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Predictive model accurately identified 60% of members that terminated health plan enrollment, offering methods for retaining enrollees. 

Softheon, a leading cloud-based health insurance exchange and service provider, published “ACA Predictive Analytics Report: Examining 2021 Billing and Enrollment Data to Accurately Predict Terminations and Inform Retention Strategies,” an in-depth analysis of Affordable Care Act (ACA) enrollment during 2021 and key interventions for maintaining member enrollment. Examining ACA subscriber, payment, and grace period data from the first three months of a health plan year, Softheon predicted with 80% accuracy which members would experience a lapse in their coverage due to nonpayment during the plan year.

Serving over 90 health plan carriers, Softheon has unique insight into how plans can interpret enrollment and ongoing billing data to improve the experience for the millions of members who shop, enroll, and submit payments on Softheon’s platform.

Softheon’s predictive model leveraged Machine Learning to determine what factors led to potential termination of health insurance, including how premiums were paid, what payment methods were used, and if the individual was part of a family plan. The predictive model revealed that carriers could target one-fifth of their membership for early or ongoing interventions and in doing so, intercede in two-thirds of all terminations for the plan year.

Furthermore, Softheon offers specific intervention methods based on its analysis that may be used by health plans to identify and intervene with at-risk members and help ensure continued coverage, including:

  • Autopay: Providing the option for members to autopay their monthly premium.
  • Cash Payments: Enabling cash payments through partnerships with conveniently located brick-and-mortar stores, like pharmacies.
  • Payment Plans: Offering payment plans for members who are experiencing a financial hardship or life event.
  • Premium-Reduction Incentives: Giving incentives to individuals who may exhibit certain health behaviors, such as premium reductions for taking a health risk assessment.
  • Better Communication: Implementing text-based communications and notifications to better reach members for payment reminders and intervention messages.

“In serving millions of members and processing billions of dollars in payments each year, Softheon is charting an innovative path forward to help health plans better understand how they can prioritize member engagement and retention,” said Eugene Sayan, CEO and Founder of Softheon. “This level of in-depth analysis represents the next chapter of our core mission to help health plans intervene early and often to provide affordable, accessible, and plentiful healthcare to more Americans.”

With a record 14.5 million sign-ups during the 2022 Open Enrollment Period, carriers are now considering how to keep individuals enrolled in their health plan. To better reach members, it is critical that organizations in the ACA Marketplace take steps that keep members insured and quickly identify how to intervene if they are at risk of lapsing. Softheon’s expertise and solutions can help organizations better facilitate health insurance shopping, enrollment, and billing amid the continued growth of the health insurance exchange.

“As health insurers participation in the ACA Marketplace continue to be impacted by the pandemic, socio-economic uncertainties, and the policy dynamics of the administration, it’s imperative for health plans to better understand their members, the challenges they face, and the ongoing opportunities afforded by the ACA to be able to adapt quickly in support of customer’s unique needs,” said Ferris Taylor, Executive Director at the HealthCare Executive Group. “Softheon’s success in the industry, augmented by this in-depth analysis of market and consumer trends, make it a go-to partner for health plans looking to better serve their members.”

“The ACA Marketplace saw unprecedented growth over the past two years during the pandemic, and health plans now have the difficult task of determining how to keep millions of individuals enrolled in coverage,” said Mike Trilli, Director Healthcare Payments at Aite-Novarica Group. “Softheon’s findings provide an important, yet practical, roadmap for how health plans can leverage existing data to pinpoint upcoming trends, better address the challenges members are facing, and create engagement in the individual marketplace.”

To read more about Softheon’s analysis and findings, please visit Softheon’s predictive analytics resource page.

About Softheon
Founded in 2000, Softheon’s Software-as-a-Service (SaaS) and Business Process-as-a-Service (BPaaS) solutions solve complex challenges for health plans and government health agencies. Currently, Softheon’s solutions serve 8 State agencies and over 90 health plans. Issuers and consumers utilizing Medicaid, Medicare, and the ACA Marketplace benefit from Softheon’s innovative technology that reduces administrative overhead and enhances user-experiences. Softheon is an Agent, Broker, and Merchant of Record that facilitates health insurance enrollment, administration, and renewal.

STONY BROOK, N.Y., Feb. 23, 2022 /PRNewswire/ 

Media Contact for Softheon:

Mitchel Forney