ACA-SOLUTIONS

Superior Results

JANUARY 18, 2013

INTRODUCTORY DECK

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CONTENT OVERVIEW

• Company Overview• Consulting Services• Exchange Implementation Navigator©

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ACA-SOLUTIONS:AT A GLANCE

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VISION AND MISSION

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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DELANA ANDERSON, PRESIDENT

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1988 1995 2004 20121981 Future

Centennial Life Insurance Company1992-1994 AVP, Quality Assurance1988-1992 AVP, Claims

HealthPlan Services2010-2012 VP, Healthcare Reform Program2006-2010 VP, Business Information Group & Voice of the Customer2004-2006 VP, Account Management

American Administrators2002-2004 President1999-2002 EVP, Sales1995-1999 EVP, Administration

ACA-Solutions, Inc.2012 President

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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ENGAGEMENT TEAMS

• 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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ACA-SOLUTIONS:CONSULTING SERVICES

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FOCUS: AFFORDABLE CARE ACT

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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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Organizations impacted:• Carriers• Third party administrators (TPAs)• Technology vendors

Key objectives and needs: • Achieve compliance with new

regulations• Capitalize on new opportunities• Evolve business model to adapt to

market changes• Streamline administrative processes

and procedures• Plan and implement changes• Select cost-effective solutions

PRIMARY CLIENT NEEDS

WE BRIDGE THE GAP CREATED BY

THE AFFORDABLE

CARE ACT

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CONSULTING SERVICES

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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ENGAGEMENT GUIDING PRINCIPLES

Driving Efficiency

Balancing Quality and CostACA-Solutions leverages an extensive library of templates to efficiently reduce costs while maintaining quality and consistency.

IncreasingRevenue

Employing Best PracticesACA-Solutions is passionate about promoting industry best practices while maintaining the flexibility needed to seamlessly integrate with your organization’s unique culture and needs.

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CASE STUDY

Current Client: Not-for-Profit Health PlanNeeds 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 & coordinationAnticipated Results

Exchange-compliant administrative platform Efficient, effective operations Completed

Pending In Progress

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EXCHANGE IMPLEMENTATION NAVIGATOR©

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ACA-SOLUTIONS PRODUCTS

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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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EXCHANGE-SPECIFIC CHALLENGES

• 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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NAVIGATING EXCHANGE READINESS

Verify compliance

Coordinate with other service providers

Develop and market new products

Update Web portals

Update customer service, sales, enrollment, billing and claims systems and business processes

Send and receive data from the Exchange

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• 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

THE NAVIGATOR©: OVERVIEW

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• 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

THE NAVIGATOR©: KEY BENEFITS

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THANK YOU