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Staff Photo by Matt Hamilton / From left, Andrew Hetzler, John Smith, Bobby Huffaker and Barrett Blank.

When they launched American Exchange in 2013, Bobby Huffaker and Andrew Hetzler had a hunch a lot of people could use their help finding the right health insurance in the Affordable Care Act (ACA) marketplace.

They were right.

"We had about 4,000 [clients] that first year," says Huffaker, the company's CEO. Today, Huffaker says, Chattanooga-based American Exchange "essentially doubles our revenue every year" and has "several tens of thousands of clients" nationwide.

"We've grown so much that we've been able to invest in very good talent," he says.

Earlier this year, American Exchange added Chief Revenue Officer Barrett Blank and Vice President of Sales John Smith. They joined the company as American Exchange has added services for health care providers that track revenue from patients from their initial appointment to their final payment, known as revenue cycle management. The service expands the work of American Exchange beyond its original scope of supporting people in finding the right individual health and Medicare coverage.

"Barrett has helped build sales teams with billion-dollar companies," Huffaker says. "John's been in revenue cycle management his whole career, and brings a lot of experience with major health systems.

"We're fortunate to have them," Huffaker says, "and I'm excited to see what they can do."

Blank says revenue cycle management is a "natural extension" of what American Exchange was already doing.

"We normally talk about the insurance process for people in the marketplace," he says. "Extending into revenue cycle management is thinking about the other side of that equation – the provider, the hospital, that public health-care system.

"Can we help keep those entities sustainable when they have to support individuals who may or may not have insurance," Blank says, "especially with COVID-19 causing unemployment, which affects insurance coverages?"

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Staff Photo by Matt Hamilton / Bobby Huffaker

Huffaker says American Exchange began its foray into revenue cycle management when he and Hetzler developed software that streamlines what can be a complex process.

"We've contracted with health departments in several states across the country, with more coming on board," he says. "One of our clients is the Hamilton County Health Department. When someone goes to that county health department for a flu shot, we make sure it's coded and billed correctly – and we do all that inside the software that Andrew and I created."

Hetzler says going into revenue cycle management is a key step in what the company's executives see for the company's future.

"The map I see is a fully integrated TPA [third-party administrator] type of arrangement," he says. "The culture and mission of our company is to be people-centric – how can we cover this patient better? How can we serve this provider better?"

Smith says American Exchange's "people-centric" approach to health insurance appealed to him.

"I spent the last five years at [revenue cycle management company] R1, which has $1.3 billion in annual revenue," he says. "[American Exchange] can grow into that if we want it to, but at this point in our maturation continuum, our focus is on differentiating ourselves on customer experience. Relationships are really important."

Hetzler says the health insurance industry is facing challenges, not the least of which is a seismic, pandemic-driven shift in the landscape. Hetzler cites an Urban Institute estimate that more than 10 million Americans have lost, and will lose, employer-provided insurance between May and December of this year as a result of pandemic-driven job losses.

"Going forward, hospitals and doctor groups will have to look at how to handle uninsured populations," he says. "They'll have to adopt ways to manage enrollment and revenue cycle management, especially if COVID lasts for a long time."

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Staff Photo by Matt Hamilton / Andrew Hetzler
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