Transforming Community Coverage, Together

Provider-sponsored health plans need to get the most out of their technology. When you face pressure from your parent health system and competition with larger regional and national carriers, every penny counts.

But the goal isn't just to survive; it's to thrive — diversifying revenue streams, cutting costs through horizontal integrations, boosting patient loyalty, and expanding your impact in the community.

That’s where smoother operations and smarter automation come in, giving you the margin and resources you need to further your community health mission. Softheon has the integrated technology and the expertise you need to enter or grow in the ACA Marketplace... and beyond. 

Connect with Your Expert

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Enter and Expand with Confidence:

The Expertise You Need to Do More for Your Members

Provider-sponsored health plans need more than just the right technology to achieve their goals—they need industry expertise and a partner that will guide them to new levels of retention and expansion within their communities.

That’s where Softheon comes in. We’re here to guide you through:  
  • Consolidating your Medicare Advantage and ACA operations under one infrastructure

  • Reducing costs and boosting revenue by automating reconciliation, effectuation, billing, and payments

  • Guiding billing operations to support provider-sponsored payments

  • Promoting unique payment payment and member engagement programs to promote member loyalty

  • Providing an additional analytics suite that tracks community outreach and health outcomes

Stories of Success for Provider-Sponsored Health Plans

CFHP

 

Annualized 2.2x Return on Investment

Community First Health Plan expands access to care through industry compliant, hospital-sponsorship program.

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7 Years partnership

37% CAGR in Net Premium Revenue

Health plan gains the technology to offer innovative risk incentive and sponsored-payment programs to better serve underinsured demographics. 

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MA and ACA

 

Entering Multiple Markets in Under 2 Years

Regional, provider-sponsored plan enters the Medicare Advantage market and expands their ACA footprint, with limited technical overhead.

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Health plans have achieved major transformation with Softheon:

 

95%+

average effectuation rate

99%+

average financial reconciliation accuracy

6 months

new market entry

Why Health Plan Leaders Trust Softheon

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“Softheon’s expert knowledge of the ACA marketplace, coupled with their leading enrollment and billing technology has made the perfect partner during Hometown Health’s first open enrollment period on the exchange.”
David Hansen | CEO, Hometown Health

Transform your plan into a community cornerstone. Meet with our experts to identify the greatest opportunities for impact.