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In the wake of a new ACA normal, Softheon shares its expertise with health plans entering or re-entering the Marketplace. Partnering as the Healthcare Policy and ACA Focus Area Partner for 2021 with the Healthcare Executive Group (HCEG), Softheon will facilitate continued discussion around the future of the healthcare ecosystem under the Biden Administration. If you are entering the Marketplace, there are four categories of questions you should ask of your future technology partners when issuing an RFP for your technical ecosystem: integration & onboarding, scalability, security, and industry trends.

Integration & Onboarding

Focus on Building the Proper Infrastructure

Building the proper infrastructure for your Marketplace operations may seem like a daunting task and not something you should risk taking on alone. Fortunately, technology partners exist to aid you in this complex and always evolving process. When choosing an ACA technology partner, integration capabilities should be placed at the forefront. No longer are the days where you will see a singular, on-premises mainframe system capable of meeting all your health plan operational needs while also keeping up with your health policy expectations.

Avoid Rip and Replace Solutions by Finding a Vendor Who Prioritizes Enhancing Your Current Ecosystem

Your ACA technology partner should not demand that you commit to a rip and replace solution but rather serve as a component, or series of integrated, complimentary components, of your ecosystem. It is important to determine the integration capabilities that come bundled with any possible solution, as well as clearly understanding the onboarding process associated with the many integration points. Look for a partner who adheres to opensource standards, who employs frameworks that can connect with virtually all external applications and whose data interfaces to sales distribution channels, claims administration systems, and other necessary functions to support your Marketplace business. Onboarding procedures should be well defined and focus on supporting a Minimum Viable Product (MVP). This type of out of the box efficiency and built-in integration features will cut operational overhead and help contribute toward overall revenue growth.

Consider the Following Questions Regarding a Vendor’s Approach to Integration & Onboarding:

  1. What steps are required to onboard new customers?
  2. Describe the process and timeline of a typical implementation
  3. How do you ensure a seamless integration with other data feeds and systems?
  4. How can your solution be iterated upon while utilizing best practices to achieve the common goal?

System Scalability

Enable Future Growth by Accounting for Changes in Membership

A second element to consider is your future growth within the Marketplace. In addition to accounting for increased membership year-over-year, health plans must now be equipped to handle changes in membership – potentially dramatic changes – due to global events such as the COVID-19 pandemic, on-going policy changes impacting subsidies amounts and eligibility qualifications, and variations in enrollment periods.

Prevent Development Stalls by Investing in Adaptable Technology that Quickly Addresses Unanticipated Policy Changes

Your ACA technology partner should demonstrate an ability to automate monitoring and reporting while analyzing and predicting system loads and resource demands over time. They should also possess the ability to respond quickly to changes at scale. The ACA Marketplace business is cyclical with changing peaks and valleys throughout the year. Any solution should scale both vertically and horizontally to allow for minimal disruption during unexpected peak loads.

Consider the Following Questions Regarding a Vendor’s Approach to System Scalability:

  1. What are your system scalability capabilities and what should your customers understand about those capabilities?
  2. What assets – including systems and hardware – are utilized to accommodate increased demand for or changing demands for scalability?
  3. How are your change requests prioritized, communicated, responded to, and implemented?

Security

Protect Member and Company Data by Partnering with a Vendor Wielding Robust Security Practices

Naturally, increases in scalability portend exponentially more Personally Identifiable Information (PII) and Protected Health Information (PHI) passing through the hands of your health plan and business associates. Accordingly, another integral area of consideration is your and your technology partners’ adherence to security standards, including but not limited to:

  • NIST 800-53
  • FIPS-140
  • MARS-E 2.0
  • PCI
  • HIPAA
  • HITECH

Multi-factor Authentication and Privacy Protocols are Key for Member Data Security

Your technology partner should have formally established, written information security programs in accordance with the aforementioned security standards and regulations. Complementing these protocols, multi-factor authentication (MFA) and other privacy protocols should be utilized when accessing company assets to ensure that your data and your members’ data is secure.

Consider the Following Questions Regarding a Vendor’s Approach to Security:

  1. Please outline how your security programs comply with industry standards
  2. How do you maintain, review and update already established security practices?
  3. When accessing company assets, how do you ensure security and protection of PII and PHI?

Industry Trends

Stay Abreast Amid Rapid Industry and Regulatory Change by Planning for Future Technology Now

A final component to consider when entering the Marketplace is the healthcare industry itself. With Artificial intelligence (AI), machine learning (ML), business intelligence (BI), new data sources including social determinants of health, and ever-increasing number of interfaces on the rise, it is imperative for health plans to adapt their methodologies to stay ahead of the curve. Your partner should not only be driving and adapting the latest trends in technology but they should also be tuning in to and aligning with the latest industry and technology trends in healthcare. We recommend looking for an ACA Technology partner who is just that – a partner who is providing increasing value through expertise and top of the line solutions. There should be clear alignment between your partners technology and your healthcare goals to drive your success in the Marketplace.

Consider the Following Questions Regarding Industry Trends:

  1. How do you incorporate Business Intelligence (BI), Machine Learning (ML), and Artificial Intelligence (AI) into your product development strategy?
  2. How do you incorporate big data and analytics, Robotic Process Automation (RPA), and Internet of Things (IoT) into your platform?
  3. How do you monitor for future industry and technology trends and enhance your platform to reflect and accommodate those trends?

Whether you are looking to enter the ACA Marketplace for the first time or you are planning your re-entry, we urge you to consider the questions raised above and to consider Softheon as the ACA Technology partner in your ecosystem. To learn more about how we are addressing the above, visit us at www.softheon.com or contact info@softheon.com to get started. RELATED: Healthcare Leaders Focus on Healthcare Policy & ACA

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