Tuesday, August 20th, 2019 

PPACA Implementation Integrated Approach

Financial Reporting “How will the Patient Protection and Affordable Care Act affect your business?”
  • Analysis of product development, marketing, exchange readiness and pricing
  • Readiness assessment for transition from underwriting to actuarial modeling to process control
  • Analysis of market segmentation strategy
  • Benefit design strategy and
    offerings

  • Medical loss ratio analysis
  • Cost reduction analysis
  • Claims management effectiveness
  • Medical intervention preparedness
  • Alignment of business strategy and operating model to the impact of heath care reform
  • Transference from sick care to health care
  • Coverage for services delivered in low cost setting (quality)

  • IT infrastructure ICD-10 and HIPAA-5010 conversions
  • IT development spending analysis
  • IT data capability review related to new reporting requirements
  • HIPAA and other Privacy and IT Security
  • Conversion from fragmented systems to integrated systems

  • Compliance assessment for new regulatory requirements
  • Organizational risk management and risk convergence
  • Regulatory reporting system and operational process assessment
  • Emphasis on accountability of delivered health care and not avoidance of services
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