Health plan members often make sub-optimal choices when deciding whether and how to access care. Softheon helps you guide them to make better choices which improve outcomes, measurably.
You want members to make the right choices concerning their care. Too often, they don’t. Softheon helps you change that by optimizing the effectiveness of your member interventions across a broad range of use cases and measure the value of the improved outcomes realized.
Get Started
The Pathway to Better Member Choices
Health plans struggle with the most unpredictable and seemingly uncontrollable factor: human behavior. We help you identify key themes and act on them using your data and our technology and expertise. With Softheon, you’ll have the insights and action plan to continuously identify and influence member behavior, improve activation and outcomes, and move the needle on costs across a broad array of use cases.
Intelligently predict likely member choices.
We use your existing data. Next, we use advanced technology and expertise to identify which members are most likely to engage in sub-optimal choices. We show you your highest potential opportunities and baseline performance across an expansive list of identified use cases.
Build an influential member outreach action plan.
Once you know when to focus your attention, now it’s time to engage members and influence them to make better choices. Softheon will help you set the right goals. Leverage our proprietary targeting algorithms to generate advanced member segmentation schemas and create and execute high-impact member outreach campaigns.
Measure and quantify causal impact.
Softheon’s technology and expertise helps you identify the pattern and impact of better choices. We enable configuration of all your outreach programs, including populations, Key Performance Indicators (KPIs) and similar measures. We show you the causality of action and intervention efforts.
Continuously optimize for better member choices.
Softheon helps you deploy a continuous test and learn approach that delivers a new level of intelligence based on what’s working and where to focus next. With Softheon technology and expertise, you’ll quickly realize optimal engagement and utilization patterns for members – all of which produce better outcomes and lower cost of care.
What Use Cases are on Your Mind?
Members make choices everyday. They do so across every operational domain within your health plan. Understanding the use cases you’re addressing is critical to shifting member behavior to the right choices–choices which deliver improved outcomes while reducing costs or increasing revenue. There’s always another use case, another challenge facing you. The real question is often, where to begin. Here’s some of examples of use cases across different domains–areas where Softheon has solutions to help you.
Care Management
Care management use cases involve getting more members involved in care management programs proven to improve outcomes. These programs drive better activation into care, sustained engagement, and optimized enrollment.
Utilization Management
Utilization management use cases involve influencing members to access care via appropriate but less costly sites of care. Areas of focus include redirects from high-cost, less optimal settings to more appropriate alternative physical and virtual settings.
Provider Network Performance
Provider network performance use cases focus on creating collaboration between payor and provider. It targets members who are likely to realize improved outcomes which results in better quality ratings. It also helps providers maximize VBC contract reimbursements with the payer.
Risk Adjustment
Risk adjustment use cases focus on helping the payor receive appropriate reimbursements based on the health of their membership. This applies across lines of business (Medicare, Medicaid, and Exchange) and fosters improvements in areas which help accurately identify and accurately capture HCC codes.
Quality & Ratings Improvement
Quality and ratings improvement use cases focus on improving member health through better care, such as improving the rate at which members receive wellness visits, vaccines, diabetic eye exams, cancer screenings, and similar care. Improved activation into these care settings also improves STARS and HEDIS ratings for plans.
Member Acquisition & Retention
Member acquisition and retention use cases today fall under key business areas such as increasing commercial member conversions to Medicare Advantage plans and improving member retention for both Exchange and Medicare Advantage.
ASO - Competitive Parity & Diferentiation
Competitive parity and differentiation use cases focus on validating the value and competitive advantage of various internal and third-party vendor programs provided by payers. Example use cases include things like justifying the value of care management programs offered to employers (often called “buy-ups”) and supporting health plan initiatives with ASO clients to engage employees and improve outcomes.
