Data and 'Proof Points' Are Keys to Strong Medicaid Bids

by Lauren Flynn Kelly

Requests for proposals from Medicaid managed care organizations are becoming more intense, as state Medicaid agencies look to pass on greater responsibility to insurers, further integrate services such as medical and behavioral health, and incorporate "buzz" terms like social determinants of health and value-based purchasing (VBP), observed speakers during a panel on Medicaid procurement trends at the AHIP National Conference on Medicaid.

Many states are placing more emphasis on an "integrated approach," but what integration means very much depends on the state, said Darin Gordon, founding partner of Speire Healthcare Strategies, LLC. States' definitions of VBP also tend to vary, and one "disturbing trend" he's seeing is high expectations from states that MCOs have a certain percentage of their spend on VBP in a certain amount of time. Gordon said these expectations are often not realistic because of provider reluctance to enter into value-based contracts.

Being able to demonstrate your community linkages will be critical to RFP responses around social determinants, said Carol Backstrom at Harbage Consulting. "Given how stretched states are from a bandwidth perspective, whatever you can offer up in terms of things you are already working on … the value you can add to the contract, [things that] you inherently already do well, are in my opinion going to very much [be] welcome by the state," she said.

"The three biggest expectations in RFPs are data, data, data," added Gordon. "Don't just generally talk about something; actually [have] some proof points….you have to be able to tell that story well about how you are…able to address these high need populations."

Another trend Speire has observed is quality outcomes increasing in scoring weight in RFP responses. Measures such as HEDIS and NCQA are "becoming more and more prevalent because of the national comparability that you get from those measures, but you also have to have the ability to describe the quality outcomes," said Gordon.

John McCarthy, another Speire founding partner, advised that plans meet with the state Medicaid director when they know an RFP is coming and get an idea of whether the state is open to newcomers. "Where I see the biggest barrier to entry is whether they've been there or not," he said.

From RADAR on Medicare Advantage