Marketplace Solutions for Premium Protection, Defensible Risk, Better Retention
Partnering with ACA Issuers to close premium variances, improve clinical documentation accuracy, prevent payment leakage, and keep members in a competitive market
Pareto helps ACA Marketplace (Healthcare Exchange) plans improve risk adjustment accuracy, payment integrity, and member retention. Our suite of solutions—Pareto RevenueIQ, PaymentIntegrityIQ, and RewardsIQ—combine predictive analytics with turnkey execution to reduce variance, protect revenue, and drive measurable outcomes across the Healthcare Exchange line of business.
We Understand The Challenges Facing ACA Marketplace Issuers
Exchange plans run on thin margins and dynamic enrollment. These are the issues leaders we talk to regularly raise most—and they’re exactly the challenges Pareto solves.
Risk adjustment for defensible risk scores and aligned revenue
Proactive member engagement to close care gaps and improve retention
Payment integrity and leakage prevention across high-volume transactions
Member retention and experience in a price-sensitive, highly competitive market
Operational efficiency and audit readiness amid evolving oversight
How Pareto Supports Healthcare Exchange Plans
Here’s how Exchange issuers hit their numbers—with less rework and more repeatable wins.
Make risk scores defensible.
Spot documentation and alignment gaps that depress risk revenue, prioritize what to correct, and generate evidence you can stand behind during oversight. Submission quality improves; rework drops.
Stop dollars from leaking.
Detect duplicates, coding outliers, and benefit-design edge cases across both pre- and post-pay. Resolve issues inside existing workflows to protect accuracy without provider abrasion.
Retain members where it matters.
Target onboarding, renewal, and preventive care moments with incentives tied to plan goals—improving the member experience and reducing churn. Predictive targeting focuses effort on those most likely to respond.
Learn How We Can Help Your Plan Succeed
Why Pareto
ACA Marketplace teams live in month-end cycles, enrollment volatility, and unforgiving reconciliation math. Pareto is built for that reality: delivering exception-driven workflows, evidence you can ship, and integrations that plug directly into enrollment, billing, and claims. The payoff is simple: fewer write-offs, defensible risk revenue, and retention lift issuers can actually measure.
Integration with enrollment, billing, and claims systems to accelerate fixes without ripping and replacing
Predictive targeting + turnkey execution to reduce leakage and lift retention you can actually measure
Discover the Pareto Difference
Related Resources
2018 ACA Risk Adjustment Transfer Payment Results: “Premium Stabilization Program” Beginning to Stabilize
On June 28th, 2019, the Centers for Medicare and Medicaid Services (“CMS”) released the Affordable Care Act (“ACA”) Risk Adjustment Transfer Payment results for the 2018 benefit year. Within days
FAQs
How does Pareto improve encounter data accuracy and acceptance rates?
We reconcile end-to-end data quality across medical and pharmacy claims, enrollment, and supplement encounters; flag gaps.
What does audit readiness look like for state/CMS oversight?
Lorem ipsum dolor sit amet consectetur adipiscing elit. Consectetur adipiscing elit quisque faucibus ex sapien vitae. Ex sapien vitae pellentesque sem placerat in id. Placerat in id cursus mi pretium tellus duis. Pretium tellus duis convallis tempus leo eu aenean.
About Pareto
Pareto Intelligence is a healthcare analytics and technology company that helps health plans improve quality, compliance, and financial performance. For ACA Marketplace (Healthcare Exchange) plans, Pareto focuses on premium reconciliation accuracy, risk score integrity, payment integrity, and member retention—powered by the Pareto Platform for predictive insights and transparent reporting.
Ready to Take the First Step?
Fill out the form to take the first step toward reaching your goals. Share a few details so we can provide the right resources and support tailored just for you.