SFHSS recommends waiting 3–5 years before a Medicare Advantage RFP after RFI review

SFHSS staff and consultants from Aon presented the results of a market review and request-for-information process on Dec. 9, concluding that the current incumbent Medicare Advantage vendors offer high-quality options for SFHSS members and that a formal market RFP should be reconsidered in three to five years.

Anne Thompson of Aon summarized carrier responses and staff review, noting that Kaiser and UnitedHealthcare (UHC) were the only respondents with a CMS five-star rating for 2022 and that national carriers are expanding predictive modeling and value-added services. Michael Visconti, SFHSS contracts manager, described the RFI timeline and panel composition and said the RFI allowed broader fact-finding than a restrictive RFP.

Aon’s financial perspective (Mike Clark) reported that incumbent plans offered competitive insured-premium positions and that UHC had issued a >$1 million premium refund to SFHSS in 2020 because of COVID-19–related suppressed claims.

Board members broadly endorsed the method and the recommendation. Commissioner Scott and others argued that many new market entrants remain early-stage and need time to mature to comparable quality and service levels. Supervisor Connie Chan asked for clarity that staff will continue annual monitoring and targeted RFIs as necessary; consultants and staff affirmed ongoing due diligence and incorporation of RFI learnings into the 2023 renewal process.

What this means: SFHSS will not run a full Medicare Advantage RFP in the immediate plan cycle but will monitor market developments and incorporate ideas from the RFI into upcoming renewals and contract negotiations. Staff said they will consider an RFP sooner only if the market shows rapid, verifiable improvements in quality and coverage.