Solutions & Strategic insights for health plans in the ACA marketplace
We provide solutions for health plans & the vendors who serve them
Evensun offers tools, services, and insights focused on the unique complexities of the Affordable Care Act individual and small group markets. Our expertise lies in risk adjustment, plan strategy, exchange operations, and finance.
Our services to health plans, vendors, and startups provide products and services in and around the ACA marketplaces serving multiple health plan clients, with as few as 2,000 members and as many as 1,000,000 members.
What We Offer
We have the expertise to support a robust and profitable health plan strategy. We are Affordable Care Act-focused. Our approach is not to become another vendor that your health plan can’t get rid of – rather, we want to help empower your teams to understand and take control of their ACA market product.
Products
EDGE Server Submissions
Control. Transparency. Simplicity.
Advance Premium Tax Credit Reconciliation
Capture missing premiums, improve cash flow, improve member experience, reduce your administrative costs.
Risk Adjustment Toolkit
SQL based tools to help ensure you are maximizing your return on your ACA Risk Adjustment processes.
Consulting Services
We’ll work with you on designing, marketing, and operationalizing a successful Marketplace plan.
We offer consulting services that are tailored to meet your specific requirements. The following are some examples of the types of engagements we provide.
Member Level Performance Analysis
We can help you create models that let you analyze the post-Risk Adjustment profitability of your membership, avoiding the risk of bad decisions caused by a myopic focus solely on risk score or claims spend.
Data Integrity Analysis
Before you spend millions on complex suspecting algorithms, make sure you are getting credit for the conditions already supported by the data you have from claims and encounters. We help you find gaps in your processes that may be costing you millions.
ACA Vendor Management
Now that the ACA has been in place more than a decade, vendor function creep has set in many organizations. Let us review your vendor strategies, contracts, and scope to ensure you have the right partners in place to support a successful product.
ACA Market Strategy
The ACA market is in a constant state of change, and a strategy that worked one year may not work in the next. We can review your past, present, and future and provide recommendations on strategies to help your product succeed in an increasingly competitive market.
