ACA-SOLUTIONS Superior Results
• Company Overview• Consulting Services• Exchange Implementation Navigator©   1/22/2013    Bridging the Healthcare Reform ...
1/22/2013   Bridging the Healthcare Reform Gap   3
Vision• To be a driving force for reducing administrative costs  in the health insurance industry.Mission• To provide the ...
HealthPlan Services                                                        2010-2012 VP, Healthcare Reform ProgramCentenni...
• ACA-Solutions employs top-quality experts, hand-picked and  carefully aligned with engagements that would benefit the mo...
1/22/2013   Bridging the Healthcare Reform Gap   7
Carrier Challenge:                           Balancing non-reform product                           development and system...
Organizations impacted:• Carriers                                           WE BRIDGE THE• Third party administrators (TPA...
Most common engagement types:• Analysis and Subject Matter Expert Opinion• Exchange Readiness Assessments     Conduct com...
Employing Best PracticesACA-Solutions is passionate aboutpromoting industry best practices whilemaintaining the flexibilit...
Current Client: Not-for-Profit Health Plan  Needs          Exchange subject matter expert with health insurance          ...
1/22/2013   Bridging the Healthcare Reform Gap   13
ACA-Solutions develops     robust, comprehensive tools     based on common client     objectives. All products are     con...
• The first open enrollment period is less than a year away• Capitalizing on opportunities in this new channel requires  a...
Develop and market                 Send and receive data                       new products                      from the ...
• A comprehensive and customizable tool for planning  and managing your Exchange implementation.• A guide to the transform...
• Single custom Excel template captures all business  requirements, implementation plan, and open items• Enables linking a...
1/22/2013   Bridging the Healthcare Reform Gap   19
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An introduction to ACA-Solutions

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ACA-Solutions provides ROI-driven solutions, enabling the health insurance industry to bridge the gap created by the Affordable Care Act (ACA) and meet the mandated MLRs.

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An introduction to ACA-Solutions

  1. 1. ACA-SOLUTIONS Superior Results
  2. 2. • Company Overview• Consulting Services• Exchange Implementation Navigator© 1/22/2013 Bridging the Healthcare Reform Gap 2
  3. 3. 1/22/2013 Bridging the Healthcare Reform Gap 3
  4. 4. 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 1/22/2013 Bridging the Healthcare Reform Gap 4
  5. 5. HealthPlan Services 2010-2012 VP, Healthcare Reform ProgramCentennial Life Insurance Company 2006-2010 VP, Business Information Group &1992-1994 AVP, Quality Assurance Voice of the Customer1988-1992 AVP, Claims 2004-2006 VP, Account Management 1981 1988 1995 2004 2012 Future American Administrators ACA-Solutions, Inc. 2002-2004 President 2012 President 1999-2002 EVP, Sales 1995-1999 EVP, Administration DeLana Anderson has 30+ years of extensive health insurance knowledge and is experienced in helping Carriers implement process improvements and integrate technology solutions.1/22/2013 Bridging the Healthcare Reform Gap 5
  6. 6. • 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 experienceExample: 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. 1/22/2013 Bridging the Healthcare Reform Gap 6
  7. 7. 1/22/2013 Bridging the Healthcare Reform Gap 7
  8. 8. 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.1/22/2013 Bridging the Healthcare Reform Gap 8
  9. 9. Organizations impacted:• Carriers WE BRIDGE THE• Third party administrators (TPAs)• Technology vendors GAP CREATED BYKey objectives and needs: THE• Achieve compliance with new AFFORDABLE regulations• Capitalize on new opportunities CARE ACT• Evolve business model to adapt to market changes• Streamline administrative processes and procedures• Plan and implement changes• Select cost-effective solutions1/22/2013 Bridging the Healthcare Reform Gap 9
  10. 10. 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 1/22/2013 Bridging the Healthcare Reform Gap 10
  11. 11. Employing Best PracticesACA-Solutions is passionate aboutpromoting industry best practices whilemaintaining the flexibility needed toseamlessly integrate with yourorganization’s unique culture and needs. Balancing Quality and Cost ACA-Solutions leverages an extensive library of templates to efficiently reduce costs while maintaining quality and consistency. 1/22/2013 Bridging the Healthcare Reform Gap 11
  12. 12. Current Client: Not-for-Profit Health Plan Needs  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 & coordination Anticipated  Exchange-compliant administrative platform  Completed Results  Efficient, effective operations  In Progress  Pending 1/22/2013 Bridging the Healthcare Reform Gap 12
  13. 13. 1/22/2013 Bridging the Healthcare Reform Gap 13
  14. 14. 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.1/22/2013 Bridging the Healthcare Reform Gap 14
  15. 15. • 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 1/22/2013 Bridging the Healthcare Reform Gap 15
  16. 16. Develop and market Send and receive data new products from the Exchange Coordinate with other Update customer service, sales, enrollment, billing service providers and claims systems and business processes Verify compliance Update Web portals1/22/2013 Bridging the Healthcare Reform Gap 16
  17. 17. • 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 1/22/2013 Bridging the Healthcare Reform Gap 17
  18. 18. • 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 1/22/2013 Bridging the Healthcare Reform Gap 18
  19. 19. 1/22/2013 Bridging the Healthcare Reform Gap 19

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