Thought leadership

How U.S. Healthcare Payers Can Optimize Costs by Choosing the Best Core Administration Vendors

December 1, 2017

Cost cutting and application portfolio rationalization are top of mind for Gartner healthcare payer CIOs. The insights gleaned from Gartner's most common core administration inquiries can help guide your member enrollment, claim payment and premium billing modernization efforts.

A Better Digital Member Experience: Are Healthcare Payers Ready?

November 21, 2017

Healthcare payers continue to strive to improve consumer satisfaction, but the level of improvement is still lagging. This is especially true in the era of the Affordable Care Act, where consumer demand for more retail-like experiences has become prominent. Consumers what a digital experience that replicates other industries and provides omnichannel approaches.

Whitepaper: Top Factors to Successfully Manage Broker Commissions

November 7, 2017

As we enter the fifth annual open enrollment period (OEP), our industry has witnessed a rising number of brokers whom have elected to avoid working with the ACA Marketplace. Of the nearly 36,000 brokers that have made this difficult decision, the majority cite a downturn in commissions as the leading factor. For brokers to consider enrolling consumers into ACA coverage, they need assurance from the payer community that they will be accurately compensated. In this whitepaper, we examine Softheon’s solution for assisting payers calculate and deliver their brokers’ commissions.

Whitepaper: 1115 Waivers: Key Takeaways from Indiana and Michigan

September 28, 2017

This paper provides an analysis of how the Section 1115 waiver was utilized in Indiana and Michigan to modify and expand their respective Medicaid programs. In addition to the analysis, the paper will also provide the key takeaways or most important findings from each state’s implementation. These key tenets can help other states that are still planning how to proceed with a Section 1115 waiver.

Hype Cycle for U.S. Healthcare Payers, 2017

August 15, 2017

This Hype Cycle tracks the maturity and adoption rates of emerging technologies that are important to healthcare payers' digital transformation. CIOs can use this note to prioritize, create roadmaps and coordinate initiatives with their peers and partners to enable critical business capabilities.

Whitepaper: The Medicaid Administration Cloud

August 15, 2017

With the Affordable Care Act (“ACA”) and the implementation of Medicaid Information Technology Architecture (MITA) 3.0, both blue and red states are transforming their programs through implementing unique approaches. This paper provides an in-depth analysis on how and why the United States’ Medicaid programs are undergoing major policy and technological shifts. 

Whitepaper: Softheon Broker & Employer ‘Value Add’ Functionality

June 29, 2017

This paper focuses on four specific features within Softheon’s Marketplace shopping platform, designed explicitly for ease of use for Brokers and Employers/Employees alike. It provides an overview of: Softheon’s decision support, co-Browsing, rnrollment and rating options and; broker reporting and analytics dashboard.

Research Brief: Provider-led Health Plans Positioned to Succeed in Managed Care

May 16, 2017

Steadily rising in number since 2010, provider-led health plans (PLHPs), or pay-viders, have expanded into additional lines of business – including Commercial, Medicare Advantage, or Medicaid Managed Care lines of business.  In this paper, we will focus on those provider-led organizations that have expanded into managed care, examining growth, membership, and operational impacts.

Whitepaper: HIX 2.0: No Need to "Rip and Replace" Existing Investments to Ensure Success in ACA Marketplaces

April 20, 2017

Service-oriented architecture (SOA) based enterprise information and business process integration frameworks have emerged as the preferred solution for breaking through these silos and unlocking the value of information. This paper will examine the basic premises underlying SOA and describe how frameworks, such as those from Softheon, and service adapters can help organizations realize the benefits of SOAs.

Whitepaper: What to Consider When Offering HSAs and HRAs

April 20, 2017

While Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs) have long been argued by thought leaders as the solution to rising healthcare costs, we are now seeing the potential for them to become a primary component of the American healthcare payer system. This whitepaper discusses some of the attractive components of HSAs and HRAs for employers and employees alike.

Infographic: Personalize, Engage, and Empower: The Consumerization of Healthcare

March 23, 2017

The U.S. healthcare market continues to evolve. To deliver on your goals and outcomes, consumer-centric value chains and actionable insights that shape the future of healthcare services are inevitable. This infographic highlights this transformation and its influence on healthcare and consumer experiences.


Private Exchanges: Targeting Employer Needs with Consumer-Driven Approaches

June 14, 2016

With the ever-growing demands and expectations of today’s consumers, adapting Consumer-Driven Health Plans (CDHPs) is becoming increasingly common. Private exchanges allow for increased transparency, providing consumers and employers with choice-driven defined contribution benefit programs. This trend of designing emerging technologies to provide consumer-oriented experiences is prevailing as the new industry standard.

Payment Reform & The Shift Towards The Value Based Model

May 25, 2016

Rewarding volume, high cost, and high margin services, rather than value, the traditional fee-for-service payment method has proven to be an unsustainable payment approach. In this whitepaper, we examine how costs are projected to continually lessen with national payment reform efforts that have set out to implement a new payment model.

Exchange Operator - A New Model for Marketplace Operations and Information Technology

April 14, 2016

Now that federal grants authorized by the Affordable Care Act (ACA) no longer subsidize states for Marketplace operations and information technology (IT), states that run their own health insurance exchanges are feeling budgetary and political pressure to find the most efficient ways to do so. At the same time, a new field of vendors – “Exchange Operators” - that specialize in IT services to health insurers and exchanges has emerged. In this paper, Day Health Strategies, Health Management Associates (HMA) and Wakely Consulting Group set forth the rationale for states to consider.

Turning an ACO Into a Health Plan

June 15, 2016

While participation in ACOs are voluntary, the US healthcare system has witnessed a spike in ACO interest and adoption. This whitepaper offers best practices for achieving distribution platform optimization, increasing provider collaboration and access to quality care, and embracing the value based model.

Open Enrollment: A Look Back at the 2016 ACA Marketplace

September 9, 2016

With open enrollment season upon us, there’s no better time than now to reflect on the success that the Affordable Care Act (ACA) has brought us in 2016. Download our infographic to learn more on the 2016 OEP’s performance.

ACO: The Next Big Thing in Healthcare

April 14, 2016

The rapid growth in accountable care organizations (ACOs) piloted by the Centers for Medicare and Medicaid Services (CMS) is something that has not gone unnoticed. Learn more in our complementary infographic, ACOs: The Next Big Thing in Healthcare.

Emerging Markets Infographic

April 4, 2016

Each industry has its unique opportunities. Learn more about the emerging markets in healthcare - Healthcare Providers, Health Plans, State & Federal Governments, & Employers and Agents - in this FREE infographic. See how these markets have evolved and their projection for growth!

What Does the Future Hold for Blockchain as a Digitalized Platform for Healthcare Payers?

August 24, 2016

As Blockchain technology emerges, it is important to understand how it can deliver unique benefits to health plans, healthcare providers, and government agencies across the health insurance landscape. This whitepaper explores the benefits and opportunities that blockchain has presented for healthcare payers.

Provider Sponsored Insurance Plans Expand Membership

October 15, 2016

Health systems are pursuing new opportunities in health insurance that promise the delivery of competitive advantages. Learn how providers can expand membership and strengthen bottom lines by entering the insurance business as a PLHP.

Can Provider-Sponsored Health Plans Add Value?

April 26, 2016

With competition in full swing, providers are taking new measures to ensure financial and competitive stability in the marketplace. Through creating and offering their own health insurance coverage, providers are finding themselves taking advantage of the value based payment model, while securing a lucrative future where risk is mitigated. Learn more about the how provider-sponsored health plans are revolutionizing value based care.