In the dynamic world of healthcare, technology plays a pivotal role in shaping organizational strategies and addressing challenges. Tom Cohen, Executive Vice President of Healthcare Solutions at Softheon, shares insights into how his organization leverages AI and other innovations to streamline operations and foster a culture of continuous improvement.
Tom Cohen: In my role at Softheon, I get to engage directly with the evolving challenges and opportunities in government-sponsored markets. On most days, I’m brainstorming with health plan leadership on how to simplify operations and grow their business. Collaborating closely with our skilled internal teams and engineers, we help shape how our technology can best support health plans. Having a touchpoint on ever-changing industry trends allows Softheon to quickly adapt and remain compliant with regulatory shifts while staying focused on our customers. Our approach integrates this flexible mindset into both our strategic planning and product development, enabling a culture of rapid adaptation and scalability.
Tom Cohen: One major challenge is balancing the appetite for leveraging APIs versus the sophistication of health plans to understand and use them. Softheon serves both regional and national health plans, all of which have different tech ecosystems and dedicated internal resources. I’ve seen that a one-size-fits-all approach does not work in the healthcare market. However, custom solutions are costly and take time to build. Softheon has invested heavily in out-of-the-box configurations that allow our solution to integrate with various health plans and their internal and external tech and partners. This flexibility enables us to meet the unique needs of each plan but not jeopardize our scalability with custom solutions.
Tom Cohen: We’ve been rolling out generative AI capabilities to bring efficiency to our internal teams by synthesizing all our regulatory and solution-based data. This initiative not only improves our internal operations but also offers our partnered health plans greater accessibility to Softheon’s process documentation through a chatbot interface. Additionally, we’ve developed a Medicare Advantage solution that aligns with our ACA offering, helping health plans manage both under-65 and over-65 lines of business more effectively, creating a unified approach that simplifies operations.
Tom Cohen: Innovation is ingrained in our company culture, driven by our founder's engineering background. I encourage my team to be lifelong learners who have the desire to understand and improve the healthcare industry. The Individual Coverage Health Reimbursement Arrangement (ICHRA) is a growing market that my team and the rest of Softheon have been digging into and collaborating on. Fostering innovation can happen outside the company as well. I’ve been focused on scaling our partnership program to expand our knowledge and coverage outside our specific domain and better improve upon the successes of health plans and other vendors.
Tom Cohen: While AI will continue to drive efficiency, I believe the most significant impact will come from improved data interoperability. The adoption of API frameworks is critical for ensuring seamless data flow between systems and enhancing overall healthcare operations. Additionally, the focus on administrative cost reductions will drive more entities to identify those vendors who cover more lines of business and can eliminate vendor (and cost) fatigue. Technology can only go as far as the data that enables or powers it and payers can only benefit from data created by vendors if it's shared with them in a consumable and actionable way.
Tom Cohen's insights underscore the importance of strategic vision and innovation in healthcare technology. By embracing AI and improving data interoperability, organizations can overcome traditional challenges and enhance their operational efficiency, paving the way for a more integrated and effective healthcare system.