Softheon Launches First AI Tools to Help Health Plans Implement AI Safely and Securely

‘AIME’ enables customer service agents and health plan users to accurately and efficiently handle complex health insurance questions and data analysis

Softheon, a cloud-based health tech company that provides the back end technology for payors and health systems, has announced the development of Artificial Intelligence Management for Enterprise (AIME) in its Softheon +AI platform. Using proprietary technology and training data, AIME is designed to support Softheon customers across a range of challenges, from enhancing call center employee knowledge to making it easier to understand and analyze health plan data.

Softheon’s Enterprise solution focuses on upholding the highest standards of patient privacy and providing accurate information, eliminating “hallucinations” or creative inaccuracies. These standards are upheld by ensuring AIME is not trained on sensitive data and integrating domain-specific knowledge based on the documentation of the organization to guarantee outputs are factually accurate.

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Using AI to solve healthcare challenges is at the forefront of Softheon’s investment and innovation strategy. Last year, Softheon acquired NextHealth Technologies, an AI-powered healthcare analytics platform. Integrating AI into Softheon’s existing product has been a meaningful and practical way to harness the power of this cutting edge technology. Now, Softheon has set out to help payors layer AI into their operations.

“I’m proud to share that Softheon +AI can help payors take practical, tangible steps towards implementing AI. AIME especially is poised to impact how health plans empower their workforce and improve member engagement,” Eugene Sayan, Founder and CEO of Softheon, said. “Most importantly, Softheon’s solutions are designed for the critical and sensitive nature of healthcare environments. We see this as a continuation of our mission: powering growth to make healthcare more productive, intelligent, and successful.”

Terry Burke, Senior Advisor for Oliver Wyman’s Health & Life Sciences Practice, framed Softheon’s AIME this way: “Intense competition, turbulent market conditions and demanding consumers are fueling the need for health payers to rapidly innovate. The introduction of AIME within the Softheon +AI platform will enable the future for payors that are early adopters. AIME helps unlock payor capacity, enhance customer response time, and drive smart routing of critical information, all the while ensuring a high-touch, human-in-the-loop safeguard. AIME makes payors BETTER-FASTER-LEANER-SMARTER.”

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Softheon +AI can impact customer’s experiences across a range of use cases, including:

• AIME – a group of tools focused around conversational AI.
  • Member Engagement: Use AIME to answer member questions before they get to a live agent, and act as a guide while filling out applications or forms.
  • Call Center Agent Assist: Give call center employees answers to complex customer questions, directing agents to relevant supplemental documentation.
  • Knowledge Repository and Management: Empower employees to conduct intelligent documentation lookups, summaries, and analysis by training a large language model on a carrier’s internal, proprietary document base.
  • Data Analytics: Deploying expert querying data, AIME can analyze large data sets and enable non-technical staff to ask questions and get intelligent answers from the data.
• Softheon Intelligent Automation – Softheon’s products leverage AI agents to intelligently automate virtually all areas of shopping, enrollment, b******, and payments.
• Softheon Insights – using a mix of AI tools and expert guidance, Softheon helps health plans solve complex challenges around member behavior change in critical areas like care management, utilization, quality improvements, or risk adjustment.

Industry leaders are paying close attention to new developments in the AI space. “The health care industry is working to unlock the potential of AI, and Safety Net Health Plans have significant interest in how it applies to their operations,” said Margaret A. Murray, CEO of the Association for Community Affiliated Plans, the national trade association representing community-based Safety Net Health Plans. “ACAP-member plans understand the promise AI holds to shorten wait times, contain costs, and help optimize health outcomes for enrollees.”

Softheon +AI is a growing suite of AI tools that help payors take practical, tangible steps to start reaping the benefits of AI in their organizations. Like Softheon does with shopping, enrollment, b******, and payments for ACA and Medicare Advantage today, Softheon brings experts to the table that can help guide plans through AI adoption.

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