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A national health plan was considering entering the DoD health care market but had little internal knowledge or experience in this market with which to inform their strategic decision making and ultimately, their product offering. The cost of market entry, including bid and proposal costs, were estimated at tens of millions of dollars. Before committing to such a sizable investment, the health plan wanted to conduct due diligence and to enhance program knowledge among corporate executive. Rainmakers was engaged because of extensive subject matter expertise in TRICARE and other federal health care programs and strategic planning capabilities.
The Rainmakers Solution:
In addition to providing expert strategic planning support, Rainmakers TRICARE health care policy and operations experts analyzed relevant health care policies and developed training for health plan executives. The resulting training included topics such as, a detailed overview of the TRICARE Management Activity (TMA), program history and objectives, legislative and regulatory requirements, current policies for provider contracting and reimbursement, customer service standards, medical management guidelines and information technology and reporting requirements. In addition, we examined the challenges and opportunities of the contract statement of work requirements, past bid protests and GAO rulings, and lessons learned from past contracts. This training was specifically designed for an executive audience and took into account their extensive knowledge of commercial health care products and operations, yet provided enough detail to enable the client team to effectively make strategic investment decisions. In addition to training, we developed recommendations to the executive team regarding specific offerings and solutions that would ensure compliance with TRICARE policies, provide exceptional customer service, yet achieve goals for profitability.
Based on the training and guidance provided by Rainmakers, the client's knowledge of the TRICARE market was significantly enhanced and this enabled them to move forward with their government health care growth strategy.