Medicare Advantage Expansion Accelerates Growth Across New Markets
Learn how a growing Medicare Advantage plan expanded into new counties by onboarding a large delegated provider group, rapidly increased access to care, optimized operations, and created a repeatable model for future growth.
The Strategic Opportunity Behind Medicare Advantage Growth
With rising beneficiary demand, Medicare Advantage (MA) continues to be one of the fastest-growing segments in healthcare. For health plans, MA offers a more predictable revenue stream and the flexibility to innovate around care delivery. For patients, it often means access to broader benefits, care coordination, and improved outcomes.
Recognizing an opportunity in underserved markets, a regional MA plan set out to expand into new counties and significantly increase its provider network. The goal: introduce a fully delegated arrangement with a provider group of PCPs and specialists while maintaining service quality, regulatory compliance, and business continuity.
The expansion had to be completed within a tight window to meet open enrollment timelines. Success required not just signing a contract but ensuring that all operational, technical, and clinical systems were fully aligned to support the newly delegated providers. The health plan turned to Freed Associates to lead the cross-functional work required to launch in new geographies.
Standing Up Delegated Operations in Record Time
Freed was engaged to provide program leadership, technical planning, and change management support for the expansion. The scope included standing up a comprehensive operational infrastructure to support the delegation arrangement and connecting technology systems across organizations.
To ensure clarity and speed, Freed established a centralized program management office (PMO) that would drive alignment across more than 10 multi-organizational workstreams including, member eligibility and enrollment, claims processing, and utilization management.
Each workstream had representation from both the health plan and delegated provider group, many of whom had never worked together before. Freed’s team provided day-to-day coordination, issue resolution, risk tracking, and progress reporting to ensure that all stakeholders remained focused and accountable.
Building the Infrastructure to Support Delegation
The success of the expansion hinged on designing and implementing seamless, accurate data exchanges. Freed led the development of over 20 new technology deployments, including:
- New EDI feeds for eligibility, authorizations, claims, etc.
- Reporting for performance monitoring and delegation oversight
- System enhancements for new functionality
Freed worked closely with IT teams on both sides to design data exchange protocols, test file integrity, and implement process flows that met both operational and regulatory requirements. Each new feed or function required not just the build, but extensive testing, training, and contingency planning. In many cases, Freed facilitated joint working sessions to resolve logic mismatches, streamline handoffs, and align escalation paths all within the rapid expansion timeline.
Enabling Change and Sustaining Readiness
Standing up a product in new geography also required significant change management, particularly around roles and responsibilities between the health plan and the delegated provider group. Freed developed detailed transition plans, communication materials, and training documentation to ensure that all operational teams were ready to support the new population on day one.
Throughout the process, Freed emphasized knowledge transfer and documentation to create a lasting playbook for future market expansions. The result was a stable, repeatable model the plan could replicate in future geographies and provider groups.
Results: A High-Stakes Launch Delivered On-Time
Despite a tight timeline and significant complexity, the health plan successfully launched its MA expansion on time, meeting all internal and external deadlines. Key outcomes included:
- On-time go-lives delivered for all core operational functions (eligibility, claims, UM, capitation, etc.)
- Post-launch operations stabilized, ensuring continuity of care and service
- Roadmap created for future geographic and provider group expansions
The health plan was able to begin enrolling members as planned and positioned itself to grow its footprint further using the infrastructure and governance model developed through this engagement.
Laying the Groundwork for Sustainable Growth
Feedback from stakeholders at both the health plan and delegated provider group underscored the importance of external, objective program management in navigating a change of this scale. By bringing discipline to the implementation process and ensuring every detail was addressed Freed helped the plan achieve not just a successful launch but a foundation for long-term MA growth.
