General Session: MLR Discussion
Wednesday, September 20
1:00 PM – 2:00 PM (PT)
Medical Loss Ratio (MLR), and its application to dental insurance, has rocketed to the top of our industry’s issue list. In this session, experts will discuss the facts and myths about dental MLR.
- What does the dental MLR advocacy landscape look like?
- Will other states follow Massachusetts by applying a high-premium medical plan MLR to a low-premium dental plan?
- What might happen in states like Maine and Colorado that recently passed MLR reporting laws?
The panel will also consider the operational challenges created by high MLR—including its potential impact on plans offered, insurance markets served, provider relations, plan operations, and access to dental coverage.
Audience members will be invited to submit questions during this general session, but responses to questions will be offered in the follow-up session.
Mike Adelberg, MPA, MA
National Association of Dental Plans
In November 2022, Michael (Mike) Adelberg joined NADP as Executive Director. Adelberg comes to NADP after leading Faegre Drinker Consulting’s healthcare provider and plans practice in Washington, DC, where his practice was largely focused on insurance benefits, including dental benefits. Before joining Faegre Drinker Consulting, Mike held several senior positions within the Centers for Medicare and Medicaid Services (CMS). Adelberg was responsible for establishing the Affordable Care Act policy for pediatric dental coverage and stand-alone dental plans. Before that, he oversaw Medicare Advantage plan contracting and market conduct, including supplemental dental benefits. Adelberg holds a master’s degrees in Public Policy and Administration from Northern Illinois University, and History from Rutgers University. He’s authored or co-authored studies in leading journals such as Health Affairs, the American Journal of Managed Care, and Health Services Research, led or co-led four foundation projects, and has been quoted in leading media including the New York Times, Washington Post, and NPR.org.
Joanne Fontana, FSA, MAAA
Principal and Consulting actuary
Joanne Fontana is a principal and consulting actuary in the Health Practice of Milliman’s Hartford office. She has been with the firm since 2006. During that time, she has consulted for insurance companies, including several major dental carriers, employers, government entities, and other organizations. Joanne focuses mainly on managed care and dental, with experience in premium rate development, provider contract analysis, valuation of post-retirement health benefits, and health care reform. Over the past several years, she has worked closely with the National Association of Dental Plans, the California Association of Dental Plans, the American Dental Association, and other dental clients to assess the impact of healthcare reform on the dental industry. She manages Milliman’s Dental Actuarial Analytics PPO Network Study. This product uses a vast contributor database of dental claims to provide competitive insights on dental network discounts and utilization to study participants. She has worked with carriers and employer groups on dental insurance procurement and Medicaid dental procurements with state entities and bidders. She has done core actuarial dental pricing and underwriting work for many dental carriers. Joanne is considered an industry expert in dental products and pricing. She has presented on dental-related issues at multiple industry forums and authored many topical articles. Before joining Milliman, Joanne spent more than 10 years as an actuary with Cigna, where she held various healthcare financial leadership roles, including Chief Actuary of CIGNA’s dental insurance business.
Vice President, Group Benefits Contracts and Compliance
Crystal McElroy is the vice president of the group benefits contracts and compliance team at MetLife in Irvine, California. She oversees all contracts, compliance, and regulatory issues related to MetLife’s Group Benefits business. Crystal is presently the Chair of the NADP Commission on Advocacy Policy and volunteers on the NADP Government Relations Workgroup. She also serves as the co-chair of the CADP Legislative and Regulatory Committee and is the president of the CADP Board of Directors and is a member of the NADP Board of Directors. Before joining MetLife in Oct. 2013, she served as a senior attorney with the California Department of Managed Health Care in the Office of Plan Licensing for seven years. She reviewed the dental and health plan licensing documents related to plan benefits, disclosure documents, networks, and mergers and acquisitions. Crystal graduated from the University of California, Los Angeles, majoring in Biochemistry and a minor in Political Science in 2003. She obtained her Juris Doctor from the University of the Pacific, McGeorge School of Law 2006.
VP of Business Transformation
Roosevelt Innovations, LLC
Mike joined Delta Dental of Michigan, Ohio, and Indiana in 2009 as a senior implementation manager. In his role, he was responsible for onboarding and implementing the largest clients to the administrative platform. His last seven years with Delta were as the director of group administration, overseeing the contracting, benefit setup, and maintenance of all clients. Before Joining Delta Dental, he worked, owned, and managed a national financial company specializing in corporate lease financing for Fortune 500 and publicly traded companies. Mike is a Chartered Insurance Operations Professionals member with a Lean Six Sigma Black Belt Designation. He is focused on developing and maintaining strategic planning, contract negotiations, process improvements, corporate relationship management, and market penetration.
Director of Government Relations
National Association of Dental Plans
Before becoming director of government & regulatory affairs, Owen served NADP as a senior government affairs analyst. He worked closely with NADP members to coordinate the dental benefits industry's response to congressional proposals on dental in Medicare and issues related to the COVID-19 pandemic, the Affordable Care Act, Medicaid and Medicare Advantage and state regulatory activity. Before joining NADP, Owen developed health policy proposals and research at the Roosevelt Institute and Health Management Academy, as well as on several political campaigns. Owen graduated from American University with a degree in political science specializing in American government and is a Master of Public Policy candidate at the University of Texas at Dallas. His graduate research focuses on the origins of national health systems.
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