-: Hi everyone,
my name is Loren Koerber,
Vice President within Optum's Advisory Services Practice.
And today I have a few questions
for my colleague, Amy Jensen,
about how small community-based
and regional health plans consider their journey
as they enter new markets.
Amy, is executive level
and organizational support important
when expanding into new lines of business?
-: Most definitely Loren,
it is a journey
to successfully enter
a new government line of business.
And one that is not easy
or for the faint of heart.
Entering a new market is a heavy lift
across all domains.
So, health plans will need cross-functional support
and engagement.
-: Is it a heavy lift
for small community plans
and large nationals?
-: Absolutely.
It's generally tougher
for smaller community plans
who may not have the infrastructure
or resources
to easily expand services.
And it is important
to keep the expenses in check.
For example,
Medicaid profit margins
are generally much smaller
than commercial lines of business.
One of the things
that we recommend is a strategy roadmap
that includes an organizational assessment
or gap analysis.
-: So, a vendor could be performing the strategy roadmap
or gap analysis,
and really be a partner
for these community-based plans,
putting skin in the game
and fees tied to outcomes, rght?
-: Exactly, and that is something
that our team focuses on.
We do always put fees at risk
with our services.
-: And then they can build the framework
and operational platforms
that make sense for them
and the agencies they serve.
But what does the timing look like
for the strategy roadmap?
-: You know, for a new market entry strategy,
we typically recommend developing
and implementing the strategy approximately
12 to 18 months
before entering the market.
In the Medicaid arena, for example,
states have a set schedule
and generally re-procure every three
to five years.
So, plugging into that procurement timeline
will be very helpful.
-: And plugging into a vendor partner early on is important,
you know, to make sure these initiatives
are thoughtfully planned.
This has been really helpful, Amy.
Thanks so much for your input.
-: Thank you.
(upbeat music)