Exploring the Medicare Advantage opportunity for startups

Analyze priorities, budgets & barriers to adoption in Medicare Advantage Organizations (MAOs)

This cheat sheet (+ bonus video) covers practical issues such as

Utilization

How do you ensure high registration and usage rates among members?

ROI measurement

How do you quantify your clinical and financial ROI and contextualize it to total cost of care?

Recommended resources

Shortcut learnings on how to create an initial MAO target list, what conferences to attend, trend overview and more.

Sales cycles

Dive into the hurdles that may slow down purchasing cycles.

Business model

Gain insights into the sources from which MAOs draw budgets for new vendor relationships.

Messaging strategy

Evaluate differentiation in the context of MAOs’ relative priorities.

We've documented the right insider questions to be aware of before entering this market

A must-read

Gretchen Jacobson

VP of Medicare at The Commonwealth Fund

Misha is extremely knowledgeable about Medicare and healthcare strategy and product innovation.
 
He always has informative insights into the strategies of healthcare companies, how they are positioned in the market, and how they may change their strategies or products in response to policy changes.

Emily Nicoli

Chief Nursing Officer, UHC Retiree Solutions

I worked with Misha for 3 years, and enjoyed collaborating with him on a number of projects within the MA space.
 
Carriers and providers alike are looking at innovative ways to address SDOH needs for the senior population, and as the head of the product team he looked to create a strategy and benefits to support our members.

Roman Kalista

CEO/Founder at RxDiet

Misha’s knowledge of healthcare product innovation, strategy, and execution is unmatched. 

We were struggling with the right product design and positioning and Misha helped us better understand the payer procurement process and how to reposition our product to gain immediate traction.

The Medicare Advantage opportunity

The average Medicare beneficiary has over 43 Medicare Advantage plans available to them.

In this crowded landscape carriers are investing more in differentiation and partnering with outside vendors to achieve it.

Rise above the noise

Nonetheless, selling to Medicare Advantage Organizations (MAOs) presents unique challenges. Assessing the viability of your startup’s offering demands a deep understanding of health plan priorities and budgets.

 

Avoid common mistakes

To aid you through this process, we’ve collaborated with experts from the Medicare Advantage Organization (MAO) market and documented the right insider questions to be aware of before entering this market. 

Why we built this resource

Too often we’ve seen founders start entering into the MAO market without asking themselves the right questions on viability ahead of time.

These are the 50 questions to determine if a startup is a good fit for this channel & covers –

  • Determining relative priority of the value proposition  
  • Planning for potential barriers to adoption 
  • Identifying who pays with precision 

Learn from Medicare Advantage experts

About the Authors

Jonathan Friedman

Jonathan is a Partner at LionBird, leading new investments in companies in the healthcare delivery segment and serving on the boards of Heyday Health, Laguna Health, OneStep, Mellie and others. 

Prior to co-founding LionBird, he previously worked for the CEO of Azzorti, a multi-national consumer products company, managing new product launches, sales operations and other cross-functional projects. 

He is a member of The Kauffman Fellows Program (class 24), has been frequently featured in technology publications such as TechCrunch and VentureBeat, and also compiles the popular LionBird Bites newsletter, which is read by most of the VC industry in Israel.

Misha (Mike) Golosker

With over 20 years of experience in Medicare, employer group benefits, provider network strategies, product development, and management, as well as pharmacy benefit management, Misha’s expertise spans various facets of the healthcare landscape.

Previously, he served as Vice President of Product Strategy at UnitedHealth Group Inc., where he played a pivotal role in maintaining the #1 market share for one of UHG’s fastest-growing and most successful lines of business. Through his strategic planning and execution, Misha developed a robust product portfolio that not only drove growth and retention but also enhanced competitiveness and offered unique value to 1.8 million members, contributing to over $24 billion in annual revenue.

In that role, Misha was accountable for internal and external vendor relationships with over $100M in annual spend. He oversaw the development and implementation of 6 new product offerings and 5 product redesigns, delivering accuracy and sustainability of core offerings, and leveraged the power of their membership base to negotiate exclusivity with national vendors, bringing unique solutions to the market.

Now at Palette Consulting LLC, he specializes in helping clients understand the payer and carrier space, and member needs by product and segment, and creates tailored product strategies for each unique opportunity. He helps clients move from concept to contract, providing invaluable insights and expertise in the healthcare industry.

LionBird is a venture capital firm investing exclusively in pre-scale digital health companies.

Since its inception, the firm has invested in more than 35+ founding teams and now has over $150 million in AUM. Our focus is on helping founders lay the best foundations for their companies to scale and succeed.

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