Launching an ACA Product with a Historically Medicaid-Focused Payer

Fast-Tracking ACA Entry to Sustain Membership and Growth

Challenge

Looking to offset forecasted downturns from Medicaid redeterminations, the client was looking to establish an ACA Marketplace product in their existing footprint as well as expand into new states. Timing was critical as the new plan had to be available for the 2024 Plan Year in order to capture beneficiaries losing their Medicaid coverage. Organizational knowledge was also a concern as the client had little to none experience in this new domain.

Solution

ProspHire performed a rapid assessment to identify the critical gaps that needed closed as well as key milestones to launch an ACA Product. ProspHire also made recommendations on which operational functions should be outsourced to mitigate risk while still reaching financial goals. The team then provided ground level support to organize each business unit around a roadmap to achieve QHP Certification, Pennsylvania Insurance Department approval and Operation Readiness to launch the product.

Result

As a result, the client received the necessary approvals to enter the Marketplace for Plan Year 2024. Due to an exhaustive competitive analysis, product design and rate formulation, the client’s product was well positioned for their targeted consumers. The client exceeded their enrollment goals by over 300%, enrolling over 10k members in their first year. This allowed them secure valuable MarketShare, build name recognition in a new line of business and set the groundwork for future expansions.

Client Overview

The client is a regional Managed Health Care Organization (MCO) that offers Medicaid, Medicare and CHIP coverage to members in the state of Pennsylvania and New Jersey.