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.

1. ACA-SOLUTIONS
Superior Results

2. • Company Overview
• Consulting Services
• Exchange Implementation Navigator©
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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
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5. HealthPlan Services
2010-2012 VP, Healthcare Reform Program
Centennial Life Insurance Company 2006-2010 VP, Business Information Group &
1992-1994 AVP, Quality Assurance Voice of the Customer
1988-1992 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.
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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 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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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.
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9. Organizations impacted:
• Carriers WE BRIDGE THE
• Third party administrators (TPAs)
• Technology vendors GAP CREATED BY
Key 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 solutions
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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
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11. Employing Best Practices
ACA-Solutions is passionate about
promoting industry best practices while
maintaining the flexibility needed to
seamlessly integrate with your
organization’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.
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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
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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.
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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
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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 portals
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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
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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
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