Approach

Trexin’s approach to addressing this disruptive change centered on studying the regulatory requirements and using a “one set of facts” process approach to build upon our existing expertise of the healthcare payer business, systems, and data. Working closely with business leaders, subject matter experts, and IT, Trexin defined the detailed business requirements and then designed, developed, and tested a 3R prototype solution. The Trexin team built the prototype utilizing IBM’s health plan data model and ETL tools, combined with a deep understanding and analytical analysis of the regulatory requirements and payer data related to members, plans, medical claims, and pharmacy claims. The prototype implementation team fielded by Trexin included experts in healthcare, regulation & compliance, program management, and analytics (including data architecture, data modeling, and data integration).

Results

Because of Trexin’s specialized knowledge of the ACA 3R requirements and our proven track record of being able to deliver actionable healthcare expertise, the 3R prototype successfully demonstrated how our Client could not only comply with the new government regulations but also strengthen their business model in the individual and small group markets. In recognition of these results, our Client has subsequently asked Trexin to help design and build their 3R production solution.