Softheon has been recognized by CIOReview Magazine as the recipient of “Top 20 BPM Solution Providers - 2016,” based on our proprietary methodology, reflecting its position in the industry. This profile has been developed by the CIOReview research and editorial team based on insights from an interview with Eugene Sayan, CEO.

Softheon
Intuitive Technology for Simplified Business Process

Eugene Sayan, CEO

Traditionally, the term “healthcare” has not been paired with the practice of Business Process Management (BPM), however the industry is evolving with new healthcare regulations that have resulted in the creation of a more competitive healthcare environment. From the Patient’s Bill of Rights and electronic health records, to health insurance and Medicaid, Affordable Care Act (ACA) reforms are making healthcare more complex. With numerous new regulations, plus additional data to gather, analyze, and share, healthcare organizations can face tremendous challenges in not only integrating new processes, but also continuing their mission of delivering quality patient care. Failure to meet these demands can result in serious financial losses, as well as patient dissatisfaction. With BPM at the core of healthcare, organizations can overcome these challenges and avoid the pitfalls of change in the industry. BPM can help healthcare organizations manage new requirements, regulations, and processes required by the ACA, which allows them to focus on improving the quality of care that their customers receive. New York-based Softheon is an eminent technology company that offers BPM solutions to healthcare payers, providers, and government organizations to thwart complexities arising from the volatile state of the healthcare market. The firm is set towards enabling the healthcare payers and government agencies to be more operationally efficient and meet ACA mandates.

Suitable BPM for Healthcare

BPM has become a key focus for many healthcare payer organizations, whether aimed at streamlining and automating critical processes, reducing cost, or improving process effectiveness.“Our BPM layer orchestrates complex business processes that may span across multiple systems,” states Eugene Sayan, Softheon founder and CEO. The firm offers a cloud-based BPM platform to deliver Health Insurance Exchange (HIX) integration, Direct Enrollment (in conjunction with healthcare.gov website), and compliance with Edge Server submissions, which is a necessary filing for subsidized insurance products.

The firm’s BPM repository hosts composite service “Agents” which are highly automated and configurable modules that handle known business processes. Softheon BPM manages, orchestrates, and runs agents that can perform an array of different functions including importing data from various formats, rule based distribution, notifications, security, and many others. “This is all done by interacting with the data in the Softheon Data Repository,” explains Sayan.

Softheon’s BPM adaptability stems from the wide variety of automated workflow processes and exception handling that exists within the application. “We take an agile approach in designing a solution that accounts not only for routine business processes, but also for exceptions that may appear in day to day processing,” says Sayan. With the use of Softheon Agents, customers can design automated workflows and procedures for a wide range of business issues. Agent configurations can be created or modified with Softheon Rule Composer to allow for the creation of complex rule-based workflows.

Expanding Healthcare Payers Reach

Alternatively, Softheon offers Marketplace Connector Cloud (MC2) which is a SaaS platform for remediation of the interactions between insurance marketplaces and health plan partners' existing IT assets. Softheon MC2 serves as an abstraction layer, isolating insurer systems from technical and integration requirements of the Federally Facilitated, State based, or private marketplaces. “Through a single unified platform, Softheon MC2 supports interfacing with diverse sales channels such as public and private exchanges, while minimizing disruptions to health plans’ existing information systems and processes,” says Sayan.

The firm’s platform provides health insurance services to consumers in real time. In regards to the functionality of Softheon’s BPM based cloud platform, “We provide critical services like real time underwriting, premium billing, invoicing, and integrated payment platforms,” affirms Sayan.

We see ourselves as industry disruptors because we often challenge current processes in an effort to make them more efficient

In addition to the MC2 solution, Softheon provides a variety of services that help organizations have an effective business process. The firm has worked with both private and public agencies to devise a solution for Asset Verification (AVS), which allows users to consolidate a variety of information from disparate sources and calculate a risk score based on the findings. These risk scores allow caseworkers to review questionable applicants for Fraud or Abuse of government programs. “We have also served as the EDI gateway, not only for internal carriers, but also for state agencies,” says Sayan.

Keeping up with Customer Demand

Softheon BPM provides the tools to effectively and rapidly improve an organization's processes as their goals and objectives evolve. Utilizing an agile methodology, the firm continues to add to its pipeline of innovation, based on industry trends and new compliance requirements. In general, Softheon has been successful in laying the groundwork for organizations to achieve operational efficiency. For instance, one client, a mid-size regional health plan, faced some operational challenges in their first year participating in the public exchange space. The client first participated in the health insurance exchange market in the 2014- 2015 open enrollment period, but did not have a clear strategy because they were too concerned with the operations and integrations associated with the new sales channel. Due to these distractions, this health plan did not meet their expected sales volumes. After allowing Softheon to handle the operations and integration efforts involved, the client began to focus on plan benefit design and the strategic marketing of their products. Their second year was a huge success, where they increased their enrollment count by 300 percent. Overall, Softheon provided the client with the resources they needed to successfully participate in this new outreach channel.

Staying Ahead and Relevant

The technology of today can be prevalent only for a short period. However, “Disrupting technologies in the BPM arena are the ideas or processes that attempt to change the status quo of operations,” asserts Sayan. “We see ourselves as industry disruptors because we often challenge current processes in an effort to make them more efficient.” Furthermore, Softheon produces its best solutions by working together with industry experts, taking their business knowledge, combining it with technological knowledge, and producing something that can be truly amazing.

Anticipating a future with greater opportunities, Softheon will continue to enhance its MC2 platform by adding new components such as Credit Card Merchant Processing, and ACA Data Analytics & Risk Management. Softheon provides Cost Share Reduction Reconciliation services, and enables the establishment of additional channels of business as well. In addition, Softheon has created an online health insurance brokerage, Welltheos, and works to assist Hospitals and ACOs with design, implementation, and the operation of their insurance business unit.

“We have ventured into the Payvider space, where we plan to show healthcare providers how to create their own insurance products by leveraging our extensive expertise in the Healthcare Payer space,” says Sayan. Furthermore, as the value proposition of private exchanges gain more and more traction, “We anticipate to setup a competitive position for ourselves in the market,” concludes Sayan.

Softheon

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

Monday, August 28, 2023

'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.

Softheon Launches CITIZ3N, New Subsidiary Dedicated to Government Solutions in Healthcare

Thursday, April 11, 2024

STONY BROOK - Softheon, announces the launch of CITIZ3N, a subsidiary dedicated to revolutionizing government solutions in healthcare. As part of the illustrious '3' Softheon Brands, CITIZ3N is a testament to our commitment to innovation and excellence in the government solutions sector.

CITIZ3N stands at the forefront of innovation, driven by Softheon's unwavering dedication of excellence and its ambition to lead technological progress. With a firm focus on healthcare accessibility and efficacy, CITIZ3N aims to transform the landscape of government-driven healthcare solutions through cutting-edge technologies and unparalleled services.

At the core of CITIZ3N's mission lies a dedication to empowering local, state and federal agencies with state-of-the-art technology and comprehensive services. The primary objective is to drive down costs, elevate member experiences, streamline eligibility verification processes, and expand healthcare accessibility to all strata of society.

Eugene Sayan, CEO of Softheon, expressed excitement, stating, "CITIZ3N marks a pivotal evolution in our quest to redefine government-driven healthcare solutions. With a steadfast commitment to innovation and service excellence, we are poised to revolutionize how healthcare is accessed and delivered across various levels of government."

General Manager, Rob Miller, announced "CITIZ3N leverages Softheon's technology and expertise to usher in a new era of healthcare accessibility and efficiency. At the heart of CITIZ3N's vision in making healthcare affordable, accessible, and plentiful for all Americans, driving positive change and enhancing lives for all citizens."

Company
Softheon

Management
Eugene Sayan, CEO

Description
A provider of Health Insurance Exchange (HIX) Integration, Direct Enrollment, Premium Billing, and Edge Server Solutions for insurance carriers of all sizes

Softheon Intuitive Technology for Simplified Business Process