Preparing for new market expansion

Loren

- 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?

Amy

- 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.

Loren

- Is it a heavy lift for small community plans and large nationals?

Amy

- 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.

Loren

- 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?

Amy

- Exactly, and that is something that our team focuses on. We do always put fees at risk with our services.

Loren

- 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?

Amy

- 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.

Loren

- 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.

Amy

- Thank you.