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Evidence-Based Strategies for Medicaid RFP

 

With RFP Intelligence, payers can understand the utilization patterns and distinct needs of the Medicaid population in each service area with an all-payer claims database. Whether entering, expanding, or re-bidding on existing coverage areas, strengthen your proposals with region-specific insights that highlight areas of competitive advantage. 

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In Florida, a state-level view of PCP utilization per patient does not reflect the regional utilization rates.

Gain visibility into region-specific utilization patterns 

 

Healthcare is local. Medicaid patients do not interact homogeneously with the healthcare continuum, resulting in regional variability. With RFP Intelligence, payers can explore utilization beyond their current member population or within greenfield markets.  

Respond to the Medicaid population’s changing needs 

 

Years of forgone preventative care will result in higher acuity patients that will be more costly to manage. MCOs need to develop care strategies with the most up-to-date data to effectively manage the Medicaid population’s post-pandemic needs. 

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While primary care utilization has returned to pre-pandemic levels in some regions, most markets in Texas exhibit sustained declines. 

Enhance proposals with RFP Intelligence

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Explore 5-year trends for: 

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Member and cohort-specific utilization of outpatient, emergency department, primary care, and telehealth services.

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Preventable admissions and emergency room visits of outpatient, emergency department, primary care, and telehealth services.

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True access to providers based on Medicaid utilization patterns, so payers can ensure that they build networks that support and improve care access.

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Outmigration by Medicaid region highlights network development opportunities to support access to care outside their local market. 

 
 
"The competition in Medicaid managed care is fierce, and understanding the distinct needs of the Medicaid population in each service area is essential for success. Our RFP solution enables visibility into crucial metrics such as utilization, preventable admissions and ER visits, access to providers, and outmigration by Medicaid region. Focusing on the unique demands, local supply, and care patterns for the Medicaid population helps payers highlight evidence-based trends and design effective local interventions for one of the most difficult populations to manage.”
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 - Jared McKee
SVP, and GM of Payer Solutions

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