The Challenge- Health System’s Medicare Advantage Plan Launch Jeopardized Due to Network Adequacy

A nationally recognized healthcare system decided to reenter the managed care space by launching a Medicare Advantage plan. While the strategic decision was made internally, the organization underestimated the complexity of compliance requirements—particularly CMS network adequacy standards. Despite having a dominant provider network, they lacked mandatory specialties and coverage per time and distance criteria. Initially resistant to contracting with rival systems and assuming CMS would allow exceptions, the organization faced significant risk of failing to meet regulatory requirements. 

Our Role and Approach

Gentry Consulting provided project management and managed care expertise to guide the health system through compliance challenges. Drawing on experience from similar health plan stand-ups, we educated leadership on regulatory realities and developed actionable strategies to address gaps. Our approach included:

• Analyzing service area geography and provider distribution.

• Advising specialty rotations and equipment placement to meet adequacy standards.

• Identifying recruitment targets for critical specialties.

• Recommending new clinic locations to close compliance gaps.

Solution Delivered 

• Achieved full CMS network adequacy across the targeted service area.

• Positioned the health system to launch its Medicare Advantage plan by the open enrollment deadline.

• Turned compliance from a barrier into a strategic enabler for market entry.

Results & Impact 

By anticipating compliance obstacles and implementing proactive solutions, Gentry Consulting ensured the health system’s readiness for managed care participation—laying a foundation for long-term success.