Where is the Healthcare Industry Going Next? · 2016. 3. 9. · Trizetto . FACETS . QNXT . New York...
Transcript of Where is the Healthcare Industry Going Next? · 2016. 3. 9. · Trizetto . FACETS . QNXT . New York...
Where is the Healthcare Industry Going Next?
Healthcare Technology & Business Trends
Company : Solution
Federal & State Based Marketplace (HIX) Integration
Premium Billing
Private Exchanges
Direct Enrollment
Edge Server/CSR
Reconciliation
Softheon: Marketplaces
HealthEdge
ikaSystems
DST
Trizetto FACETS
QNXT
New York
California Massachusetts
Washington
Arkansas
Indiana
FFM
EPIC
Interstate Highway of Exchanges Carriers can drive their cars and trucks on Softheon, rather than
building their own roads to Public and Private Exchange destinations
Value: Health Insurance
Centene
MDwise
FirstCare of Texas
Paramount Health
Community Health Choice
IU Health
Community Care of Oklahoma
Total Health Care of Michigan
Florida Health Care Plans
Community First Health Plan
Health Republic Insurance
Affinity Health Plan
Group Health Cooperative
New York
Arkansas
FFM
Indiana
Massachusetts Washington California
Towers Watson
GoHealth
AON Hewitt
Metrics: Exchange Enrollments
Enrolled over 700,000 in 2015, and grown to nearly 1,600,000 in 2016
Metrics: Billing & Payments
Processed over $350,000,000 Insurance premiums in 2015, projected to grow to $600,000,000 in 2016
Market: Payment Transaction Confirmed Minus Fee Funds Deposited to Carrier
Transaction Authorized And Reconciled Against
Billing
Consumer Pay Insurance Premium by Credit & Debit Card, ACH, and Check
Consumer
Value: Health Insurance: Softheon
Metrics: Administrative Loss Ratio
Value: Health Insurance: Softheon
Build 24 FTEs 180 Days
Plug In 4 FTEs 30 Days
Value: Edge Server and PCM Technology At Softheon, we are leveraging our proven Edge Server technology for data submission.
Edge Server
We have configured our Edge Server platform for CSR to: • Aggregate Professional, Institutional,
Pharmacy, and Supplemental Data • Accommodate disparate Enrollment
Data to validate: • Member Coverage Period • Monthly Premium Amount • QHP Plan ID
• Provide Plan Catalog Management
Data Analytics: Claims Analysis
Value: Health Insurance: Profit & Loss
Data Analytics: P & L Analysis
Value: Health Insurance: Analytics
Value: Health Insurance: Actuarial
Grow with Innovators