Thought leadership

January 29, 2019

In the early days of the Patient Protection and Affordable Care Act (ACA), there was an expectation that most (if not all) states would establish a State-Based Marketplace (SBM). However, for several well-documented reasons, most states deferred to or relied on the Federally Facilitated Marketplace (FFM) for most – or all – of their Marketplace operations and information technology (IT).

August 16, 2018

The infographic gives an overview into the guardrails, application requirements, and state alterations the 1332 Waiver allows. Some details discussed include: state adoption and implementation, how the ACA’s basic protections will be retained, and the standards health insurance marketplaces must live up to.

August 7, 2018

The infographic discusses what reforms states can implement, what constraints states are under for changing Medicaid rules, and which states have approved or pending 1115 Waivers.

August 2, 2018

Softheon’s Asset Verification System, Verify, is the ‘first of its kind’ to certify both Health and Human Services (HHS) programs. Designed exclusively to detect fraud, waste, and abuse of enrollees and applicants while providing real-time identity confirmation, Softheon Verify™ combines robust data certification and a simple workflow to access and manage complex, varied Health & Human Services (HHS) eligibility and asset verification data. Download our solution overview to learn more.

July 26, 2018

Download our infographic and get the scoop on health savings accounts (HSAs). This infographic offers quick facts HSAs and offers insight into why Health Plans should begin viewing HSAs for members the same way employers view 401ks for employees; make contributions on their behalf.

May 4, 2018

Softheon’s Consumer Premium Bill Presentment, Bill Payment Index (CPBP2) report includes data from more than 60 commercial health and dental plans across 29 states, and measures bill presentment and transaction types including, but not limited to, print and mail fulfillment, electronic delivery, online (card and ACH), IVR (Card and ACH), Walk-in, and lockbox payments. The analysis represents over 3.2 million covered lives, or nearly 37% of the commercially insured U.S. population, under the Affordable Care Act, and more than $4 billion-member premium transactions in 2017.

Apr. 18, 2018

In our new whitepaper written by Jane Good, Founder, JGood Advisors, we will be discussing Enhanced Direct Enrollment (EDE). EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.

Feb. 1, 2018

This whitepaper provides an in-depth analysis of why the United States’ Centers of Medicare & Medicaid Services (CMS) Medicaid programs are undergoing major technological shifts. With the implementation of Medicaid Information Technology Architecture (MITA), states are struggling to move forward with integrations and configurations with technology. More specifically, this paper will discuss, the background of MMIS programs, MITA culture, integration and modularity, and lessons learned.

Feb. 1, 2018

Today’s administration of the small group market is burdened with cumbersome, manual processes and outdated technology. Paper-based enrollments and renewals slow down the process and leaves too much room for errors that further delays the sales cycle. Manual processes can be replaced with cloud-based digital solutions that integrate with a carrier’s current IT infrastructure. This datasheet demonstrates some ways Softheon can help address common challenges.

Jan. 16, 2018

In today’s digital era, government agencies are not just buying software, they are investing in higher levels of technology maturity for the enterprise. Softheon’s MITA-aligned, HIPAA compliant financial management service is the missing piece for state agencies looking to achieve this high level of technological maturity. This datasheet highlights the components of our Medicaid Administrative Cloud (MAC) platform.

Jan. 16, 2018

In 2017, we saw new technologies like Blockchain, Artificial Intelligence (AI), Machine Learning (ML) and the Internet-of-Things (IoT) make big advances across multiple industries. However, to date, we have yet to see them have a dramatic impact in healthcare. Will 2018 bring more of these innovative technologies to healthcare? Have a look at where we see these exciting new technologies going. Read the full predictions on Blockchain, Machine Learning, Artificial Intelligence, and Internet-of-Things (IoT).


A better digital member experience: are healthcare payers ready? – Nov. 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.

Top factors to successfully manage broker commissions – Nov. 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 – Sept. 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.

The Medicaid administration cloud – Aug. 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.

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, enrollment and rating options and; broker reporting and analytics dashboard.

HIX 2.0: no need to “rip and replace” existing investments to ensure success in ACA marketplaces – Apr. 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.

What to consider when offering HSAs and HRAs – Apr. 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.

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 – Apr. 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.
Personalize, Engage, and Empower: The Consumerization of Healthcare – Mar. 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.

What does the future hold for blockchain as a digitalized platform for healthcare payers? – Aug. 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 – Oct. 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.