Enter the ACA at Warp Speed

Technology can help you enter new markets

As the Marketplace continues to grow, health plans are pressed to find new ways to evolve.
Today, a manual approach to payments and operations is a significant roadblock preventing health plans from meeting growing demand. Whether breaking into new markets or expanding in your current space, success comes down to a plan’s ability to scale, automate, and optimize processes…without spending valuable time and energy overhauling legacy systems.

How technology improves healthcare services for health plans

Automating adaptation to compliance changes

Manual processes create blindspots and inefficiencies, making it difficult to keep up with rapidly changing compliance requirements. Evolving with shifting regulations isn’t just about finding the time and resources—it requires a flexible infrastructure that enables health plans to change alongside the market.

When tracking, managing, and submitting regulatory data and reports, digital platforms allow administrative teams to focus on what matters most: pursuing new opportunities and markets.

Simplifying back-end processes through automation

Many health plans still rely on manual processes to effectuate members and maintain coverage. As a result, plans are forced to work with inaccurate data, delayed subsidy payments, and a lack of transactional oversight. Valuable time and resources are spent playing catch up, making membership growth impossible.

Modular solutions optimize existing systems by automating and simplifying back-end processes. This allows health plans to place their energy and attention on strategic and mission-focused growth.

Empowering insights and communication through composable solutions

When navigating and adapting to industry shifts, more health plans are finding that traditional systems are incapable of achieving lasting and sustainable growth. Reliance on siloed processes restricts communication between computing, storage, and data. Today, technology empowers flexibility with composable solutions.

Rather than requiring a “rip and replace” approach, a composable infrastructure connects multiple existing systems and enables seamless integration. With new levels of flexibility and communication, health plans can quickly pivot and identify new solutions.

Increase retention and effectuation rates by enabling scalability

Operational efficiency is crucial to achieving, sustaining, and increasing profitability after entering the ACA. However, manual overhead and isolated processes result in:

Lost revenue through missed or delayed subsidy payments
Decline in renewal rates due to member abrasion
Labor and resources wasted on resolving inaccuracies and inconsistencies

With the right tech stack, carriers can rapidly evolve and expand their enrollment processes…without the trouble of overhauling their current systems.

Optimizing the customer experience

Member satisfaction is intrinsic to growth within the ACA. When health plans rely on siloed systems and manual overhead, they jeopardize their ability to expand. Inaccurate invoices, irrelevant communication, and member abrasion undermine profitability.

Integrated tech solutions give carriers the ability to strategically create and optimize their member journey. In a highly saturated market, a seamless and enjoyable member experience is your key to standing out amongst your competition.

Here’s what health plans achieved with innovative healthcare technology:

99%+

average reconciliation accuracy

ROI (in the first year), as much as 1,075% ROI

73%

reduction in deployment time

95%+

average effectuation rate (vs. 94% national benchmark)

Healthcare technology use cases

Implementing a premium billing and payments system

When health plans need to accommodate a growing ACA population, the right tech stack eliminates inefficiencies caused by manual overhead, such as late and inaccurate invoices, inconsistent payment data, and poor communication with regulators.

After implementing Softheon’s automated Marketplace billing and payment system, this Texas health plan achieved the following:

Increased effectuation rates
Improved member experience and satisfaction
228% membership increase and CAGR of 37% over a 7-year period

Achieving profitability and scalability in the ACA

Staying profitable after the ACA’s inception was a challenge for both regional and national carriers. One health plan knew that attempting to scale through manual processes and traditional systems would lead to a costly downfall.

By utilizing a commercial-off-the-shelf (COTS) platform, the health plan was able to:

Increase membership from 10K to nearly 1M in months
Enter multiple new states
Establish a competitive presence without raising operational costs

Building an expansive customer journey

In today’s marketplace, member attention and loyalty are harder to retain. When choosing a carrier, the shopping and enrollment process is crucial to stand out against competitors.

By reinventing enrollment, billing, and payment processes, one ACA plan was able to reduce reconciliation issues and increase its renewal rates. As a result, the health plan achieved:

14% renewal increase in one year
11% increase in effectuation
Membership grew by 300% more than the industry average