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Redesigning the Model of Care during the Procurement Cycle

  • Shanah Tirado

By Shanah Tirado

A large public health plan in the Northeast was in the midst of the procurement cycle for a state demonstration. The product proposed for the demonstration covered under 65 dual-eligible members, a high-risk population, in which there was a large proportion of chronic conditions and mental health and substance use disorder (MH/SUD) comorbidities. The health plan wanted to redesign the model of care for this product as well as strengthen its re-procurement bid response. The health plan engaged COPE Health Solutions to partner on these efforts and to provide a combination of strategic advisory, project management, and access to clinical, policy, and procurement subject matter experts.

Our Approach
The team worked hand in hand with the client to develop a comprehensive view of the health plan’s current status and to identify future opportunities to both improve the populations’ outcomes and improve financial performance.

  • Data analysis: The team reviewed utilization characteristics to identify potential predictors of avoidable spend; they also applied factors that were available via a registry and evidence-based best practice to identify key combinations of factors that would be used to stratify the population’s risk.
  • Design and collaboration: Design sessions were undertaken with frontline heath plan care team members to validate assumptions, review initial recommendations from key interviews and collaboratively troubleshoot key barriers inherent in the current care model. These design sessions provided internal design, review and iteration of recommendations with COPE Health Solutions subject matter experts (SMEs). The team provided the health plan with market relevant, evidence-based care model redesign, analytics and network-related recommendations. The health plan executives and team members that were working to develop and produce a competitive RFP response used these findings, data points and model recommendations to strengthen their submission.

Next, for the demonstration application, the COPE Health Solutions SME team provided procurement strategy and planning, content development, and project management.

  • Proposal support: A team of COPE Health Solutions SMEs, project managers and content writers worked with health plan product leaders to identify the key win themes, messages, necessary data points and integrated messaging needed to competitively respond to the current duals solicitation. The work included providing a procurement gap analysis and performance improvement planning. Key components included the identification of gaps between procurement response requirements and current state processes and engagement in a strategic planning session to prioritize gaps. As the deliverables successfully demonstrated value and identified internal gaps in their ability to provide strategy and content writers, the scope was expanded to include support with covering the response for key procurement sections including, care planning, innovation, provider network and interdisciplinary care team. COPE Health Solutions SMEs provided technical advisory support and review services to the sections of the proposal that were not under their content development purview to ensure cross proposal consistency of themes, voice and compliance.


Though too early to see measurable impacts of the refreshed model of care (go-live was in July), the model is operational; executive and operational dashboards identify KPIs; care teams are staffed, and members are all assigned to new relationship managers and interdisciplinary care teams.

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