By Gen Gillespie and Mac Davis

Our experience tells us that organizations looking to enter the SNP space should undertake significant and time-intensive planning before launch.  Consider the following your executive primer to drive success and performance for your SNP product. 

Establishing Governance and Focus 

In the process of setting up your organization, it’s vital to think not only about the relative immediacy of your launch but also about the scope and opportunities for continued success. Creating operational accountability for long-term ownership — and constancy of quality, throughout — is an important piece of that puzzle. Whatever you launch today, your team will have to live with later. 

Establishing that measure of accountability and constancy relies heavily on understanding the unique complexities of your healthcare landscape. While there is some overlap between the Medicaid and SNP spaces, SNP is a relatively new product governed by the Centers for Medicare and Medicaid Services (CMS), and, in many cases, by state-specific Departments of Insurance. That reality means you’ll need to think about CMS Federal and State compliance as well as driving product success.   

Sound like a tall order? It can be. But here are some guiding principles: 

Do not establish a siloed SNP function. Instead, leverage the best-in-class assets, capabilities, and business processes you’ve already established and allow your core businesses to flourish in this dynamic SNP space.  

Create a forum and structure around Medicare accountability. In the majority of cases, Medicare provides both a richer benefit than Medicaid and more comprehensive compliance requirements. Orienting your governance around Medicare will not only equip you with the right internal safeguards, it will clarify the focus on Medicare aspects that need to be administered on behalf of CMS.   

Although you don’t have to set up dedicated Medicare Profit & Loss (P&L) leaders prior to launch, doing so is a proven best practice — in fact, it’s already strengthened many of the largest Medicare-Medicaid programs (MMP) available. Each of those programs reported benefits from being able to tailor their products for maximum performance in ways that deviate from Medicaid and other lines of business.  

Self-assess your experience. Belong Health’s team is well-versed in helping organizations assess their experience levels in respect to new and existing domains — but this is a process you can begin on your own!   

Consider evaluating each of your functions relative to experience and capacity, then grid those functions along four quadrants:

• Strong Experience/Low Capacity
• Low Experience/High Capacity
• Strong Experience/High Capacity
• Low Experience/Low Capacity

An honest evaluation, via this exercise, will help you form an initial hypothesis around which areas need focus for a successful launch. That hypothesis, in turn, provides vital information to test further planning, to support gap analyses, and to naturally guide the development of a strong timeline for launch.  

Build your SNP around key functions that can speed you to profitability. Our study of plans that transitioned into SNPs revealed they often struggle to find profit for the first three years with this product. This is little surprise, as there is no shortage of moving parts to consider — membership growth, underlying conditions, and early administrative costs among them — but getting to a point of profit is crucial, throughout.  

In the sections that follow, we’ll assume a launch of January 2024 as we explore five core functions to focus on to drive early plan performance — provided, of course, clear and consistent accountability remains in place.  
 

Core Function #1: The Bid Process

The bid process is nothing to take lightly. In addition to pricing the product you aim to create, a successful bid process assesses its level of profitability and competitiveness in the marketplace. Naturally, this discovery requires some serious research — Which competitors grew? Which didn’t? What benefits did they add or delete?  

Once Medicare releases its bid pricing tool and plan benefit package on April 1st, you’ll have only about two months (first Monday in June, at midnight) to turn in your bid.   

And once that bid process closes? You’ll immediately be back at work, ramping up the planning process for next year – What should expansion look like? What are competitive benefits? How do we stay ahead of other players in the space?  

These exhaustive processes benefit from year-round planning and an all-encompassing team effort. Involve your P&L leader, your finance lead, actuarial support, your sales team, and network analytics. All hands on deck!   

Core Function #2: Sales and Enrollment

Unsurprisingly, successful sales enrollment relies heavily on the health of the bid process outlined above. After all, it’s the bid that sets pricing and benefit structure to be marketed throughout the fall. And because you’re dealing with a benchmark-based program, sales and marketing work should begin in tandem with that bid process. Your sales and marketing lead will thank you for keeping them abreast of what product you’re taking to market and how you plan to get it there.  

In recent years, sales and enrollment processes have become more competitive than ever. Across nearly every geography in the country, there is now more choice for Medicare consumers.   

Remember: enrollment drives your top-line revenue and contributes to keeping your product afloat. To perform in Medicare Advantage, you’ll need a critical mass of membership.  Plans that outperform in Medicare sales and marketing typically get three things right – providing market-competitive benefits that address consumers’ needs and wants, contracting a competitive and marketable network, and implementing an effective planning process.  All three need to move in lockstep.  Why?  

Regarding benefits and network, consumers typically ask three questions of salespeople before picking a plan:  

1. How much does it cost? (benefit and bid data)  
2. Are my doctors in the network (network development data)  
3. Are my needed services and drugs covered? (network development/sales data)  

With the benefit of strong groundwork from the bid and competitive networks aligned by end of Q1 prior to your launch year, Medicare sales teams can focus on using Q2 to test some of the backend functions you’ll use to enroll members and build campaigns for your sales team.   

And all this work positions a new Medicare plan well for Q3 — the most crucial quarter of all — when marketing efforts can begin in earnest, as Medicare confines marketing and sales to an Annual Enrollment Period (AEP) in Q4. If you can implement that planning process, by the time AEP arrives, you’ll be primed to swiftly generate leads, introduce them to customer service, and move them through an efficient sales pipeline.