Keep your Medicare Advantage network build on track with these tips


As fall settles in, and you’re sitting at your (home office) desk with a pumpkin spice latte, chances are your organization is well into its Medicare Advantage provider network builds. Network builds are such large projects, with so many moving parts, that it can be difficult to truly understand how well a project is progressing. If you’re not able to maintain both a 35,000 foot view of your Medicare Advantage build and get in the weeds of county-by-county progress, it could be going off the rails, and you might not even know it. 

Avoid this fate, especially as you get deeper into the fall and winter, and deeper into your network build with some key questions you need to be able to answer to know that you’re still on track. 

Have you started your Medicare Advantage network builds and expansions?

If you haven’t, you’re already at risk of falling behind. With June as your deadline for filing a complete and compliant network with CMS, your project is at risk already. Starting early is key to your success. It gives you time to recover if you can’t recruit all the providers you anticipated, or if credentialing your network takes longer than you expected. Get going early to minimize the impact of the inevitable bumps along the way.

Did you complete a thorough market assessment before you started your recruiting and contracting efforts? 

It’s often possible to see all the positive indicators for success in a given market – favorable demographics for new Medicare enrollees, less competition, or success in similar or nearby geographies, and miss out on red flags that should be accounted for in your strategy. 

Have you identified any critical health system that must be successfully contracted to reach adequacy? 

That’s not always the case, but if it is, you need to understand it right out of the gates. If the organization has indicated that it’s not joining additional networks for the upcoming plan year, you could end up in a no-win situation. Your go-to-market strategy should include advanced modeling capabilities that allow you to plot multiple paths to adequacy–or at least notify you as far in advance as possible of risks to overall network adequacy.

How is the build progressing? 

When answering this question, you may learn something you don’t particularly like – your project is off-track, it’s behind schedule, or you’ve failed to contract key provider groups or facilities necessary to achieve adequacy. When this happens, you need a plan to either move on or salvage the project. By frequently assessing adequacy, you should be able to identify alternative paths to meeting CMS standards, and quickly push new targets into recruiting workstreams. If a tactical pivot isn’t enough, you’ll need to consider alternative geographies for your build. Without visibility, you often won’t recognize you’re off track until it’s too late; with it, you preserve your ability to change focus as needed.

Do I have the proper sources allocated to the build?

Sometimes your build goes awry simply because you’re understaffed.  You may fall behind in recruiting or credentialing because you don’t have a large enough team to handle all the projects they’ve been given. Once you’re deep into a build, though, it’s likely too late to hire and train up new members of your team. You need experienced recruiters or medical credentialing professionals quickly. Have a plan in place to address this possibility; don’t wait for it to surprise you.

Providers have signed their contracts. Is that all we need?

No! Don’t fail to account for credentialing. A network isn’t compliant simply because you’ve contracted the required providers; they also need to be credentialed. Often organizations treat credentialing as a separate project. They wait until their network is fully contracted before they start credentialing. This creates a completely unnecessary time crunch that could jeopardize your build. Credentialing is an integral part of the network development process. Plan for it to ensure you stay ahead of the game and reduce risks and delays in going to market

You can’t afford to fly blind on a Medicare Advantage build. Having a partner that can offer a single technology platform that combines recruiting and contracting workflows with analytics and reporting will help you avoid these pitfalls puts you well on your way to keeping your Medicare Advantage projects on track. Learn more about provider network development at andros.

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