Abstract
The stakes in Medicaid managed care procurement have never been higher. The contracts are larger, the covered populations more diverse, and the requirements more demanding. For community plans, competing with well-resourced, technology-driven national plans can feel like an uphill battle. But here’s the good news: community plans have unique strengths that can set them apart—if they know how to leverage them.
Let’s face it, today’s RFP process is exhausting. In some states, it has practically become a blood sport, with protests, lawsuits, and behind-the-scenes decisions seemingly shaping outcomes. Yet, for community plans, this environment also presents opportunities. The key to staying competitive lies in playing to your strengths and preparing well in advance.
During the 2024 ACAP CEO Summit, Siftwell hosted an event where industry experts and veteran MCO executives shared their perspectives on how community-facing plans can win the bid. Here are the key takeaways:
Tell Your Story – Early and Often
One of the biggest challenges community plans face isn’t just gathering data, but *telling their story* effectively. Too often, community plans assume that simply being embedded in the community will give them an edge. But that’s not enough anymore. You need to start strategizing long before the bid cycle begins—gathering proof points, showcasing outcomes, and leveraging your integrated relationships with local providers. These efforts will differentiate you from larger, more distant commercial plans.
Establish a process and template for teams to uniformly capture success stories. As plan staff engage with members, encourage them to document instances where members experience health or social improvements because of plan-supported interventions and interactions. Catalog these success stories so that when the RFP asks targeted questions, your plan will be ready with the best examples.
Concurrently, well before the RFP release, convene a cross-functional work group to strategize how best to showcase your strengths. Consider efforts around HEDIS, state-specific initiatives, quality programs, plan-specific interventions, and community reinvestments. Determine how to trend this data, highlighting positive outcomes, promising practices, and overall successes. Working ahead will allow you to compile all necessary data and ensure you’re driving the measurable results you want to highlight.
Start Early, Be Nimble
National plans flex their RFP muscles all the time—they bid everywhere, borrow content and outcomes from market to market, and constantly fine-tune their processes. As a community plan, you are nimble. You know your local geography, your people, and their needs. Chances are, you are also a good partner with the state and are often asked to implement pilot programs, trial new processes, or engage with new providers. Your local presence and awareness is your secret weapon. Regardless of when the next bid is due, now is the time to start preparing for it. Build your story, gather your data, and work on a strategy that doesn’t just meet the RFP requirements but exceeds them. Flexibility is key—don’t hesitate to innovate and adapt along the way.
Technology Isn’t Just for the Big Guys
Yes, AI might feel like the domain of the big national plans, but it’s a tool that can benefit any health plan—especially when it comes to improving health outcomes at the individual member level. It’s not about implementing technology for technology’s sake; it’s about using data smartly. Take a critical look at how your teams use plan data. There are solutions available to bring all data variables together so that insights can be used across your teams—not just for analytics and quality, but to inform care management strategies, community investments, and financial projections alike. Your plan must understand what the data is telling you and use those insights to shape better, more personalized care strategies.
Think about maternal health, for example. Technology can help identify pregnant individuals who are most likely to experience a high-risk pregnancy and ensure they get the care they need before it’s too late. Understanding the data can empower plans to develop strategic care management models that yield better health outcomes for both the mother and baby.
If the thought of merging all data into usable insights feels overwhelming, there are industry consultants and partners who can help you think through it and share best practices.
Lean on Your Community Ties
When disaster strikes, it’s community plans that step up. Whether it’s a hurricane in the Carolinas or a health crisis in Arizona, you’re the ones who know exactly what your members need, because those in crisis are your neighbors, and you’re literally living in the same communities. This intimate knowledge of local issues isn’t something a national plan can replicate, and it’s one of your biggest advantages. But here’s the catch: you can’t wait until the RFP drops to start telling that story. The work starts now.
The RFP process may feel more daunting than ever, but it’s also an opportunity to regroup, get your house in order, and lean into what makes your plan special. Community plans are the heart of their regions—when they speak, they speak from the ground up. By focusing on data, using technology tailored to your members’ unique needs, telling a compelling story, and leveraging local ties, you can go head-to-head with national competitors and come out on top.
