Insights

A Health Plan Looks to Expand into Regional Medicaid Markets

Health plan engages T2C to assist in business case evaluation and identification of high priority markets.

Background:

A regional health plan sought to expand into the Medicaid market and engaged T2C to assist in business case evaluation as well as identification of highest-priority markets. T2C assessed the health plan’s core competencies and operating model and conducted a comprehensive market analysis to create informed market entry strategies. Utilizing the data-driven and independent evaluation of the regional Medicaid marketplace, T2C worked with the client to create an approach to enter the new desired markets.

T2C was engaged to help evaluate the business case for expansion into these markets and identify potential markets of highest priority. A second workstream was responsible for examining the plan’s Medicaid bidding strategy, with the ultimate goal of improving the success rate on bids for state Medicaid contracts.

Challenges:

Market expansion required a comprehensive evaluation of the health plan’s core competencies and operating model. It also necessitated a thorough market analysis to best understand the ideal market entry approach and strategy.

The client wanted to apply lessons learned from previously lost bids to improve their strategy. With the desire to best focus company efforts, the client also wanted to allocate time and resources to opportunities with the highest probability and success.

Solution:

T2C assessed the plan’s operating model and conducted the required market analysis to establish ideal market characteristics, understand target expansion areas and the competitive environment and prioritize attractive markets for entry. Top Tier advised the client on expansion strategy and formulated a market entry approach.

T2C reviewed previously submitted bids across criteria, including the completeness of the response, competitive strengths that may not have been fully exploited and the richness and continuity of bid proposal content. In addition, the client looked to us for industry best practices as well as comparative analysis of the regional winning bids. Top Tier developed opportunity qualification criteria to identify ideal bidding opportunity attributes and provided review and coaching on new bids.

Value:

Client leadership was given a data-driven and independent evaluation of the regional Medicaid marketplace. T2C created an analytical and tactical approach to enter the new regional markets and provided recommendations for the plan to continue to grow in the regional Medicaid space.

Utilizing industry and firm best practices, T2C helped the client focus resources on the highest-probability bid opportunities. The client became a successful bidder for the duals demonstration/Medicare-Medicaid Program (MMP).