Case study at-a-glance
DentaQuest, a Sun Life company, is a purpose-driven oral healthcare company dedicated to improving the oral health of all. DentaQuest manages dental and vision benefits for 30+ million Americans and provides direct patient care through a network of more than 80 oral health centers in six states. DentaQuest provides outcome-based, cost-effective dental solutions for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals nationwide.
The breadth of operations means DentaQuest needs to manage risk, third-party engagement, and all related regulatory compliance across several highly regulated markets.
DentaQuest started working with SAI360 in 2017, looking to address some specific challenges: policy management and risk management solutions for client contracts.
Julie Wing is DentaQuest’s Director of Regulatory Compliance and Privacy. In this role, she manages the relationship with SAI360 including the day-to-day management and planning of DentaQuest’s operations and vision.
SAI360 THIRD-PARTY RISK MANAGEMENT
In the healthcare industry, license renewal tracking is a source of risk. DentaQuest is licensed to provide dental and vision services nationwide. Each state has specific renewal requirements to maintain active, compliant status. DentaQuest needed to monitor these renewals throughout the year and to stay ahead of them. Failure to meet renewal deadlines can lead to states applying liquidated damages, including but not limited to loss of licensure.
“We initially needed a Third-Party Risk Management (TPRM) solution that could manage and monitor client and network contracting, along with a workflow from negotiation to execution and the ability to track renewals. The solution seemed to also fit a similar role for our licensing needs based on its configurability,” explained Wing.
DentaQuest selected the SAI360 GRC Healthcare platform and its TPRM module. “SAI360 gave us the flexibility to build a licensing module that allowed us to manage at the contract and addenda levels,” explained Wing. “We use the contract level for license details, then a workflow at the addenda level to manage and track renewal requirements. The workflows connect relevant people, whether it’s a contact in finance to receive a jurat or a tax document or it is the utilization management department requested to share updates or specifics on a policy.”
SAI360 POLICY MANAGEMENT
Another area that SAI360 transformed was DentaQuest’s policy management. SAI360 GRC Healthcare Policy Management became the company’s centralized repository for up-to-date information, policies, and regulations by state.
Wing said: “Before SAI360, separate business areas held their policies. Any client could ask us to share or verify our latest policies. If we didn’t provide the appropriate, accurate information, we could face corrective action plans or liquidated damages. It’s imperative that everyone within our business and network has access to the latest and correct policies, irrespective of state or business area. SAI360 Policy Management ensures that.”
Another benefit of SAI360 Policy Management is transparency. Wing said, “Having the correct policy structure allowed us to be transparent. We created a catalog with links, so users can search for policies. We did the same for license and renewal requirements with a catalog search, so users can find any license, whether it’s a renewal requirement or specific state requirements we’ve applied. For our users, the level of transparency is transformative.”
“There are so many things SAI360 can do, and when you combine that with the configurability, it’s a game changer.”
SAI360 INCIDENT MANAGEMENT
“Privacy incident management and clinical incident management are two essential incident categories for DentaQuest,” said Wing. “Incidents must be reported and tracked at every level. From simple incidents to possible HIPAA events, all are required on a regulatory level.”
“Again, the configurability of SAI360 is the difference maker,” added Wing. “SAI360 Incident Manager enables us to create a Corrective Action Plan (CAP) module built from the incident level. We then use the investigation component of SAI360 to assign CAP issues to relevant individuals. This helps us assign multiple activities and users at once. Users can add their documented investigation to the CAP to create an auditable trail. Once that rolls up, we close out the CAP.”
“All CAP data is reportable. When we attend the quarterly corporate compliance committee meetings, we can report amounts for specific time periods. We can show the numbers by CAPs, by issue, and break out the data in a more tangible fashion. We can show the resolution rate, expose trends, and share management and corporate governance information in standard and custom reports.”
HOW VITAL WAS CONFIGURABILITY?
“There are so many things SAI360 can do, and when you combine that with the configurability, it’s a game changer,” said Wing. “There are default modules to create from. When we have a specific need, we can configure new modules.”
Wing continued, “Meanwhile, SAI360 is honest when there were things that couldn’t be done, and they would tell us why. But then they would make suggestions. As a customer, it’s a relief to work with vendors like SAI360 who have integrity and don’t just say yes to everything or attempt to sell something for the sake of sales.”
VALUE AND RETURN ON SAI360
“It was quick to see the value in SAI360 because we saw immediate results. We could keep up with licensure, policy review deadlines, and were able to provide patient safety organizations with specific information by creating and configuring the solution,” said Wing. “SAI360’s software is user-friendly. It gave our users the confidence to use the solution and to be self-reliant.
WHAT’S NEXT FOR DENTAQUEST AND SAI360?
“We started working with SAI360 for policy management and tracking licensing. SAI360 allowed us to create a foundational level across the organization. Now we can step back and connect all the areas to our compliance program,” said Wing.
“Going into 2023, we will ramp up our use of SAI360 Regulatory Compliance Manager. This is key for our existing products and plans, so we are ready to enter new markets and the regulations encountered.”
“For us, SAI360 is a living, breathing tool. It’s always accurate and always up to date. Every time we look at a dashboard, we never have to refresh it. What we’re viewing is live and current at that moment. The dashboard reporting and transparency has been a huge help, especially when it relates to our Executive Leadership Team, who analyze real data in a visual format to understand exactly where we are,” said Wing.
“SAI360’s Customer Experience and Account Management teams are tremendous,” said Wing. “There is a genuine partnership with SAI360 who listen to us when we want to do something and respond, that this might be our solution. There’s always alternatives, ideas, and a sense of collaboration. One of my managers used to say the juice has to be worth the squeeze: SAI360 is certainly worth the squeeze.”