SFHSS announces RFP for Medicare HMO/PPO plans for plan year 2025

San Francisco Health Service System staff announced Sept. 14 that they will issue a formal request for proposals for the SFHSS Medicare HMO and PPO plans for plan year 2025.

Contracts administration manager Michael Visconti said the RFP will evaluate network stability, preserve a passive PPO offering, consider multiple regional HMO options, and seek multi-year rate guarantees where feasible. Visconti said the RFP process will begin in November and run through May'June, noting the timeline depends in part on final CMS rules for Medicare-plan financials.

Visconti provided a brief history of current Medicare offerings: a UnitedHealthcare MAPD plan has been available since 2016 with about 17,000 covered lives, and the Kaiser Permanente Senior Advantage HMO serves roughly 14,000 members. He said SFHSS expects strong interest from major carriers "including UnitedHealthcare, Humana, various Blue Cross and Blue Shield plans, Kaiser Permanente, and Cigna." He also said the procurement will include a communications blackout for bidders once the evaluation begins, in accordance with board policy.

Board members asked about differences between the earlier RFI and the forthcoming RFP; Visconti said the RFI was exploratory while the RFP is a formal process that will lead to contracts and require board approval of recommendations in May or June next year. He also said SFHSS will leverage internal analytics to provide prospective respondents relevant member data and that the agency will evaluate how carriers incorporate Inflation Reduction Act provisions into Medicare plans.

What's next: SFHSS will present a proposed scope and calendar at the Nov. 9 board meeting; the board encouraged commissioners to bring policy questions to that meeting so they can be integrated into RFP materials.

Direct quotes in this article are taken from the meeting transcript and attributed to Michael Visconti.