Customer Success Story

Building a Medicare Advantage Network

For a National Health Plan

The Story

A national health plan wanted to expand their Medicare Advantage (MA) offerings. Their goals:

Offer new MA plans in two states with established product lines.
Launch MA plans in three new states.

To achieve these goals in an acceptable time frame, the health plan needed every resource available. Unfortunately, they ran into a challenge: their internal network development team had no bandwidth due to other projects and the available resources on their commercial team did not have any experience with Medicare Advantage requirements.

The Solution

The health plan had specific cost and quality requirements, so andros kicked off the project with a thorough market assessment — evaluating the existing payors, beneficiaries, and providers in each market to determine the feasibility and resourcing requirements for each provider network.

The Results

The health plan achieved 100% adequacy in four states.
Despite unforeseen obstacles (a major IDN in the fifth state decided not to enroll any of their providers in new MA plans that year), the plan achieved 91.4% network adequacy for the fifth state.
Successfully recruited 4,849 physicians in 379 facilities across the five states.
Collected and managed provider data for each network and prepared each provider directory for filing.
andros managed the entire five-state network development project continuously for five months.