Representative Engagements

Optimetra brings a unique blend of objectivity, discipline, and insight to every engagement. We arrive with a comprehensive understanding of the issues clients face in growing their public sector business. Our knowledge and experience with common challenges enables us to be immediately productive and provide expert advice. Below is a representative sample of recent engagements organized by client type.

Managed Physical and Behavioral Healthcare Organizations

Arizona
Client: Large Medicaid MCO competing for Arizona Healthcare Cost Containment Acute Care Services contract
Engagement: Developed the majority of the technical proposal
Outcome: Client won the contract

Georgia
Client: Large Medicaid MCO competing for Medicaid contract in a six-region area of the state
Engagement: Developed complete technical proposal
Outcome: Client won four of the six regions, including Atlanta

Indiana
Client: Large Medicaid MCO competing for a statewide, eight-region Medicaid managed care contract
Engagement: Led the technical proposal team, including proposal management and development
Outcome: Client won the contract and gained access to over 535,000 Medicaid members

Kansas
Client: Large Medicaid MCO competing for Kansas HealthWave XIX and HealthWave XXI Medicaid statewide contract
Engagement: Developed the majority of the technical proposal
Outcome: Client won the contract and expanded its Medicaid membership by 70,000

Mississippi
Client: Large Medicaid MCO competing for a CHIP contract
Engagement: Led the technical proposal team, including proposal management and development
Outcome: Client won the contract and expanded its membership by 65,000

Nevada
Client: Large Medicaid MCO required assistance analyzing and enhancing a recomplete proposal for a Medicaid TANF and CHIP contract
Engagement: Analyzed the existing technical proposal and provided a detailed improvement approach
Outcome: Client won the contract for two counties and expanded its Medicaid membership by 100,000

Pennsylvania
Client: Large Medicaid MCO competing for an adultBasic contract
Engagement: Provided proposal management and development support
Outcome: Client won the contract

Client: Large Medicaid MCO competing for HealthChoices Lehigh/SEPA contract
Engagement: Provided strategic support and proposal editing
Outcome: Client invited to final negotiations with the state

Tennessee
Client: Large Medicaid MCO competing for a Medicaid contract in the Tennessee Middle Region
Engagement: Led the technical proposal team, including proposal management and development
Outcome: Client won the contract and expanded its Medicaid membership by 170,000

Texas
Client: Large Medicaid MCO competing for retention and expansion in an eight-region service area
Engagement: Led the technical proposal team, including proposal management and development
Outcome: Client won the contract and expanded its Medicaid membership by 401,000

TRICARE
Client: National MCO competing for TRICARE Managed Care Support Services contract in multiple regions
Engagement: Provided proposal development and program design support
Outcome: Client awarded South Region contract valued at $21.8B

Arizona, New Jersey, Ohio, Texas, Wisconsin
Client: National Medicaid MCO needed to submit applications for Medicare Special Needs Plans in multiple states
Engagement: Led the application team, including management and development of five applications
Outcome: Applications were approved in all five states, enabling the client to better serve its dual-eligible members

National
Client: National Medicaid MCO wanted to transform and improve its Business Development Unit
Engagement: Conducted discovery activities and recommended a strategic approach and alternatives for the overall design of the business development organization. This included design of the organizational structure, design and documentation of processes, staff recruiting, and system recommendations to support departmental functions
Outcome: Client continues to refine the process which has reduced resource strain, increased discipline in Business Development, and has resulted in increased market success

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Administrative Services Organizations

Georgia
Client: QIO/ASO competing for Medicaid Utilization and Compliance Review ASO contract
Engagement: Led the technical proposal team, including proposal management and development
Outcome: Client was awarded the contract

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Quality Improvement Organizations

National/CMS
Client: Large QIO was competing for an End Stage Renal Disease (ESRD) Network Information Technology Support contract
Engagement: Provided proposal management and development support
Outcome: Client was awarded the contract to support IT needs of 18 ESRD networks nationwide

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Pharmacy Benefits Management Organizations

National
Client: Commercial PBM needed to assess its strengths and weaknesses with respect to the Medicaid market
Engagement: Provided proposal evaluation and operational gap analysis with respect to the Medicaid market
Outcome: Client was able to leverage strengths and address weaknesses and better position the organization for Medicaid opportunities

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Non-Profit Organizations

Pennsylvania
Client: A $65M non-profit Center for Independent Living needing leadership and development for a long-range business plan
Engagement: Delivered a plan that identified and addressed strategic business and market opportunities; information systems development issues; financial analysis, planning, and reporting capabilities gaps and requirements; and Human Service capabilities gaps and requirements
Outcome: The organization is far better positioned for changes coming in Healthcare. They continue to successfully execute against the plan, relying on Optimetra for change management services, as well as ongoing project management training.

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Medicaid Management Information Systems Organizations

Iowa
Client: Large MMIS vendor competing for a statewide MMIS contract
Engagement: Created the workplans for implementation and upgrades of the MMIS system in a complex, multi-vendor environment
Outcome: Bid withdrawn, but client gained residual value, as the plans can be leveraged for future opportunities

Kansas
Client: Large MMIS vendor competing for a statewide MMIS contract
Engagement: Developed the project planning and management section of the proposal, as well as limited ITS sections
Outcome: Client gained an integrated project management approach for proposal response, increasing their competitive advantage for future opportunities

Louisiana
Client: Large MMIS vendor competing for a statewide MMIS contract
Engagement: Created the workplans and reviewed 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
Outcome: Client was awarded the contract. The workplans and project management methodology were considered by the client and the evaluators to be a significant factor in the contract award

National
Client: Large MMIS vendor needed a generic MMIS implementation plan for reuse among multiple bids, using the company’s blueprinting methodology
Engagement: Developed a generic work breakdown structure and schedule for implementation of a Medicaid Management Information System
Outcome: Client is able to leverage the implementation plan for future opportunities

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