Increasing healthcare costs are driving policy makers and government payers to accelerate Medicaid programs’ focus on value. Medicaid managed care contractors have a strategic imperative to ensure their core business and supporting operations deliver the value expected for every dollar invested in each Medicaid member.

As a Medicaid Managed Care Organization (MCO), whether your contract is coming up for renewal or you are competing for a first time entry to a new market, your success will be determined by multiple factors including your:

  • Proposed pricing
  • Demonstrated ability to deliver quality care
  • Accessibility of your provider network to patients
  • Ability to demonstrate operational and administrative performance
  • Commitment to regulatory compliance

As a practical matter however these rather obvious criteria are in fact “table stakes”. You have to get these right in order to even be in the game. Assuming you can nail these your ultimate success really depends on these additional factors:

Strength of your proposal:

  • How well do you articulate your capabilities, commitments, and offers? Do you clearly communicate what and how will you deliver while putting your best foot forward?
  • Are you able to add any differentiating innovative capabilities that were not required in the Request-For-Proposal, but the buyer would find attractive?
  • How strictly do you address and follow the Request-For-Proposal requirements and administrative instructions? Missing a detail here can eliminate an otherwise good proposal from consideration.
  • How professionally do you package your proposal – your packaging is often considered to be a reflection of the care and attention to detail you provide for both your state customers and the Medicaid program members they represent.

Specific individual buyer decision drivers:

  • Do you know who the decision making buyers are and what their specific individual decision drivers are?
  • What is the relative decision driving authority of each individual team member evaluating the competitive proposals? Who makes the final decision as opposed to just being a voice at the table?
  • What are their specific decision making criteria and how do they weigh them? It’s common to include this information at a group level within the RFP, but how do the individuals weight the various decision criteria?

Political situation:

  • What are the professional and personal relationships and their history between your Medicaid MCO executives and the public officials making or influencing the buy decision? Are there any risks in this area you need to mitigate?
  • What is the relationship between your MCO and the community as represented by the multiple applicable community service or advocacy groups? Are there investments here you need to make?
  • What is the state of your connection and relationship with key legislative or executive branch individuals who might influence a decision?

Strength of competition:

  • Who are your competitors?
  • How many contracts will be awarded between them?
  • What are their strengths and challenges?
  • How does past performance for all incumbents (including you, if applicable) stack up along key performance metrics of interest to the buyer?
  • What new innovations might your competitors offer for this contract?
  • How can you best position your proposal relative to your competitors?

As with marketing any healthcare related product or service there are the basics of your offering that must be of high value to your potential customers. But in the end these will typically only get you an audience. Successful Medicaid MCO’s make the extra investment to discover those additional factors that ultimately distinguish between competitors and result in new contracts.

Most organizations don’t have the luxury of maintaining the specific expertise necessary to ensure success of a contracting process that happens every few years in a market, and your regular executives and senior staff have full time jobs. Utilizing experienced outside expertise not only fills that gap but also offers an opportunity for a fresh perspective on your capabilities, the prospective customer, and the competitors. And the right consulting partner can provide access to information that may be awkward to pursue internally.

Find out more by scheduling a complimentary consultation!

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