The client wanted to develop an Affordable Care Act (ACA) compliant health insurance plan within 12 months to expand their organization, diversify their offerings in the marketplace and grow membership. In order to offer their product on the ACA Marketplace Exchange, they needed to achieve URAC accreditation and QHP certification.
ProspHire drove an end-to-end current state assessment to analyze organizational impacts, identify compliance gaps and mitigate risk. The process included identifying regulatory, legislative, ACA QHP and Centers for Medicare & Medicaid (CMS) requirements and developing processes to achieve compliance. The team also provided utilization management, change management and quality management support, analyzed the organization’s current state readiness, interviewed business functional leadership and provided strategic recommendations to close gaps and achieve accreditation and certification.
As a result, ProspHire enabled the client to successfully launch an ACA compliant health insurance plan in the bronze and silver categories within 12 months. Additionally, ProspHire delivered an organizational roadmap with step-by-step processes to stand up the plan, support change management, mitigate operational and technical gaps, manage risk and go to market. ProspHire also helped the client establish a clear path to maintaining URAC accreditation and QHP certification ongoing.
The client is a leading nonprofit, Catholic healthcare organization dedicated to innovation across the continuum of care.