Softheon Launches First AI Tools to Help Health Plans Implement AI Safely and Securely
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Softheon Launches First AI Tools to Help Health Plans Implement AI Safely and Securely

CIO Review

'AIME' enables customer service agents and health plan users to accurately and efficiently handle complex health insurance questions and data analysis

NEW YORK - Softheon, announced the development of Artificial Intelligence Management for Enterprise (AIME) in its Softheon +AI platform. Using proprietary technology and training data, AIME is designed to support Softheon customers across a range of challenges, from enhancing call center employee knowledge to making it easier to understand and analyze health plan data.

Softheon's Enterprise solution is dedicated to maintaining the highest standards of patient privacy while delivering precise information, thus eliminating any instances of misinformation or imaginative inaccuracies. These standards are upheld through the careful measures taken to ensure that AIME (Artificial Intelligence for Member Engagement) isn't trained on sensitive data. Additionally, domain-specific knowledge derived from the organization's documentation is incorporated to ensure that the outputs are both factual and accurate.

Leveraging AI to address challenges in the healthcare sector is a central focus of Softheon's investment and innovation strategy. In the past year, Softheon acquired NextHealth Technologies, a healthcare analytics platform powered by AI. The integration of AI into Softheon's existing product lineup has proven to be a practical and significant means of harnessing the potential of this cutting-edge technology. Presently, Softheon is actively engaged in assisting payors to integrate AI into their operational frameworks.

"I'm proud to share that Softheon +AI can help payors take practical, tangible steps towards implementing AI. AIME especially is poised to impact how health plans empower their workforce and improve member engagement," Eugene Sayan, Founder and CEO of Softheon, said. "Most importantly, Softheon's solutions are designed for the critical and sensitive nature of healthcare environments. We see this as a continuation of our mission: powering growth to make healthcare more productive, intelligent, and successful."

Terry Burke, Senior Advisor for Oliver Wyman's Health & Life Sciences Practice, characterized Softheon's AIME as follows: "Intense competition, volatile market conditions, and discerning consumers are driving the imperative for health payers to swiftly innovate. The incorporation of AIME within the Softheon +AI platform is poised to shape the future for forward-thinking payors. AIME facilitates the unlocking of payor potential, expedites customer response times, and directs the intelligent routing of vital information. Importantly, it also ensures a high-touch, human-involved safeguard. AIME transforms payors into entities that are BETTER-FASTER-LEANER-SMARTER."

The impact of Softheon +AI on customer experiences encompasses a range of use cases, which include:

• AIME: A collection of tools centered around conversational AI.

• Member Engagement: AIME aids in responding to member queries prior to involving a live agent, offering guidance during application or form completion.

• Call Center Agent Assist: Call center staff receive answers to intricate customer inquiries, with guidance toward pertinent supplementary documentation.

• Knowledge Repository and Management: Staff members gain the ability to conduct intelligent documentation searches, summarizations, and analyses through training a comprehensive language model on the carrier's internal proprietary documents.

• Data Analytics: AIME employs adept data querying to analyze extensive data sets, permitting non-technical personnel to pose questions and receive informed responses from the data.

• Softheon Intelligent Automation: AI agents power Softheon's products, facilitating intelligent automation across shopping, enrollment, billing, and payments.

• Softheon Insights: Combining AI tools with expert guidance, Softheon aids health plans in tackling intricate challenges related to member behavioral shifts in vital areas like care management, utilization, quality enhancement, and risk adjustment.

Prominent figures in the industry are closely observing advancements in the AI sector. Margaret A. Murray, CEO of the Association for Community Affiliated Plans, the national trade association representing community-based Safety Net Health Plans, commented, "The healthcare industry is actively exploring the potential of AI, and Safety Net Health Plans are particularly interested in its implications for their operations. ACAP-member plans recognize the promise that AI holds to reduce wait times, control costs, and optimize health outcomes for enrollees."

Softheon +AI is a progressively expanding suite of AI tools designed to empower payors with pragmatic, concrete steps to commence harnessing the advantages of AI within their organizations. Just as Softheon has successfully managed shopping, enrollment, billing, and payments for ACA and Medicare Advantage, it now offers expert guidance to steer plans through the process of AI adoption.

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