The Challenge- An Ambitious Vision to Launch an ACA Consumer Oriented Health Plan

A healthcare consulting firm sought to participate in a new ACA program designed to launch Consumer Operated and Oriented Plans (CO-OP). Their vision was ambitious: secure federal funding, establish a legal entity, and launch a compliant health plan under evolving ACA regulations. However, the project faced significant complexity—compressed timelines, regulatory uncertainty, and multiple gating requirements, including commitments prior to funding. 

Our Role and Approach

Engaged as a strategic execution partner, Gentry Consulting developed a comprehensive scope and roadmap to translate vision into actionable steps. We managed critical milestones, including securing a health system sponsor, navigating CMS/HHS requirements, and aligning operational readiness with compliance mandates. When the grant program shifted to a loan structure, we adapted timelines and strategies to maintain momentum despite delays. 

Solution Delivered 

• Secured a two-part ACA CO-OP loan (capital and startup funding) after multiple rounds of federal review.

• Obtained HMO licensure from the state Department of Insurance despite regulatory conflicts.

• Successfully navigated the inaugural ACA qualified plan certification process, ensuring benefit design and premium structures met exchange requirements.

• Stood up the health plan and all operations by the first enrollment period deadline, despite compressed timelines.

Results & Impact 

Gentry Consulting transformed a complex, high-risk vision into a fully operational health plan—achieving compliance, licensure, and exchange certification under unprecedented regulatory and timeline challenges.