As the dust settles on this year’s Medicare Advantage (MA) bid submissions, the real work is just beginning. With bids filed and assumptions made, it’s time to clarify the trends, justify the numbers, and prepare to translate projections into actions. From defending cost assumptions and risk adjustment strategies to bolstering quality ratings and mapping out competitive moves, there’s no shortage of tasks to keep teams occupied over the summer.

At HLTHWorks, we understand that bid submissions aren’t just about securing approval—they’re about building a robust plan that will drive MA success into 2025 and beyond. Here’s a quick look at what’s next in this post-bid phase and how HLTHWorks is here to support your team as you bring your MA product vision to life.

1. Explaining Trends and Assumptions to CMS

CMS scrutiny is thorough, and explaining bid assumptions is a nuanced process. The projections on cost trends, utilization, and member demographics set the tone for your entire plan. Defending these assumptions with clear data and a sound rationale is key to gaining CMS approval and maintaining regulatory compliance. HLTHWorks offers the expertise to articulate these assumptions in a way that balances optimism with realism, ensuring your bid is both credible and achievable.

2. Risk Adjustment: Aligning Predictions with Reality

Risk adjustment has always been a cornerstone of MA bid planning, especially with CMS’s evolving focus on accurate coding and data transparency. Whether it’s aligning diagnoses with predicted health outcomes or adjusting for emerging population trends, the real challenge lies in ensuring your coding assumptions translate into actual member health data. HLTHWorks provides an in-depth understanding of these nuances, helping your team prepare to monitor, adjust, and optimize risk scores throughout the year.

3. Quality Rating Management: Preparing for Success

With the CMS Stars program impacting both payments and member satisfaction, MA organizations need to have a solid plan in place for boosting or maintaining their quality ratings. Managing these metrics requires investment in member engagement, care management, and preventive services, all of which hinge on the assumptions made during bid submissions. HLTHWorks is equipped to support quality program planning and execution to help your team hit key quality targets.

4. Retention Strategies and Competitor Moves

The competitive landscape is always shifting, and post-bid season is the time to fine-tune member retention strategies while keeping a close eye on competitors’ plans. Whether it’s new benefit structures, provider partnerships, or enhanced digital experiences, understanding competitors’ moves is essential for staying competitive. HLTHWorks’ comprehensive market insights help you evaluate the competitive landscape, anticipate shifts, and refine strategies to retain and grow your member base.

5. From Planning to Execution: Transforming Assumptions into Action

A winning bid is only as good as its execution. As you translate bid assumptions into real-world operations, HLTHWorks stands ready to assist. Whether it’s implementing population health strategies, supporting clinical workflows, or aligning data systems for real-time monitoring, we’re here to help you deliver on your product vision for 2025.

Good Luck – and Let’s Make It Happen

It’s a busy season, but with careful planning, coordination, and a little help from HLTHWorks, your Medicare Advantage plan can stand out in the year to come. As you move forward, we’re here to support you every step of the way—from assessment and strategic planning to execution and evaluation. Here’s to a productive and successful summer as we lay the groundwork for an impactful 2025!