned his MBA at the University of Wisconsin-Milwaukee with a major in health care management. He also holds a Bachelor of Business Administration Degree from the University of Wisconsin-Whitewater.