2026 MSDA Symposium: Beyond Program Integrity, Driving Better Outcomes in Medicaid Dental

The 2026 MSDA Symposium brought together an incredible group of leaders, innovators, and stakeholders focused on one of the most important challenges in Medicaid dental today: strengthening program integrity while still preserving access to care and supporting provider participation.

This year’s discussions centered around how the industry is evolving beyond purely reactive models of oversight and toward more balanced, data-driven strategies that improve outcomes for providers, health plans, and members alike.

It was fantastic connecting with colleagues, clients, and industry peers throughout the event, and we’re incredibly appreciative to MSDA for another outstanding symposium.

One of the highlights of the event was SKYGEN’s presentation, “Beyond Program Integrity: Driving Better Outcomes in Medicaid Dental,” delivered by Ryan McCumber, Director of Risk and Benefit Management at SKYGEN.

The presentation explored how modern program integrity must function as a holistic ecosystem, one that combines prevention, analytics, clinical expertise, provider engagement, and continuous improvement.

A major theme throughout the presentation was the importance of balance.

For Medicaid, provider networks are often fragile, and overly aggressive approaches can unintentionally create provider abrasion that ultimately impacts member access to care. Rather than defaulting immediately to punitive action, Ryan discussed the importance of proportional intervention, communication, and context-driven evaluation.

That means:

• Asking questions before jumping to conclusions
• Engaging providers directly to understand behaviors and workflows
• Leveraging clinicians in the review process to ensure decisions remain evidence-based and grounded in real-world care delivery

Another key takeaway was the importance of combining technology with human expertise.

SKYGEN’s Enhanced Benefits Management (EBM) model leverages advanced analytics, AI-driven pattern recognition, analysts, and clinicians in a fully integrated feedback loop to identify trends and isolate meaningful risk without creating unnecessary network disruption.

Importantly, the presentation reinforced that analytics alone should never drive action. Data helps identify opportunities and patterns, but clinical validation and collaborative review ensure that interventions remain measured, accurate, and fair.

The session also highlighted the importance of proactive safeguards and continuous improvement through tools such as Enhanced Claims Management (ECM), where insights from EBM are operationalized into updated rules, controls, and workflows that help prevent improper claims before they escalate.

But one of the most memorable moments of the session came during the audience Q&A.

An attendee referenced the classic “carrot and stick” analogy and posed a fantastic question:

When we talk about program integrity, so much of the conversation focuses on the “stick” - oversight, audits, investigations, and enforcement. But what are we doing about the “carrot”? What are we doing for the high-performing providers?

It was an incredibly thoughtful question and one that deserves broader discussion.

The reality is that SKYGEN’s EBM model is not purely punitive. In fact, the model is specifically designed to identify both high-risk outliers and high-performing outliers. Excellent providers can and should be recognized, understood, and reinforced.

That philosophy extends well beyond EBM itself.

SKYGEN’s Provider Select Suite was designed specifically to help health plans define, measure, and recognize provider performance based on their own strategic goals. Through configurable provider scoring, recognition programs, and enhanced provider search capabilities, the platform enables organizations to reward providers delivering high-quality, cost-effective care.

In some cases, these recognition programs can even support internal performance-based incentive strategies similar to value-based reimbursement models.

The “carrot” philosophy also extends into SKYGEN’s Gold Card Program, which rewards high-performing providers by removing prior authorization requirements for qualifying providers with strong approval histories and demonstrated clinical appropriateness.

Under the program, providers meeting qualification thresholds receive a 12-month exemption from prior authorization requirements while still remaining under continuous monitoring and oversight. The result is reduced administrative burden, faster care delivery, improved provider satisfaction, and better member outcomes—all while maintaining strong program integrity controls.

Ultimately, the answer to the attendee’s question was clear: yes, program integrity absolutely requires accountability, but it should also recognize and encourage excellence.

At SKYGEN, we genuinely believe most providers enter dentistry for the right reasons. Our goal is to identify opportunities early, educate and collaborate whenever possible, reward high-performing providers, and pursue formal investigation only when the facts truly warrant it.

That balanced approach - precision over disruption, partnership over assumption, and continuous improvement over reactive enforcement - was at the heart of this year’s presentation and many of the broader conversations throughout the symposium.

Overall, the 2026 MSDA Symposium was an outstanding event, and we’re incredibly grateful to Mary Foley and Marty Dellapenna for organizing the event. We look forward to continuing the conversation and participating again next year.