Should Surest prioritize expanding its network of in-network providers to improve member access, or focus on negotiating deeper discounts with existing providers to reduce costs?

Introduction

The trade-off we're examining today is whether Surest should prioritize expanding its network of in-network providers to improve member access or focus on negotiating deeper discounts with existing providers to reduce costs. This decision is crucial for Surest's growth strategy and member satisfaction. I'll analyze this trade-off by considering the business context, user impact, technical feasibility, and resource allocation.

Step 1

Clarifying Questions (3 minutes)

• Business Context: I'm thinking Surest's current market position might influence this decision. Could you share our current market share and how it compares to our main competitors?

Why it matters: Helps determine if growth or cost-cutting should be prioritized Expected answer: Mid-tier market share with room for growth Impact on approach: Would lean towards network expansion if growth is needed

• User Impact: Based on member feedback, I'm assuming access to providers is a key pain point. What percentage of our members have reported difficulties finding in-network providers in the past year?

Why it matters: Quantifies the urgency of expanding the network Expected answer: 20-30% of members facing access issues Impact on approach: High percentage would strongly support network expansion

• Technical Feasibility: Considering our current provider management system, I'm curious about its scalability. How easily can our system onboard and manage a significant increase in providers?

Why it matters: Determines if rapid network expansion is technically viable Expected answer: System can handle moderate growth with some upgrades needed Impact on approach: Would influence the pace and scale of network expansion

• Resource Allocation: Given our current team structure, I'm wondering about our negotiation capabilities. Do we have dedicated resources for provider negotiations, or would this require new hires?

Why it matters: Assesses feasibility of pursuing deeper discounts Expected answer: Small existing team, would need to expand for extensive negotiations Impact on approach: Could favor network expansion if negotiation resources are limited

• Timeline Considerations: Thinking about our annual planning cycle, how urgent is this decision? Are we looking at implementing changes for the next enrollment period or further out?

Why it matters: Influences the scope and speed of potential solutions Expected answer: Changes needed within 6-12 months for next enrollment Impact on approach: Would prioritize quicker-to-implement option if timeline is tight