Executive Summary
Administrative and Clinical Support
Desire for digital support
AI tools to streamline administration
Increasing preventive care
Clinical tech tools
Supporting Practice Growth
Marketing strategies and payer support
Virtual reality
Practice growth: DSOs and private equity
Willingness to adapt
Advancing Collaboration
Desire
integrated care
Enhancing payer-provider
It’s a new era in specialty benefits, one that’s fueled by rapid advancements in technology, changing consumer expectations and a growing focus on holistic health. Within this changing landscape, one thing rings true: when there are better, more positive patient outcomes, everyone wins.
While the relationship between payer and provider – the parties most often responsible for the delivery and administration of these patient outcomes – has traditionally been fraught with misunderstandings, new evidence demonstrates that payers and providers have more to gain from working together than not. For instance, according to the Council on Health Care Spending and Value, up to 28% of administrative waste could be eliminated each year if payers and providers worked together. This is echoed by consumer preference, with our Consumer Insights report finding that 39% of consumers believe that better options for coordination of care between providers would improve their vision/dental care experience the most.
This survey commissioned by SKYGEN – a leader in Software as a Service (SaaS) and third-party administration (TPA) technology and services for vision and dental benefits administration – delves into the perspectives of dental and vision providers as they grapple with industry transformation. The research reveals providers’ emerging needs and paths for improving payer-provider collaboration.
Among a core sample of dental and vision providers of all demographics across the U.S. from practices large and small who were surveyed, the predominant takeaway is that the landscape for payer-provider partnerships is vast.
Key takeaways include:
• Payers have a breadth of opportunities to enhance provider relationships, including integrating advanced technologies like artificial intelligence (AI), virtual reality tools and predictive analytics.
• Payers are keen to adopt value-based reimbursement and integrated models of care.
• Providers emphasize communication, training and resources as critical to a successful payer-provider partnership.
Ultimately, the industry is ripe for growth, with providers eager to advance the industry with requests for AI, virtual reality and predictive analytics. This poses numerous opportunities for payers to transform specialty benefits at every level by fostering collaboration with providers; stronger partnerships equal significant improvements in care delivery and outcomes.
The 2025 SKYGEN PULSE Report uncovers fresh ideas and strategies payers can employ to further their provider partnerships and enhance the delivery of cost-effective, high-quality dental and vision care.
Acknowledging the importance of payer-provider collaboration is one thing but being equipped with the tools, strategies and resources to do so is another thing entirely. When it comes to bridging the payer and provider divide, knowing exactly what providers want in the realm of clinical and technological transformation is just one way that payers can master the future of specialty benefits.
Providers face several challenges in the billing process, with 33% of vision providers identifying eligibility verification as their biggest hurdle, and 30% of dental providers citing authorization requirements as their primary concern. Despite these difficulties, providers recognize the value of technological solutions in addressing these issues. As a result, over half of dental (52%) and vision providers (51%) advocate for insurers to adopt or integrate automated billing and coding software to improve efficiency and accuracy.
“Real time insurance eligibility verification is very helpful for us... [in] reducing administrative burden and preventing billing errors.”
“A digitized system for claims management which can accurately identify errors or missing information for a smoother overall process would be great.”
The growth opportunities within artificial intelligence (AI) are enormous and providers are anxious to participate, with 56% of dental and vision providers actively exploring AI options, and an additional one-third using AI already. Payers in turn should consider the opportunity that AI presents, with providers eager to see them adopt automation via AI to support areas such as utilization management (90%) and claims adjudication (87%) for improvements in speed and consistency. The majority of respondents expressed little to no concern about security issues related to AI integration.
Investing in advanced technology solutions can enhance the accuracy and speed of billing processes while reducing errors and administrative workload.
Payers should collaborate with technology vendors to identify solutions that support providers’ daily billing operations.
56% OF DENTAL AND VISION PROVIDERS ARE ACTIVELY EXPLORING AI WHAT PROVIDERS ARE DOING WHAT PROVIDERS WANT FROM PAYERS
87% 90% UTILIZATION MANAGEMENT CLAIMS ADJUDICATION
Providers serve as advocates for expanded coverage of services they consider essential for providing high quality care. By supporting both technology integration and benefits coverage for the use of advanced preventative and screening technologies, payers can help providers enhance patient care.
Oral cancer screenings with advanced diagnostic tools
“AI technology with the capability to identify dental problems such as cavities and gum diseases could significantly improve the overall efficiency of dental diagnoses and treatment processes.”
“Support portable devices that allow for comprehensive eye exams outside the clinic.”
Low vision aids and rehabilitation services
Specialized screenings for conditions like diabetic retinopathy
Genetic testing for eye conditions
Expanding coverage for preventative and advanced screening services can significantly enhance patient outcomes and provider satisfaction. Payers should consider these areas as opportunities to differentiate their offerings and demonstrate their commitment to comprehensive patient care.
The volume of clinical data is growing exponentially, but its value depends on our ability to keep up with, analyze and interpret it effectively. Remote monitoring devices top the list of technologies vision and dental providers wish insurers would adopt to enhance care. Naturally, tools for seamless patient information sharing and predictive analytics closely follow, reflecting providers’ desire to improve their ability to access, share and interpret clinical data.
Remote patient monitoring devices
Technology to connect different providers/insurances to share patient information
Patient risks/outcomes predictive analytics tools
Mobile health applications
Patient/provider communication platforms
Telehealth platform support
Advanced EHR solutions supporting medical/dental/ vision care integration with payer claims systems
AI-assisted diagnostic/treatment planning tools
“Remote monitoring services would be quite beneficial in keeping an eye on elderly patients and reducing the workload for the practice.”
“Utilizing patient data algorithms can forecast the course of a disease and customize treatment regimens.”
Providers say support in remote patient monitoring, health data sharing technologies and predictive analytics can lead to better health outcomes, proactive care management and streamlined administrative processes for providers and payers.
To accelerate growth, providers are networking with peers, expanding services with digital tools like virtual reality, and employing marketing and outreach strategies. Both vision and dental providers agree that marketing support (39% vision, 42% dental) and enhanced plan options (44% vision, 37% dental) would be the most valuable assistance from payers interested in supporting their growth.
“A smartphone application dedicated to managing and organizing patient health records and medical history has the potential to significantly improve and simplify healthcare practices.”
“Customized eyewear solutions platforms that assist patients in creating and placing orders for personalized eyewear.”
What does virtual reality mean for the patient
Virtual reality (VR) therapies in dental offer a range of applications aimed at improving patient experience and treatment outcomes. Here are some examples:
1. Distract patients during dental procedures, reducing anxiety and perceived pain.
2. Explaining complex dental procedures by providing 3D visualizations.
3. Guide patients through exercises and movements required for post-procedure recovery, particularly in cases involving jaw or facial surgeries.
Payers can support providers’ efforts toward practice growth by offering marketing resources and facilitating networking opportunities. Additionally, payers may consider benefit plan offerings that include coverage for advanced educational, diagnostic and treatment solutions such as those available with virtual reality. KEY TAKEAWAY
Virtual reality (VR) therapies in vision are innovative approaches designed to improve eye health, diagnose and provide therapeutic interventions. Here are some examples:
1. Treat conditions such as Amblyopia (Lazy Eye) and Strabismus (Crossed Eyes) by providing interactive games and exercises to strengthen eyes.
2. Perform visual field tests to detect and monitor peripheral vision loss.
3. Stimulate neurological injuries such as stroke or traumatic brain injury.
More than half of dental providers (53%) would consider a DSO partnership, while 93% of vision providers view private equity investment as beneficial for their practices. More specifically, more than twothirds of dental providers (69%) view DSO growth positively and as an opportunity for growth/retirement planning. Similarly, most vision providers view the growth of private equity positively (93%) and as an opportunity for growth/retirement planning (84%).
To foster collaboration and future partnerships, 89% of vision and 71% of dental providers want payers to ensure transparency in billing and reimbursement, particularly regarding differences between DSOs and private or group practices. Additionally, 84% of vision providers and 69% of dental providers seek improved communication about partnership opportunities and the potential implications.
Payers can support providers considering partnership or collaboration with DSOs and private equity by offering transparency and communication regarding the implications of these partnerships. Providing clear information about billing and reimbursement implications can help providers make informed decisions and foster positive relationships.
Providers are overwhelmingly receptive to value-based care models and are willing to adapt their practices to meet payer requirements. When asked specifically about participating in value-based care, more than 8 in 10 dental providers believe it would add value to their practice and are highly open to adopting these models. Across the board, all providers surveyed expressed a strong willingness to modify their practices to align with value-based care requirements.
Implementing/optimizing electronic health records (EHRs) for better tracking patient outcomes and sharing information
Enhancing efforts to educate patients about their conditions
Adopting technology for data analytics and/or risk stratification and management
Developing stronger care coordination methodologies with other healthcare providers and/or community resources
Accepting compensation models that reward providers for achieving health outcomes and/or adapting billing and coding practices to meet the requirements of value-based reimbursement models
Regularly evaluating and improving practice performance based on specific quality and efficiency metrics
Expanding access to care via more flexible hours or telehealth services
Investing in additional training for staff to meet the requirements of value-based care
I am not willing to adapt my practice to fulfill the requirements of value-based care models
Payers can capitalize on the positive reception of value-based models by offering training and resources to help providers transition smoothly. Supporting the adoption of data analytics and electronic health records can also support better patient outcomes.
“Machine learning software designed to provide tailored treatment suggestions based on individual health data would be highly beneficial. This type of tool could revolutionize the way healthcare is delivered by optimizing treatment plans to suit each patient’s unique needs.”
Integrated care is a key area where providers see significant potential for a collaborative payer-provider partnership that can improve patient outcomes. The majority of providers (88%) expressed interest in integrating medical, dental and vision care to enhance patient outcomes.
Unfortunately, our research shows that while providers feel that integrated care would be beneficial for patient outcomes, the health information they need from other providers is rarely accessible via the technologies available today.
For approximately what percentage of your patients do you receive the following information via tools/technologies available today in your practice?
Dental/vision health risk assessment preformed outside of your practice
CPT codes performed outside of your (dental/vision) practice
Gap in care alerts (i.e., evidence-based recommendation for health actions a member can take)
HCPCS codes performed outside of your (dental/vision) care practice
ICD10 codes captured outside of your (dental/vision) care practice
Incentives available from insurance carrier for performing certain procedures on high risk patients (e.g., diabetics)
Lab results requested and performed outside of your (dental/vision) practice
MA / Medicaid risk adjustment factors
Primary care physician
Rx data (drug, NDC code and therapeutic class) prescribed outside of your (dental/vision) practice
Social determinant of health information (e.g., social economic status, education, housing)
Providers indicated they would be more motivated to pursue greater collaboration if they received increased payer support in key areas. For example, 39% of vision providers and 33% of dental providers expressed a desire for better access to premium health education materials and online content to share with patients. Additionally, over one-third of dental providers noted that public acknowledgment of health outcomes would significantly boost their motivation. Providers also cited priority access to new health programs (33%) and the development of customized plans based on collaborative insights from multiple providers (33%) as important motivators.
Encouraging collaboration across medical, dental and vision care can lead to more comprehensive and effective patient care. Payers can foster the adoption of integrated care models by “sweetening the pot” with premium educational materials and public recognition of provider achievements in patient outcomes.
“[Payers should provide] tools for patient education and engagement specific to dental care and enhance the knowledge related to the patients.”
“As per my views on running the practice smoothly, insurance companies should manage education material for remote area patients.”
While communication is essential, providers have additional ideas for strengthening payer-provider partnerships. Forty-two percent of dental providers and 44% of vision providers believe that aligning policies and procedures is the most important factor. For dental providers, enhanced communication channels with payers (38%) come next, while 40% of vision providers emphasize the importance of patient-centered care models.
Regulatory support and advocacy
Shared incentive programs for providers and payers for achieving specific health outcomes
Collaborative care teams of medical/dental/vision care providers with payer representatives
Integrated care platforms with patients’ data across medical/dental/vision care
Policy and procedure alignment
Research and best practice sharing
Patient-centered care models with input from medical/dental/vision care providers and payers
Enhanced communication channels between providers and payers
Joint training programs/education initiatives for providers and payers staff
Regulatory support and advocacy
Shared incentive programs for providers and payers for achieving specific health outcomes
Collaborative care teams of medical/dental/vision care providers with payer representatives
Integrated care platforms with patients’ data across medical/dental/vision care
Policy and procedure alignment
Research and best practice sharing
Patient-centered care models with input from medical/dental/vision care providers and payers
Enhanced communication channels between providers and payers
“[Payers] should help by offering the platforms for collaborative research and data sharing.”
“Having a secure messaging platform specifically designed for communicating with patients would provide immense value and convenience for healthcare providers. This platform would offer a safe and reliable way for healthcare professionals to exchange information, discuss treatment plans and follow up with patients.”
Payers can enhance communication and drive collaboration by creating platforms for knowledge sharing and developing standardized integrated care models. Aligning policies and procedures can further streamline care delivery and improve patient outcomes.
A large majority of providers find value in case management for Medicaid patients with special needs, the dental home model and coverage of preventive care. They also see opportunities for enhancing care with the aim of improving health equity in these areas:
CASE MANAGEMENT FOR MEDICAID PATIENTS WITH SPECIAL NEEDS
• Expand coverage and offer training resources
• Offer incentives for achieving patient outcomes
• Vision providers would like to see public recognition for their case management efforts
• Improve provider training and support
• Increase patient education and engagement
• Increased funding and resources for dental home services
• Expand access to preventive care
• Partner with community organizations on health education programs
• Expand access through telehealth service
Payers can address health equity by expanding access to preventative care and partnering with community organizations. Supporting coverage for telehealth services can also improve access to care for underserved populations and reduce barriers to service.
Payers have significant opportunities to strengthen their relationships with dental and vision providers. On the operational side, providers indicate they face challenges with billing and reimbursement, particularly regarding patient eligibility verification and authorization requirements. Simplifying these processes can enhance provider satisfaction and operational efficiency. Providers are also interested in integrated billing and coding systems, highlighting the need for technological support in practice management.
In terms of business models, providers are very much interested in valuebased reimbursement, dental homes and case management approaches. Payers can facilitate adoption and a smooth transition by offering comprehensive training and resources.
From a clinical perspective, providers recommend expanding coverage for preventative care and advanced screenings to improve patient outcomes and health equity. They believe that integrating solutions like AI for utilization management and VR for patient therapies can enhance clinical and administrative tasks, leading to better care delivery. Providers also believe that integrating medical, dental and vision care will enhance patient outcomes, and would be more willing to seek out patient health information from other providers if they have support from payers in terms of patient education.
By aligning their offerings with provider priorities, payers can cultivate deeper partnerships with providers, driving enhanced healthcare delivery and elevating patient satisfaction.
SKYGEN developed this report in collaboration with Hanover Research. The survey was designed to understand dental and vision provider perceptions, focusing on how providers and payers can better collaborate. The survey was conducted online, and respondents were recruited via a panel. The analysis includes a total of 201 respondents following data cleaning and quality control. Hanover Research performed statistical analysis with a 95% confidence level using z-tests, with a p-value of less than 0.05, and a margin of error of ±1% for the overall sample.
SKYGEN transforms dental and vision benefits management and administration with flexible technology and services that connect and change lives for the better. Through partnerships with payers, providers and government agencies, SKYGEN helps its customers navigate dental and vision benefits management and administration. With its portfolio of third-party administration (TPA), intelligent Software as a Service (SaaS) automation, marketplace connectivity, risk management solutions and above-and-beyond services like Enhanced Benefit Management (EBM), Provider Select Suite platforms, mobile apps and portals, SKYGEN serves nearly 50 million members across all 50 states, more than 40 government and commercial insurers and process 3 million claims monthly. For more information, please visit www.skygenusa.com.
Founded in 2003, Hanover Research is a global research and analytics firm that delivers market intelligence through a unique, fixed-fee model to more than 1,000 clients. Headquartered in Arlington, Virginia, Hanover employs high-caliber market researchers, analysts, and account executives to provide a service that is revolutionary in its combination of flexibility and affordability. Hanover has been named a Top 50 Market Research Firm by the American Marketing Association every year since 2015. To learn more about Hanover Research, visit www.hanoverresearch.com.
AGE (N=201)
26 to 34
35 to 44
44 to 54
55+
GENDER (N=201)
Male Female
RACE (N=201)
American Indian or Alaska Native Asian Black or African American
Hispanic White
Prefer not to say
U.S. REGION (N=201) Urban area Midwest South West
AREAS SERVED (N=201)
INSURANCE (N=201)
Private/commercial health insurance
Medicaid
Medicare Advantage Plan
COMPANIES (N=201)
PRACTICE TYPE (N=201)
Private Practice
Group Practice
Dental Service Organization (DSO)
Corporate/Chain Optometry
Hospital-Based Practitioner
PRACTICE SIZE (N=201)
Small (1 to 5 providers)
Medium (6 to 20 providers)
Large (21 to 100 providers)
Extra Large (More than 100 providers)
JOB ROLE (N=201)
General Dentist
Dental Specialist
Optometrist
Ophthalmologist
Dental Clinic Owner/ Managing Director
Office Manager
Dental Support Organization Manager
EXPERIENCE (N=201)
Up to 10 years out of school
11 to 25 years out of school
25+ years out of school
SPECIALTY (N=97)
General Dentistry, Orthodontics and Dentofacial Orthopedics
Periatric Dentistry (Pedodontics), Periodontics
Endodontics, Prosthodontics, Oral and Maxillofacial Surgery
Oral and Maxillofacial Pathology
Oral and Maxillofacial Radiology
Cosmetic Dentistry
Dental Anesthesiology
Dental Public Health
Oral Medicine
Orofacial Pain
PRACTICE REVENUE (N=201)
$100,000 to $499,999
$500,000 to $999,999
$1,000,000 to $4,999,999
$5,000,000 or more
AGE GROUP SERVED (N=201)
Children
Adolescents
Adults
Elderly
INCOME GROUP SERVED (N=201)
Low-income families (earning significantly less than average, making basic living expenses challenging to afford)
Middle-income families (earning an income that supports a comfortable lifestyle, covering basic needs and allowing for some discretionary spending)
High-income families (earning significantly more than average, easily affording basic needs, luxuries, and investments, with great financial freedom)
GROUPS SERVED (N=201)
Patients with special needs Immigrant populations
Homeless individuals Veterans
LGBTQ+ community
RACIAL GROUPS SERVED (N=201)
American Indian or Alaska Native Asian
Black or African American Hispanic
Pacific Islander
