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ACA-SOLUTIONS
Superior Results
JANUARY 18, 2013
INTRODUCTORY DECK
04/09/2023 Bridging the Healthcare Reform Gap 2
CONTENT OVERVIEW
• Company Overview• Consulting Services• Exchange Implementation Navigator©
Bridging the Healthcare Reform Gap 3
ACA-SOLUTIONS:AT A GLANCE
04/09/2023
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VISION AND MISSION
Vision• To be a driving force for reducing administrative costs in
the health insurance industry.Mission• To provide the highest-quality, ROI-driven products and
services to our clients.
Top Priorities for 2013• Focus on Health Insurance Exchanges: bridging the
technology and business process gap • Continue to build reputation as trusted advisor
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DELANA ANDERSON, PRESIDENT
04/09/2023
1988 1995 2004 20121981 Future
Centennial Life Insurance Company1992-1994 AVP, Quality Assurance1988-1992 AVP, Claims
HealthPlan Services2010-2012 VP, Healthcare Reform Program2006-2010 VP, Business Information Group & Voice of the Customer2004-2006 VP, Account Management
American Administrators2002-2004 President1999-2002 EVP, Sales1995-1999 EVP, Administration
ACA-Solutions, Inc.2012 President
DeLana Anderson has 30+ years of extensive health insurance knowledge and is experienced in helping Carriers implement process improvements and integrate technology solutions.
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ENGAGEMENT TEAMS
• ACA-Solutions employs top-quality experts, hand-picked and carefully aligned with engagements that would benefit the most from their expertise
• All associates have a minimum of 10 years experience
Example: Rona Wiener – Sr Technology Associate• 15+ years of successfully planning, leading
and executing large-scale initiatives• Specializes in business process improvement• Has a strong passion for advocating best practices • Expertise is most frequency utilized in the areas of enterprise analysis
and planning, process engineering, requirements management, product design, and project recovery.
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ACA-SOLUTIONS:CONSULTING SERVICES
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FOCUS: AFFORDABLE CARE ACT
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Carrier Challenge: Balancing non-reform product development and system enhancements with the barrage of tasks associated with the implementation of Affordable Care Act (ACA) provisions.
Our Solution: Leverage health insurance industry knowledge, broad operations experience, and Healthcare Reform subject matter expertise to enable Carriers to be compliant with the law and positioned for growth.
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Organizations impacted:• Carriers• Third party administrators (TPAs)• Technology vendors
Key objectives and needs: • Achieve compliance with new
regulations• Capitalize on new opportunities• Evolve business model to adapt to
market changes• Streamline administrative processes
and procedures• Plan and implement changes• Select cost-effective solutions
PRIMARY CLIENT NEEDS
WE BRIDGE THE GAP CREATED BY
THE AFFORDABLE
CARE ACT
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CONSULTING SERVICES
Most common engagement types:• Analysis and Subject Matter Expert Opinion• Exchange Readiness Assessments
Conduct compliance reviews and gap analysis Analyze current state and plans for change Identify gaps and risks Identify opportunities for improvement Assist with implementing recommendations
• Exchange Implementation Planning• Business Process Engineering
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ENGAGEMENT GUIDING PRINCIPLES
Driving Efficiency
Balancing Quality and CostACA-Solutions leverages an extensive library of templates to efficiently reduce costs while maintaining quality and consistency.
IncreasingRevenue
Employing Best PracticesACA-Solutions is passionate about promoting industry best practices while maintaining the flexibility needed to seamlessly integrate with your organization’s unique culture and needs.
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CASE STUDY
Current Client: Not-for-Profit Health PlanNeeds Exchange subject matter expert with health insurance
operational background Analysis of Exchange legislation and guidance Identification and tracking of key impacts and recommended
actions to ensure compliant operations Centralized and portable Exchange business requirements for
development of a new, configurable, Exchange-ready administrative platform
Solution Needs assessment and strategic planning recommendations Exchange Implementation Navigator©
Implementation plan creation & coordinationAnticipated Results
Exchange-compliant administrative platform Efficient, effective operations Completed
Pending In Progress
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EXCHANGE IMPLEMENTATION NAVIGATOR©
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ACA-SOLUTIONS PRODUCTS
04/09/2023
ACA-Solutions develops robust, comprehensive tools based on common client objectives. All products are configurable, easy to use, and adhere to industry best practices.
Subject Matter Expertise:ACA-Solutions tools reflect the intellectual capital acquired from over 25 years of health insurance operations experience and nearly a decade of IT project work.
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EXCHANGE-SPECIFIC CHALLENGES
• The first open enrollment period is less than a year away• Capitalizing on opportunities in this new channel
requires a strategic and tactical transformation• Exchange-related projects and initiatives are complex
and require cross-functional planning and coordination• Broad range of system and process updates
Creating new product designs Integrating with the Exchange framework Complying with CSR and APTC requirements
• With many regulations yet to be finalized, effective risk and change management are also critical success factors
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NAVIGATING EXCHANGE READINESS
Verify compliance
Coordinate with other service providers
Develop and market new products
Update Web portals
Update customer service, sales, enrollment, billing and claims systems and business processes
Send and receive data from the Exchange
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• A comprehensive and customizable tool for planning and managing your Exchange implementation.
• A guide to the transformation required to offer QHPs and comply with Exchange regulations, including: A structured repository of all Exchange regulations, consistently
analyzed, categorized and cross-referenced An integrated cross-functional plan with full traceability to
regulations Enhanced search capabilities, executive reporting, custom
values, and more• The Navigator© provides a “ready to use” solution for
assessing Exchange readiness and addressing gaps
THE NAVIGATOR©: OVERVIEW
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• Single custom Excel template captures all business requirements, implementation plan, and open items
• Enables linking and enhanced search capabilities• Designed for cross-initiative planning• Provides built-in traceability• Promotes consistency and re-use
Pre-defined structure and methodology Drop-down values to maintain data integrity Copy and paste
• Supports executive reporting• Minimizes version conflicts
THE NAVIGATOR©: KEY BENEFITS
Bridging the Healthcare Reform Gap 1904/09/2023
THANK YOU