Case Studies
Optimetra is committed to providing our clients with high-quality proposal development and project management solutions. The following case studies provide insight into our extensive capabilities. Select a category to see how we've helped our clients achieve success in a specific area.
- Medicaid Managed Care
- Medicaid Management Information Systems (MMIS)
- Center for Medicaid and Medicare Services(CMS)
- TRICARE
- General
Medicaid Managed Care
Situation
A large Medicaid managed care organization required assistance developing a complete proposal for a statewide, eight-region Medicaid managed care program in the State of Indiana.
Solution and Value Added
Optimetra led the technical proposal team, including strategy; project management; and content creation, to develop a winning proposal response that resulted in an expansion of 535,000 Medicaid eligibles for the client in the State of Indiana.
Situation
A large Medicaid managed care organization required assistance analyzing and improving a recompete proposal for a statewide managed care contract to provide services for TANF, CHAP, and SCHIP recipients in designated urban areas in the State of Nevada. The procurement was in recompete due to protest.
Solution and Value Added
Optimetra analyzed the existing technical proposal and provided a detailed improvement approach. Optimetra also redeveloped certain sections of the proposal based on this improvement approach. The outcome was a winning proposal response that resulted in a contract award of Washoe (Reno) and Clark (Las Vegas) counties with total Medicaid eligibles at approximately 100,000.
Situation
A large Medicaid managed care organization required assistance in preparing their technical proposal response for the State of Kansas to provide capitated physical health services to the Kansas HealthWave XIX and HealthWave XXI beneficiaries on a statewide basis.
Solution and Value Added
Optimetra assisted this client in developing the majority of its technical response. The result was a winning proposal response that resulted in an expansion of 70,000 Medicaid eligibles for the client in the State of Kansas.
Situation
A large Medicaid managed care organization required assistance developing a complete technical proposal in response to the State of Tennessee request to provide managed care services to TennCare enrollees in the Middle Grand Region of Tennessee.
Solution and Value Added
Optimetra led the technical proposal team, including strategy development; project management; and content creation, to develop a winning proposal response that resulted in an expansion of 170,000 Medicaid-eligible members for the client in the State of Tennessee.
Situation
A large Medicaid-only managed care organization required assistance developing a complete proposal for recompete and expansion of mandatory Medicaid managed care programs in an eight-region service area in the State of Texas.
Solution and Value Added
Optimetra led the proposal team to develop a winning proposal package that resulted in an expansion of 401,000 Medicaid eligibles for the client in the State of Texas.
Situation
A large Medicaid-only managed care organization required assistance developing a complete proposal to deliver Medicaid managed care services to a six-region service area in the State of Georgia.
Solution and Value Added
Optimetra led the proposal team to develop a winning proposal package that resulted in the client winning a contract to offer services in four of the six Georgia regions, including Atlanta.
Situation
A large Medicaid managed care organization required assistance documenting the company history and Strengths, Weaknesses, Opportunities, and Threats (SWOT) with respect to an upcoming market opportunity.
Solution and Value Added
Optimetra conducted the necessary research and analysis to accurately determine the client's position with regard to the upcoming bid. This pre-work helped the client better understand their competition, strengths, and weaknesses, increasing the probability of success in this procurement.
Situation
A large Medicaid managed care organization required interim support, management, and department oversight for the company's Business Development Department.
Solution and Value Added
Optimetra's Lead Consultant provided executive-level leadership in this interim role, helping the client advance this department and continue to grow their business until a hiring decision was made. This is an executive leadership responsibility for which consultants are not often favored. As such, this is a strong testimony to the level of trust Optimetra regularly establishes with clients.
Situation
A large Medicaid managed care organization needed project planning and project management services for the acquisition of a 192,000-member Medicaid health plan.
Solution and Value Added
Optimetra provided implementation and acquisition support in the form of project planning and project management services. We developed a project plan according to the company's methodology (also developed by us), as well as advising project sponsors/owners of appropriate project decisions, and mentoring another project manager who had only limited previous project management experience. We successfully managed project planning and integration of the health plan, which resulted in a projected 300 million dollars of annual revenue for the client.
Situation
A large Medicaid managed care organization required assistance developing a concept paper that explained the company’s model for a particular Medicare Special Needs Plan (SNP) and how it would create advantages for dual-eligible members, as well as providers.
Solution and Value Added
Optimetra applied our in-depth knowledge of public healthcare to a concept paper that clearly communicated our client's vision for successful integration of disparate complex programs. This paper and several others written by Optimetra position this client as a competitive thought leader in the public health marketplace.
Situation
A large Medicaid managed care organization required written assistance to influence a key state to move forward with mandatory Medicaid managed care through initial implementation of an enrollment broker.
Solution and Value Added
Optimetra wrote a very persuasive, research-supported white paper to influence the state to proceed with a Medicaid Managed Care Program. The state is still considering managed care, and the client is optimistic about the potential for this new market, which would enable them to expand their presence, increase their membership base, and ultimately increase revenue.
Situation
A large Medicaid managed care organization required assistance in responding to various inquiries from the State of Massachusetts about proposed program structure via RFI.
Solution and Value Added
Optimetra developed highly infuential responses that impacted the state’s decisions on critical issues of pharmacy and behavioral health carve-outs, which resulted in a competitive advantage for the client.
Situation
A large Medicaid-only managed care organization required assistance in developing a complete proposal for Medicaid mandatory managed care in a Michigan statewide recompete of contracts.
Solution and Value Added
Optimetra developed a compelling proposal package from scratch to support winning business in a statewide recompete of contracts, coupled with the simultaneous acquisition of a failing health plan. Ultimately, the client withdrew this bid, but much of the information and theme development for this proposal can be leveraged into future bids.
Situation
A large Medicaid managed care organization needed to develop a project management process.
Solution and Value Added
Optimetra developed the methodology, processes, and project management tools for the client. We also developed and delivered training on the methodology to over 220 employees. This included developing a trainer's guide, project scaling approach, and project management survey course & presentation. Optimetra transformed the client's project management approach into a structured, repeatable environment that increased project success rates and associate satisfaction with projects.
Situation
A large Medicaid managed care organization needed to develop a methodology for reviewing and evaluating quality of project plans.
Solution and Value Added
Optimetra developed the methodology for reviewing and evaluating the quality of project plans. We also conducted associated reviews and planning assistance for a set of 10 core projects and wrote a best-practices guide for use of Primavera TeamPlay. During this engagement, we showed the client how to effectively apply and realize the benefits of their pre-existing project management methodology, saving time and money and increasing overall project success.
Situation
A large Medicaid managed care organization needed proposal management and development of rebid proposal for a critical SCHIP market.
Solution and Value Added
Optimetra provided end-to-end proposal leadership, including RFP analysis, strategy development, resource planning & management, writing & editing, reviews, and production. We developed a winning technical proposal that resulted in our client being re-awarded this business. One state evaluator said this was the best technical proposal they had ever read, which positions this client strongly for future expansion in this state.
Situation
A large Medicaid managed care organization required assistance developing one provider manual for a new market and revising a large provider manual for an existing market.
Solution and Value Added
Solid provider manuals are critical to the success of any Medicaid managed care service. Optimetra has developed numerous provider manuals and was able to apply that experience to this effort. By supplying our client with more accurate, concise, and usable provider manuals, we enhance the service they are providing to the state, which improves the overall quality of the healthcare experience for underserved populations.
Medicaid Management Information Systems
Situation
A large MMIS vendor was developing an MMIS Proposal for State of Iowa. They needed someone to create all the workplans for implementation and upgrades of an MMIS system in a complex multi-vendor environment.
Solution and Value Added
Optimetra created a complete set of workplans, including several thousand lines for implementation and modification of a complex information system. This bid was ultimately withdrawn by the client, but the knowledge and project planning expertise that Optimetra provided can be leveraged into other efforts and so, has created residual value for the client.
Situation
A large MMIS vendor needed a generic MMIS implementation plan for reuse among multiple bids, using the company’s blueprinting methodology.
Solution and Value Added
Optimetra developed a generic work breakdown structure and schedule for implementation of a Medicaid Management Information System. The client is now able to save time and money by reusing this plan for future procurements.
Situation
A large MMIS vendor was developing an MMIS Proposal for State of Louisiana. They needed someone to create all the workplans and review the project management methodology for implementation and upgrades of the existing system, as well as implementation of a completely new client-server relational database MMIS.
Solution and Value Added
Optimetra created a complete set of workplans, including several thousand lines for implementation, modification, and creation of new information systems. We also reviewed and refined the project management methodology that was proposed. These workplans and project management methodology were considered by the client and the evaluators to be a significant factor in the contract being awarded to this client.
Situation
A large MMIS vendor needed help developing the project planning and management section, as well as limited ITS sections, of their bid for the State of Kansas MMIS procurement.
Solution and Value Added
Optimetra applied our extensive project management expertise to this engagement, developing the project planning and management section, as well as limited ITS sections, for the proposal. Our integrated project management approach for proposal response caused this client to think about their approach to project management in a more effective way, increasing their competitive advantage.
Center for Medicaid and Medicare Services (CMS)
Situation
The Information Services division of a large Government contractor required transition and project management input for their Center for Medicare and Medicaid Services Consolidated Information Technology Proposal.
Solution and Value Added
Optimetra used its healthcare and project management expertise to develop a transition plan and project management methodology for the client's CMS CITIC response. We helped the client win this very lucrative information systems integration contract by providing a comprehensive and coordinated plan for contract implementation.
TRICARE
Situation
A large, commercial managed care company needed proposal development and management assistance to compete for the TRICARE Regions 2 and 5 contract.
Solution and Value Added
Optimetra developed the ITS (Task 10), Transition (Task 11), and Medical Management (Task 3) sections of the client's TRICARE proposal response. We clarified and reengineered internal processes and developed new procedures and clarified thinking and strategies for process and system design. We provided business analysis and project planning services for the client's change order unit. We also facilitated accurate analysis and estimating for profitable recovery of millions of dollars in change order fees, and built collaborative working relationships between headquarters and regional offices.
General
Situation
A mid-sized HMO was drowning in significant backlog of commercial RFP and RFI responses for medium and large accounts.
Solution and Value Added
In less than 45 days, we rescued this struggling proposal response unit, built a new infrastructure, and won new and repeat business for the client.
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