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Softheon

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Thought Leadership

Stay current on industry specific topics with Softheon’s in-depth reports. Find out how current events impact your insurance plan offerings.

Thought Leadership

What Success Looks Like in Government Markets

Learn what senior executives from national and regional health plans - representing more than 50% of U.S. membership - top priorities are for 2023. This recap of Softheon's invitation-only Executive Advisory Council (EAC) discusses what success looks like for government health plans and the strategies used to achieve it.

Thought Leadership

Eligibility Verification RFP Guide for Government Agencies

Find the approach to eligibility verification that works for your agency. Softheon provides this guide as an outline of what to look for in an eligibility technology partner, key areas to focus on, and questions you should ask.

Thought Leadership

Using Advanced Analytics to Predict Member Terminations and Inform Retention Strategies Webinar

Paul Wingle, the Vice President of Individual & Family Plans at Aetna/CVS Health, and Kevin Deutsch, General Manager and Senior Vice President of Health Plan Cloud at Softheon, share how carrier-vendor partnerships are needed for a successful transition into the ACA Marketplace.

Thought Leadership

ACA Predictive Analytics Report

Examining 2021 Billing and Enrollment Data to Accurately Predict Terminations and Inform Retention Strategies in 2022.

Thought Leadership

Marketplace Shopping, Enrollment, and Billing RFP Guide for Health Plans

In this guide, Softheon poses relevant questions that health plans must ask during the procurement process to secure robust and scalable billing and enrollment solutions.

Thought Leadership

How to Seamlessly Enter the Expanded ACA Marketplace

The Supreme Court promotes expanding the Affordable Care Act (ACA) as a priority, potentially causing a boom in ACA membership due to an increase in subsidies and overall stability.

Thought Leadership

HIX 3.0 – Sustainable Information Technology and Operations Solutions for State-Based Marketplaces

In response to most Marketplaces experiencing a raft of technical problems since their launch in 2013, several states are taking action to improve their operations and IT infrastructures and reduce operating costs by transitioning to a new class of vendors. Exchange Operators, offer robust marketplace IT solutions on a software-as-a-service (SaaS) basis. Learn how leveraging Exchange Operator solutions can benefit State-Based Marketplaces (SBM).

Thought Leadership

Enhanced Direct Enrollment: the Evolution of the Consumer Experience

In our new whitepaper written by Jane Good, Founder, JGood Advisors, we will be discussing the benefits of future of Enhanced Direct Enrollment (EDE). EDE eliminates the “double redirect” to HealthCare.gov, using a series of CMS-based APIs to process eligibility and changes behind the scenes. EDE provides 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.

Thought Leadership

A Formula for Success: the Future of Technology Maturity Improvement

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. Prepare for the future of Medicaid technology.

Take a look at Softheon’s quick breakdowns of trends and changes in the industry.

Thought Leadership

Get Smart on 1332 Waivers

Overview 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.

Thought Leadership

Quick Facts: Section 1115 Medicaid Waivers

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

Thought Leadership

For Robust Data Verification, Get Verify

Medicaid agencies prevent fraud and abuse with Softheon's Enhanced Eligibility solution. Agencies reduce costs and ensure program integrity because Softheon leverages robust data partners, risk scores, and integrations with State systems to ensure eligible individuals receive their benefits quickly.

Thought Leadership

Get the Scoop on HSAs

Learn more about health savings accounts (HSAs) and gain insight into why Health Plans should begin viewing HSAs for members the same way employers view 401ks for employees; make contributions on their behalf.

Thought Leadership

Small Group Enrollment & Billing: Solutions & Challenges

Today’s administration of the small group market is burdened with cumbersome, manual processes and outdated technology. Manual processes can be replaced with cloud-based digital solutions that integrate with a carrier’s current IT infrastructure. Learn how Softheon can help address common challenges.

Thought Leadership

Connecting the Medicaid & ACA world

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 helps state agencies achieve this high level of technological maturity.

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Looming Budget Cuts: Safety-net #hospitals are anxiously waiting to hear whether their #Medicaid payments will be cut, via @modrnhealthcr
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SPAC-Mania: This year, the #insurance industry has seen a historic level of activity for M&As, IPOs, and SPACs, via @_diginsurance
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Stony Brook, NY 11794

(800) 236-7941

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