Case Study 11.10.2020

Expanding Community-Based Health Care

Trexin helped an esteemed federally-qualified health clinic develop the business case and strategy for expanding from Medicaid to Medicare.

Business Driver

A prominent community-based healthcare system with 35 federally-qualified health centers (FQHCs) was widely recognized to be an exemplary provider for Medicaid recipients, offering underserved communities preventive care, chronic disease management, and support. Recognizing a comprehensive community-based medical home model would include senior-centric points of care, the Board directed the company to consider a large expansion to more fully serve Medicare recipients, which would attract new senior patients and retain existing patients transitioning from Medicaid to Medicare. In response to the Board’s request and impressed by Trexin’s FQHC experience and proposal clarity regarding strategy project deliverables, the COO asked Trexin to help her team develop the business case and a 2-year strategic roadmap to implement a new Medicare line of business.

Approach

Our approach to this engagement followed Trexin’s Strategy, Assessment, and Roadmap (STAR) methodology. Consisting of 3 phases applied over a 9-week timebox involving our Client’s entire executive team and their operational leadership, the project involved more than 35 people and was conducted entirely remotely due to COVID-19 constraints. In Phase 1, Trexin helped the team clarify their business goal and strategy to expand into Medicare, focusing on organic growth vs M&A. Trexin then led the team through a series of workshops and breakout groups to translate their strategy into specific tactics with KPIs, focusing on aspects foundational to operating a Medicare line of business.

In Phase 2, Trexin guided the team to translate their tactics into future-state capability needs and product/service offerings that would embody the Medicare line of business. This future-state vision was then gapped against a current-state capability inventory, resulting in a set of well-defined capability enhancement requirements, including people, process, and technology components. In phase 3, Trexin then organized the capability enhancement needs into executable projects, which were prioritized and sequenced into an implementation roadmap. Finally, Trexin estimated the investment amounts required to conduct those projects, incorporating everything into a formal business case with projected benefits.

Results

Trexin was able to drive a fully aligned executive- and operational-level consensus on how to define and execute a Medicare expansion strategy, which focused on foundational aspects including contracting, compliance, reimbursement opportunities, marketing, and brokerage strategies. Consisting of 19 tactics and 275 capability enhancement components organized into 11 projects, the 2-year implementation roadmap and accompanying business case was presented to the Board and immediately approved.

Tagged in: Growth & Acceleration, Healthcare & Life Sciences, Strategy & Innovation
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