Healthcare Providers

Health Marketplace (Exchange)

The Affordable Care Act (ACA) is set to transform the healthcare industry. Beginning January 1, 2014 each state will have available to consumers a new Health Benefits Marketplace (formerly called an Exchange). The ACA requires the establishment of the Marketplaces to provide individuals and small employers a convenient and easy way to compare, purchase and enroll into health insurance. Additionally, the Marketplace will be the only place for individuals to find out if they qualify for a premium tax credit and cost sharing reductions.

The Health Benefits Marketplaces present new challenges and opportunities for state governments, health plans and providers. Navigant’s healthcare professionals help our clients reach their ACA goals successfully. We have proven solutions to improve compliance programs and operational efficiency.

Each Marketplace model comes with a different set of implementation and operational challenges. Navigant has extensive experience working with state governments on operational and compliance issues related to Medicaid that can be applied to the Marketplace environment.

Our comprehensive State Government platform includes: 

  • Focused design, deployment and maintenance of data analytics, performance metrics and population health statistics (including All Payer Claims Database capabilities)
  • Ongoing program monitoring, troubleshooting and operational improvement
  • Streamlining the integration between the Health Benefits Marketplace and the Medicaid agency work processes
  • Continuing compliance monitoring, financial management and accounting to support ACA compliance
  • Concerned with ACA Compliance

  • Medicaid Health Plans and Marketplace QHPs

  • Provider Sponsored Plans Establish Marketplace Presence


The Health Benefits Marketplace will act as a catalyst bringing about a significant shift in market dynamics for providers and health plans, especially for those organizations that serve as the safety net for their communities.  With the possibility of millions of people enrolling for health coverage in the Marketplace, we are working with hospitals, large physician practices and health plans to develop a “Roadmap” to optimize performance.

The Navigant Roadmap is the solution for Providers and Health Plans and it includes:

  • Developing a Market-at-a-Glance which includes: market profile, assesses Marketplace impact, internal corporate assessment and competitive analysis
  • Creating a gap analysis to highlight key functional areas for improvement
  • Evaluating strategic options and prepare scenarios of network, reimbursement and operational assumptions to provide the business model for the best strategy
  • Implementing the operating model including developing the business requirements, staffing, reporting and monitoring

Click here to learn more about the Health Benefits Marketplace.

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