Executing Significant Network Expansion for National Health Plan

Context: 

A national health plan focused on the Medicaid segment was interested in growing its presence in a southeastern state.  The organization was already in select counties and looking to expand to 14 additional counties to have a statewide network in advance of an upcoming Medicaid procurement process.  In addition to building its Medicaid network in this geography, the organization also wanted to contract providers for Exchange products in these geographies.

Approach:

The network expansion effort started with a comprehensive analysis of the provider network landscape to understand what would be required to build a competitive statewide network and meet all regulatory requirements.  Informed by this network landscape analysis and insights from executive leadership and the network team, we developed and executed against a contracting road map for all hospitals, physicians and ancillary providers we would need to contract with to be successful.  Through these contracting efforts the team built a comprehensive network for expansion.

Results:

The network expansion effort was completed on schedule to meet the Medicaid bid timeline and within the financial parameters needed to ensure long term success.  In part as a result of the successful network build, the organization was successful in winning their Medicaid bid in the next procurement cycle and offering products statewide.