    
        Top 3 Areas of Impact    
            
                        Rapid Market Entry
                    Launched an ACA Marketplace product within the 2024 Plan Year across multiple states.
                        Enrollment Growth
                    Exceeded membership goals by over 300%, securing 10K+ new members in year one.
                        Strategic Expansion
                    Established a strong foundation for future growth beyond Medicaid into new markets.

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.

Deliverables

Accelerated Readiness and Gap Assessment
Operational Roadmap and Certification Support
Competitive Analysis, Product Design and Rate Formulation

What Drove the Engagement

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.

Solutions

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.

Impact

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.