HCAA Sponsorship Guide Spring 2024

SPONSORSHIP GUIDE SPRING 2024

Welcome to HCAA’s Annual Digital Sponsorship Guide. We at HCAA have had an amazing trajectory of successful conference events. We know this success could not have happened without the partnership of our sponsors. Since its inception in 2020, our Digital Guide has focused on providing another opportunity for our amazing Sponsor Partners to let you know about their very valuable products and services.

We invite you to please take time to use it to find out more about what they offer! Remember, here at HCAA, it is always about “the value of connection”!

Carol Berry, HCAA CEO

Susan Crolla, VP of Events and Vendor Relationships

Sponsorship Guide Index

– T –

Third Party Administrator

Rocky Mountain Review 70

– W –

Wellness/EAP/On-site Clinics/Telemedicine

GRAIL 38

Healthee 42

Sharecare 107

Vida Health 90

Vitable Health 107

Cost Containment Solutions

At 6 Degrees Health, we’re transforming RBP and healthcare cost containment. Our service-first philosophy provides members with a superior healthcare experience, delivering up to 40% savings compared to traditional network plans.

With our cost containment solutions, employers take control of their healthcare spending and create sustainable and affordable plans for their employees.

6 Degrees Health Offerings:

› Reference-based Pricing

› Out-of-Network

› MediShield: Legal add-on support for patient protection

› Payment integrity

Delivering Results

Member Experience

Concierge Approach

A comprehensive approach to managing member experience that enhances satisfaction while managing costs.

MediVI Member App

Our MediVI technology is an AI-powered platform that gives your members the power of choice. Empower your members with customized provider search and live case support.

On-Ramp: Provider Outreach

Our two-phase program creates a seamless changeover for plan members and mitigates potential disruption in care.

A&G Healthcare has been in the payment integrity industry since the 90s–decades of experience, translating to millions of dollars in savings.

We’re dedicated to providing the best in class services within our tangled up healthcare system. With a mix of customizable backend tools and one-on-one personalized support, we’re developing client-driven solutions for:

• Health Plans

• Third Party Administrators

• Self-Insured Organizations

• Unions

• Health Share Organizations

• Re-insurers

The A&G Difference..

We’re more than just a partner in processing, but your advocate. All of our services are backed by customer service, reconciliation, and provider relations team to mitigate the typical headaches of provider pushback.

Adjudication System Integration

We’re partnered with most major adjudication systems such as Eldorado HEALTHpac & Javelina, Ebix Health LuminX, WLT, Cognizant TriZetto, VBA, and more. This means les can be turned around quickly to your own system with the format you expect, as well as minimal to no impact to your existing work ow.

Implementation

We customize each case, so you can be con dent that connectivity will be as smooth and e cient as possible. Leave the heavy-lifting to us so you can get back to what matters most.

Welcome to Advanced Medical Pricing Solutions (AMPS), a leader in healthcare cost containment with over 18 years of experience. We guide organizations through their healthcare cost savings journey with a personal approach. Our solutions focus on reducing medical and pharmacy costs, ensuring member satisfaction and promoting affordable and transparent healthcare. Through data auditing and detailed analytics, AMPS delivers “fair for all” pricing, advocating for fair compensation and envisioning a future of just and sustainable healthcare.

Empowering Healthcare UNLOCKING

1,700+ RBP CLIENTS SERVED

Suite of Solutions

$33 PMPM (Drexi)

At AMPS, we cater to a diverse range of clients, including self-funded employer groups, brokers, consultants, thirdparty administrators, reinsurers, health plans, health systems, health shares, Taft-Hartley funds and associations. We pride ourselves on meeting our customers where they are, offering the best cost-saving opportunities available.

CLAIMINSIGHT

- Offers a Payment Policy library and rules engine delivered through our automated editing capability.

- Systematic execution of policies and rules at a lower administrative cost.

AMPS RBP

- Combined with our unique Stop Loss placement service, AMPS RBP delivers the lowest net cost in the industry.

- Access custom networks and wraps, Member Advocacy, Provider Relations, Care Navigation and more.

- A one-stop solution for cost savings without compromising quality benefits.

DREXI

- Our fully transparent and conflict free model, Drexi operates on a PMPM model.

- Drexi owns a fully integrated cost containment solution offering PAP, International, and 340B.

- Complete ownership of contracts, passthrough of all pricing discounts and rebates to ensure consistent cost savings for Drexi PBM clients.

Join AMPS in our commitment to revolutionize healthcare cost management, providing tailored solutions that empower you to navigate the complexities while ensuring the well-being of your members. Your journey to cost savings starts here.

CarelonRx is redefining the right way to deliver pharmacy benefits

When we put people first, everyone

HEALTHCARE BENEFITS ANALYTICS

Visual, Sharable Benefits Analytics

Take control of benefits costs and optimize plan design for your employees and members with the most comprehensive benefits analytics and reporting tools available today. Healthcare Benefits Analytics is built for self-service plan design and reporting to reduce or eliminate the need for additional consultants or vendors.

With our benefits analytics software, self-funded employers, their payers, and broker/consultant advisory partners can:

> Meet plan sponsors’ clinical and financial performance goals

> Tailor plan parameters and model performance based on member populations

> Translate raw data into actionable steps for benefits managers and care partners

> Visualize key details to lower costs, enhance member benefits, and improve health

> Monitor specific member cohorts and track care management efficacy

> Measure point solution impacts to identify those with the highest ROI

Every Cedar Gate application comes with data tools that integrate multiple disparate sources into a single, unified data lake. We automatically cleanse, normalize, and enrich member information so you get high-quality data warehoused securely in the cloud, and accessible from anywhere. It’s the ultimate source of truth to power all your activities in a value-based employee benefits world.

MONITOR COST & QUALITY TRENDS

Monitor and compare key performance indicators to spot and correct undesirable cost and quality trends before they hit your bottom line.

ACCESS FULLY ENRICHED MEMBER DATA

We onboard, ingest, and augment member data from multiple disparate sources, providing over 5,000 types of data enrichment.

VISUALIZE DATA IN DIY DASHBOARDS & REPORTS

Create custom dashboards and reports, or choose from over 100 preconfigured tools to visualize and share critical data with stakeholders.

BENCHMARK WITH ADVANCED TOOLS

PREDICT & REDUCE RISK WITH AI

Use advanced AI predictive models to pinpoint specific actions that will improve member health and minimize clinical and financial risk.

MANAGE PRIORITY POPULATIONS

Use risk stratification tools to identify specific member cohorts that require additional monitoring, and report on key activities.

MODEL PLAN & BENEFITS CHANGES

Design benefits and test various scenarios to identify which plan elements have the greatest clinical and financial impact for your members.

Compare real-time performance against Cedar Gate’s proprietary national Healthcare Benchmark Database with over 12 million member lives – by region, state, MSA, and industry type.

CLAIMS ADJUDICATION

What makes us different? Well...you do.

Cervey’s Adjudicator is a next-gen plan management and claims adjudication platform designed for you, with you. We offer a solution as unique as the needs of your clients, empowering you to provide nimble support in an ever-changing industry.

We listen. You leverage.

From customized pricing based on NADAC, AWP, WAC, MAC, ACQ to rulesdriven engines, Cervey’s Adjudicator provides the innovative flexibility you’ve been waiting for. We’re not just software. We are your partner in building a solution to help you maximize your strategy.

Claims adjudication doesn’t come in one size fits all... and neither should your software.

• Infinite Flexibility: Never out of the box. Our team of in-house developers offer endless benefit configurations designed to meet your unique needs.

• Comprehensive Expertise: With two decades of experience in claims adjudication, 340B, specialty and patient assistance, let Cervey’s seasoned team tailor your total solution.

• Unmatched Service: When you need support, you need an expert. You call we answer. No outsourcing. No robots. It’s as simple as that.

• No Competing Interests: Cervey is a privately held company, independent from any PBM ownership. Your success is our success. No question.

• Industry Readiness: Cervey’s flexible model allows us to quickly adapt to any future industry changes and requirements, including NCPDP F6 and beyond.

• Interoperability: Our extensive API framework simplifies the data integration with your internal processes and external business partners.

Cervey

TriZetto Healthcare Products

Proven, flexible, comprehensive core administration platforms to help you:

Accelerate speed to market and enhance revenue growth by administering multiple lines of business on a single platform

Lower administrative costs through greater auto-adjudication, integrated workflow management and advanced connectivity

Gain efficiency with highly configurable and flexible benefit designs and management

Leverage the latest technologies through our continual investment

Cognizant (Nasdaq-100: CTSH) engineers modern businesses. We

and transform experiences so they can stay ahead in our

at www.cognizant.com or @Cognizant

©

Advantages of CHS

Over its 43-year history, Costco has demonstrated a commitment to driving costs down while enhancing consumer value.

We are an undeniable leader in finding better ways to provide quality products and services at terrific prices. Our steadfast focus on relentlessly driving down cost also extends to our own $5 billion dollars in annual pharmaceutical purchases and the operation of our 500+ Costco pharmacies. We believe we have developed a better way to purchase and manage prescription drugs, for ourselves and for other employers and organizations. We call it Costco Health Solutions (CHS).

The Costco difference is:

CHS FULL PASS-THROUGH PBM

A single PMPM admin fee is the only source of revenue

All services bundled into the admin fee. No additional charges

Full Pass-Through of all rebates, discounts or any other revenue source

Revenue only varies with member count

Formulary utilizing biosimilars and removing Humira

CHS welcomes the opportunity to discuss how our pricing and purchasing expertise can help you better manage your company’s rising pharmacy benefit costs.

Costco provides the following services as part of our low cost admin fee:

With better drug selection, an emphasis on improved rebates (100% pass through), and a focus on lower actual net cost, we can achieve a reduction in prescription benefit costs. It’s also important to note the administration fee charged is the only compensation received by CHS.

National Network of 65,000 pharmacies

Total flexibility of plan design

Flexible formulary options

Comprehensive suite of clinical programs

Wholly owned Specialty and Mail Order

Pharmacies

Client centric service model

Single or multiyear contracts

Get where you want to grow with DataPath solutions as your travel partner.

Technology? DataPath has the proven all-in-one cloud platform for comprehensive administration of CDH Accounts, HSAs and Investments, COBRA, Billing, and Well-Being benefits.

Productivity? Our extensive business process outsourcing (BPO) services provide the service expansion, staff supplementation, and cost savings you’re looking for.

Education and Marketing? DataPath offers the industry-experienced, professional marketing services that you won’t find anywhere else.

Where do you want to grow? Let’s start the journey. Contact DataPath today.

dpath.com/tpa-grow

Save time and money with a fl exible digital payments solution.

Third-party administrators (TPAs) leverage our 25 years of experience to solve complex payment requirements.

Expect more. More efficiency. More choice. More savings.

The ECHO Advantage

Enjoy the simplicity of a single payment solution:

Convert costly check payments to a fully digital platform

Eliminate the pain, risk and time involved in the 1099 process

Offer customized, consolidated family EOBs

Avoid fees for setup and implementation

echohealthinc.com

Flexible solution

ECHO is a comprehensive solution, not a one-size-fits-all approach. Our end-to-end solution is tailored to fit your needs for vendors, commissions, and member payments.

Network scale

With 1.6M + unique provider and vendor connections, we have the largest payment network, allowing increased digital adoption rates and fast, painless payment processing.

Seamless integration

Implementation and workflow designs are built around unique needs for seamless integration, with minimal time commitment for IT teams.

Compliance expertise

We’re compliance experts, processing HIPAA, HITRUST, OFAC, and IRS 1099 compliant transactions, for your peace of mind.

Tested credibility

We are trusted to process $110B+ in payments every year, we can help with your payment challenges, too.

Electronic payment modalities:

• Digital check

• Digital wallet

Included services:

• Print and postage

• Bank fees

• Admin console

• Virtual card

• All payer ACH

• EFT fraud protection

• 1099 processing for all payments

•

• AI-enhanced, automated RBP

• Intelligently optimized allowables

• NSA & state balance billing

• Contracted network agreements

• Worker’s comp

Sophisticated algorithms uncover savings with speed and accuracy.

• Billing and coding regulation compliance

• Payment guidelines

• Episode of care

• Fraud, waste, and abuse

• Contracted rate application

• Medical bill review

• Post payment appeals and member support

• NSA and state balance billing support and process compliance

• Pre-pay and post-pay negotiations Rx

Leverage ExpionIQ’s dynamic, customizable formulary solution to achieve lowest net cost goals with industryleading contracts.

Harness ExpionIQ to discover specialty drug and member savings opportunities down to the member level with actionable insights for full cost control and transparency.

Accelerate growth goals and streamline operations with comprehensive underwriting strategies, forecasting, and AI driven pricing transparency powered by ExpionIQ.

Flexible infrastructure for health spending benefits

Innovative organizations—from TPAs to banks—use First Dollar's software and APIs to launch new offerings and manage their health spending benefits.

Pre-tax benefits

FSAs, HRAs, HSAs, Commuter

Supplemental benefits

Dental, OTC, Rewards

Build your dream program

Made for your platform

Embed health spending benefits on your platform, re-brand the participant experience, or stack multiple benefits on one card

Build it your way

Built for your administrators

Use our self-service tools to launch a new benefits program and resolve member issues without filling out a service request ticket

Designed for humans

People love to use our health wallet our utilization rates are double the industry average And with an intuitive design and an accessibility score of 97, it’s easy to see why

Lifestyle benefits

LSAs, Specialty HRAs

31 years of dedicated healthcare investing in the middle market

Deep healthcare domain expertise with extensive industry network developed over decades of experience

• 42 platform investments made

• Over 130 add-on acquisitions completed

Successful track record of building category-defining and rapidly growing healthcare companies

$10 - 75M Entry EBITDA

Thesis-driven investing with an Executive-inResidence model

Control transactions in profitable and growth-oriented healthcare services companies

Dedicated Center of Excellence team with functional experts driving value-creation initiatives

$7.0B Fund Capital Raised

Current Investment Portfolio

$1.5B Frazier Growth Buyout Fund X

Tech-enabled Revenue Integrity and CDI services for hospitals and health systems

Global pharma CDMO specialized in OSD and manufacturing technology

Real-time data and insights provider to healthcare & life sciences

ABA autism therapy provider

Orthopedic physician practice management

Enterprise pharmacy solutions to hospitals / systems

Cold chain shipping solutions for pharmaceutical & life sciences companies

Mental health solutions provider for K-12 students

Tech-enabled revenue cycle management solutions

Multi-capability med device contract manufacturer

Generic pharmaceutical repackaging and distribution services

FDA 503B-registered compounding pharmacy

In-home and mobile clinic health assessments provider

Manufacturer of anesthesia and respiratory medical products

Dermatology practice management

It’s time to change the cancer status quo

Only 14%‡ of diagnosed cancers in the US are detected by a recommended screening test,1 resulting in significant human and financial challenges.

Human impact

• About 70% of cancer deaths are from cancers employees are not being screened for today.2**

• Survival varies based on the stage at which the cancer is diagnosed: 89% of patients with early-stage diagnoses survive 5 years post-diagnosis, compared to 21% of those diagnosed late-stage.3†

The Galleri

®

Cost impact

• Cancer is the #1 driver of medical costs for self-insured employers.4

• 81% of all cancer claims above $100K are caused by treatment for cancers without recommended screening.5

• 53% of employers’ total cancer spend goes towards late stage cancer.5

test: a #1 employee-ranked health benefit

6*

By adding Galleri to recommended screenings,7 employees can go further – from screening for 5 cancers to screening for 50+.8

• The Galleri test screens for a signal shared by 50+ types of cancer8 –all it takes is a simple annual blood draw.

• The Galleri test includes screening for fast-spreading cancers that often don’t show symptoms in early stages.8

• Galleri is a proactive screening tool that looks for a signal in the blood associated with active cancer. It is not a test that predicts future genetic risk for cancer.

• Using machine learning and AI, Galleri can also predict the cancer signal origin (tissue/organ).

• Galleri has a 0.5% false positive rate8 (found in study participants without cancer).

• The Galleri test is recommended for use in adults with an elevated risk for cancer, such as those aged 50 or older. (Individuals aged 50+ have a 13X increase in cancer risk versus those under age 50.)9

Since launching in June of 2021, over 150,000 tests have been completed, with 80+ employer partners, and nearly 9,200 prescribing physicians nationwide.10 Partners include innovative employers, health systems, and more (e.g. Salesforce, Intermountain Healthcare, Paramount, Valmont Industries, Providence Healthcare, John Hancock Insurance). We look forward to discussing how employers might benefit from access to this groundbreaking tool in the fight against cancer.

‡This includes screen-detected breast, cervical, colorectal, and lung cancers.

*The Galleri test was a “#1 ranked health benefit” in market research conducted by Ipsos Group S.A. Study demographics included 1,000 respondents who were full time employees working at companies with at least 3000 employees: 15% of sample aged 65+, 70% of sample aged 50-64; 15% aged under 50 with cancer risk factors. Respondents were a representative mix across gender, region, race, ethnicity.

** Assumes screening is available for all prostate, breast, cervical, and colorectal cancer cases and 43% of lung cancer cases (based on estimated proportion of lung cancers that occur in screen-eligible individuals older than 40 years).

†“Early/Localized” includes invasive localized tumors that have not spread beyond organ of origin, “Late/Metastasized” includes invasive cancers that have metastasized beyond the organ of origin to other parts of the body.

The Galleri test does not detect a signal for all cancers and not all cancers can be detected in the blood. False positive and false negative results do occur. Galleri should be used in addition to healthcare provider recommended screening tests.

When Congress needed to understand healthcare transparency to create the landmark No Surprises Act legislation, there’s a reason Bluebook was the only transparency company asked to testify before the Senate.

We were one of the first to introduce “transparency” to the healthcare market nearly 20 years ago.

Founded on the belief that everyone should have access to the true quality and cost of healthcare, Healthcare Bluebook is the most experienced and trusted expert in healthcare pricing, quality, and consumer behavior today.

Out of the gate, our core cost navigation solution met many of the initial transparency requirements.

Bluebook’s compliance solution is 100% Compliant with TiC and NSA rules and includes:

Allowing us to serve:

Bluebook Comply Base navigation supports all current requirements, including the expanded list of surgical procedures required as of 1/1/24. Additionally, we will support all future legislative requirements if/when they become officially mandated, such as Rx and Advanced EOB functionality.

• MRF Data + Historical Claims Data

• Consumer-Friendly Terms (CFTs) for all 500 currently mandated services

• Total cost illustrations based on entire episode of care

Comply Base Standard Features

• Industry’s Most Intuitive UI/UX

• Dual-Level Reporting (TPA vs. Employer)

• Qualified Payment Amounts (QPA)

• White-Labeling / Co-Branding Capabilities

Comply Premium Upgrades

• Quality Metrics

• Member Engagement and Incentives

• Plan Design Integration

• Bluebook CareConnect™ Concierge Support

• Bluebook Rx™ Pharmacy Cost Navigation

Learn how our Medical + Rx cost and quality navigation solutions can use compliance to create meaningful, hard-dollar savings for your employers and their employees. Contact TPASupport@healthcarebluebook.com to schedule a demo.

OUR SOLUTIONS

A nationwide leader delivering Care, Cost and Risk Management solutions and services that matter to you and your members.

Comprehensive Provider Access and Healthcare Services to Payers, Plans and Members.

Cost Containment, Utilization Management & Disease Management.

Personalized solutions for your members’ healthcare journey.

Hines provides fully integrated health management programs that deliver optimal clinical outcomes with superior financial results. For every stage along the continuum of care, Hines o ers custom solutions.

Led by talented, experienced and knowledgeable team of registered nurses, medical specialists, financial review professionals backed by AI driven technology.

Hines accompanies your members through every step of their healthcare journey by coordinating integrated Care, Cost & Risk Management solutions. Our industry-leading suite of health management services is entirely customizable for Payers, Plans, and Members.

We o er:

•Provider Open Access Program (POAP)

•Curated medical management

•In-depth risk analysis with predictive modeling

•Prevention and wellness engagement

•Early and continuous patient intervention

•ClaimChexTM cost management platform for optimal negotiated savings

With Hines, you're in good hands.

Designed to return control of healthcare back to the patient and plan. Opus one integrates Care, Cost and Risk Management in a single bundled package superior to a Primary PPO network or a reference-based pricing alternative solution.

With Hines, gain end-to-end health and wellness services personalized services for better care, better outcomes.

We’ll be there for you every step of the way!

Fast.

No matter what size payer you are, your software should meet your needs, save time, and get the job done. When we tailor Series 3000 for you, you’ll have all of this and more. You have nothing to lose. And your customized turnkey solution to gain. Contact us to schedule a

Tailored.

Series 3000 meets your needs and scales as you grow.

Too many TPAs limit their own revenue, their value to their customers, and their ability to di erentiate their services by not taking advantage of innovation opportunities. Every employer client represents an opportunity to establish a special relationship between you and each employer by presenting opportunities for additional value, quality improvements, and cost savings that your competitors can not or are not doing.

Ikigai Growth Partners evaluates hundreds of early-stage firms, looking for the few hidden gems that add value to your relationships. Current hot deliverables include:

• Digital direct contracting, DPC networks, vendor management, and bundled services

• Surgical optimization; faster recovery with almost no opioid utilization

• Caregiver support services for employees supporting aging loved ones

• Musculoskeletal (MSK) true digital front door, allowing immediate access to care triage and virtual expert support

• Virtual group mental health therapy

Don’t limit your organization to only those standard services and o erings that mimic your competitors. Add value to your relationships through innovation.

Come explore with us.

Michael Brouthers

Founder/Principal

Ikigai Growth Partners

mbrouthers@ikigaigrowthpartners.com

ikigaigrowthpartners.com

Member/provider

EnrollEnrich.io

Enrich

AuthEnrich.io Transform

Liberty Mutual Employer stop loss

We understand that relationships are one of the driving forces in our industry today. We are committed to meeting the special needs of our broker partners and, most importantly, our self-funded employers. Our employer stop loss coverage helps employers plan confidently for the future, without the worry of catastrophic medical expenses.

Services offered:

Specific coverage

• Incurred and paid contracts

Our mission is to be a leader in the excess loss industry through outstanding service, relationship building, and innovative products.

Liberty is here for you. Today. Tomorrow. Together.

For more information, please visit: lmi.co/business.

us on LinkedIn and be in the know on emerging trends, legislative updates, and announcements.

Please send all RFP submissions to:

MSLquotes@libertymutual.com

To learn more, please contact:

MSLSalesDesk@libertymutual.com

• Specific deductibles available from $25K (per state regulations) to $750K

• Eligible groups down to 25 covered lives (per state regulations)

• Coverage available in all states except WA

Predictive analytics

Predictive data and risk tool for underwriters to accurately price groups without experience.

Aggregate coverage

• Incurred and paid contracts

• Monthly aggregate accommodation available

• Terminal liability option available

• Solutions available for fully insured take-overs

Referenced based pricing

Strategic partnership with preferred vendors to manage cost while providing the best possible member experience.

In-house clinical team and ProAct solutions

Coverage isn’t a one-size-fits-all solution, which is why our stop loss customers enjoy the added advantage of our in-house clinical review team and ProAct solutions. Specialized to help contain costs, these benefits include:

• A voluntary risk-management program that complements each client’s individual stop loss coverage plan

• The combined support of our industry-leading underwriting capabilities, best-in-class vendors, and an elite clinical team of on-staff nurses to help improve clinical outcomes and enhance care coordination

• Access to transplant and cell and gene therapy networks, case management for catastrophic claims, and specialty pharmacy management

• Access to supplemental contract negotiations, bill review, and outof-network negotiations

• Access to our robust in-house clinical review team offering expert guidance to producer partners

• In many cases fees for vendor services can be considered as an eligible expense under the stop loss policy for members that exceed the specific deductible

30+ Services One Solution

At MedWatch, our focus is to provide clients with solutions that effectively control medical costs and enhance the outcomes of care.

Our program options allow the plan to build a tailored and effective benefit offering that not only saves the plan and plan member money, but provides enhanced care options. By promoting the utilization of quality services that result in better outcomes, members are more likely to engage and use their benefits wisely.

Compassionately Built – Seamlessly Integrated

We’ve carefully constructed 30+ programs and services that fit together seamlessly to meet members where they are in their health journeys.

With 35+ years in the industry, MedWatch’s continued innovation and growth, proprietary technology, depth of staffing, experience, and expertise provides clients with the best solutions and partner available.

Full Spectrum Care Management

( Pathways Concierge Member & Provider Support

( Utilization Management

( Case Management & Specialty Case Management

( Chronic Condition Case Management

( Disease ManagementLiving Well with Chronic Conditions

( High-Cost Infusion/ Oncology Treatment Program

( Dialysis Claim Review & Pricing

( Telemedicine

( Employee Assistance Program

( And More Uniquely

“Because no one should have to walk their healthcare journey alone.”

Sally-Ann Polson | President & CEO

Precision Analytics for Health Plan Management

“When every penny counts, we count every penny”

Optimized for TPAs, Healthplans, and Brokers

In-Depth Data Analytics: Uncover deep insights into health plan data to drive informed decision-making

Claim Re-Analysis: Delve into past claims for a thorough understanding and better future strategies

Individual and Multi-tier Modeling: Tailor your approach with versatile modeling options for individual and multi-tier plans

Integrated Medical and Prescription Data: Connect the dots between medical services and prescriptions for a holistic view

Cost Illustration: Visualize expenses many ways, enabling clearer financial planning

Product Services

Analysis Reporting: Comprehensive analysis for a deeper understanding of claim patterns as well as convenient summaries of enrollment and claims

Cost Trend Reporting: Forecast future expenses with advanced trend analysis tools

Disclosure Reporting: Essential for TPAs needing detailed stop-loss underwriting data

Plan Modeler: Simulate changes in plans, assessing impact and efficiency

Scheduling: automatically generate reports at specified intervals

Custom Reporting: Build a custom report based on specific needs

Highlights & Features

•Developed in 2005 and maintained in the USA

•Fully customizable reporting

•40+ years of collective expertise in self-funded sectors

•Unlimited user access

Your Ideal Analytics Partner

Whether you're a TPA seeking comprehensive analytics, a broker in need of indepth insights into health plans, an HMO navigating complex healthcare landscapes, or a Medicare/Medicaid payor aiming for efficiency and compliance, Planwatch is your go-to solution for efficient, data-driven decision-making.

Reimagining pharmacy management to provide the same care we would want for our loved ones

We are creating a new standard for pharmacy benefit managers and the health care industry, based on three key areas of distinction:

CONFLICT FREE

We are not incentivized to promote pharmacies we own. We work with our customers to help them choose the best and most affordable paths for their business and their members.

CROSS-BENEFIT AND SPECIALTY EXPERTISE

As the pioneers and market leaders in specialty and medical drug benefit management, we take a holistic view to lower the total cost of care and improve health outcomes.

PURPOSE BEYOND PROFITS

Because we are privately owned by not‑for profit health plans, we can focus on providing the same care we would want for our loved ones instead of worrying about the pressures of Wall Street.

Learn more about how we’re working to do what’s right for everyone we serve at REIMAGINEPHARMACY.COM

We

Who We Serve

-Third Party Administrators

-Stoploss Carriers/MGUs

-Self-Insured Companies

Products We Defend

-Code Compliance Reviews

-Single Case Agreements

-Group Wide Contracting

-Clinical Standards of Care Eval

-Specialty Drug Therapy Contracts

-Medical Record Retreival

Great teams build great products for those in need. We combine team member expertise and experience to secure advantages for our Clients. RMR provides access to credentialed and certified professionals. - CPC,CIC, RN, MD, & Ph.D, AHIMA, HIT, Nurse Auditors, and Veteran Contracting Officers.

Receiving Healthcare should not bankrupt an individual nor plan. Even more so if the cost of that healthcare is consistently inaccurate and left unchecked. Cost Containment should help, but it needs to become more comprehensive and impactful. We work tirelessly, from all corners of our industry, to increase your CLEAN CLAIM CONFIDENCE to the highest risk areas of your plans. LARGE DOLLAR CLAIMS.

-Large Dollar Claims

-In Network/Out of Network

-Inpatient/Outpatient

-CAR- T Therapy

-NICU/ICU

-Trauma Centers

-Burn Unit

-Oncology and Radiation

-Durable Medical Equipment

-Rehabilitation

-Air Flight/Ambulance

-DRG and fee-schedule Validation

-QPA Data Analytics

At RMR we understand that our Clients have specific needs. Let’s talk. Now more than ever, it is necessary to stay on top of the changes weaving their way into our industry. In turn, it is our belief that Cost Containment efforts must also evolve to maintain relevance and effectiveness. RMR’s products strive to be dynamic. This ensures both product compliance and relevant results are delivered.

Jason

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MAKING HEALTHCARE EFFICIENT WITH AUTOMATION

Corporate Solutions

You want unparalleled customer service. Employers need the right stop loss coverage. At Swiss Re Corporate Solutions, we deliver both. We combine cutting-edge risk knowledge with tech-driven solutions and a commitment to put our customers first. We make it easy to do business with us and relentlessly go above and beyond to make stop loss simpler, smarter, faster and better. We’re addressing industry inefficiencies and customer pain points, moving the industry forward – rethinking employer stop loss coverage with you in mind.

corporatesolutions.swissre.com/esl

THE PHIA GROUP’S SERVICES

Learn Plan

Save Protect

The Phia Group is Empowering Plans to Contain Costs Through Comprehensive Consulting, Legal Expertise, Innovative Plan Design, Superior Claim Negotiation & Unrivaled Recovery Services

Learn:

Plan:

Independent Consultation & Evaluation (ICE)

General Consulting & Third-Party Agreement Review

Family & Medical Leave Act - Policy Review & Drafting

Phia Document Management® (PDM) & The Flagship Template

Plan Drafting Services - Including Wraps & SBCs

Gap Free Review® - Including Stop-Loss & Employee Handbooks

Save:

Protect:

Subrogation & Reimbursement

Overpayment Recovery

Claim Negotiation & Sign-Off (CNS)

Phia Unwrapped - Out of Network Solution

Plan Appointed Claim Evaluator® (PACE)

Balance Bill Resolution & Reference -Based Pricing Support

Patient Defender

Balance Bill SafeGuard

Phone: 781-535-5600

Email: info@phiagroup.com

Website: phiagroup.com

U n d e r w r i t i n g M a n a g e m e n t E x p e r t s

S t u d e n t M e d i c a l M

S m a l l G r o u p / L e v e l F u n d e d ( M a x i m u m A d v a n t a g e )

T r a d i t i o n a l S t o p L o s s

C a p t i v e s

R i s k S h a r e

M E C

NEXT-GENERATION

ADMINISTRATION SOFTWARE

Elevate your business with cutting-edge technology that is more responsive to your needs. VBA delivers personalized, intelligent solutions that empower informed decision-making for today’s healthcare payers. We are transforming the healthcare landscape with better insights and faster, more accurate claims processing.

Pushing the Boundaries of Innovation

We work each day to develop software solutions for the problems of today and tomorrow.

A POWERFUL CLAIMS PROCESSING ENGINE WITH LIGHTNING-FAST ADJUDICATION SPEEDS

AI-ENABLED ASSISTANCE BRINGING INSTANT, ACCURATE ANSWERS TO VBASOFTWARE USERS

INNOVATIVE FEATURES AND SOLUTIONS LEVERAGING AI FOR MORE EFFECTIVE, EFFICIENT BUSINESS OPERATIONS

VBA

Empowered Members, Lower Plan Costs, Satisfied Clients

At No Cost to TPAs

Approximately 15 million Americans have surgery every year,1 and as many as 50% of those surgical procedures are medically inappropriate.2

The truth is, when patients hear the word surgery, most never take the time to consider all their options, often leading to avoidable medical expenses. Welvie is changing that.

Welvie My Surgery® is a proprietary six-step online program designed to educate and empower plan members who are considering surgery, arming them with the information needed to make the best decision for their health and well-being. When surgery is necessary, they are guided though the process every step of the way to drive better outcomes and ensure that the benefits outweigh the risks.

Step 1: Get the Right Diagnosis

Step 2: Find the Right Doctor

Step 3: Make a Decision

Step 4: Learn About Hospitals

Step 5: Prepare for Surgery

Step 6: Recover at Home

Web Portal 2.0

MediConnX360, Powered by TALON, is an identically operating native app for iOS and Android, and a web portal unlike any other, providing patients, payers, employers, providers, and brokers with ondemand, all-inclusive access to the data and services they need. That means members are instantly connected – and stay connected – to the industry’s most comprehensive, compliant, and automated benefits administration solutions.

o With MediConnX360 you can:

• Grant on-demand access of machine-readable files and reports to administrative and employer users.

• Distribute information to a large audience, using the integrated announcement feature

Provide directed selling methodologies

o And your members will be able to:

• Utilize price comparison shopping, including quality metrics and innetwork guidance.

• Verify claim payments.

• Access ID cards, Explanation of Benefits (EOBs), and Advanced Explanation of Benefits (AEOBs).

Search physicians linking members with providers.

Securely send messages and attachments.

Manage enrollment, family status changes, and ID card requests. …and much, much more!

Scale your Business with a Unified Member Experience

zAnalytics Unlocks Insights for Action

Our visual dashboard offers actionable strategies for informed decision-making for TPAs like you. The zAnalytics Reporting Suite provides personalized insights through customizable reports and enhances heathcare management choices

Pain Points Solved

• Cost Containment

• Technology Integration

• Client Retention & Acquisition

• Boosting Operational Efficiency

zAnalytics Reporting Suite

Highlights

• Claims data reports

• Plan use analysis

• HIPAA compliance reports

zAnalytics Highlights

• Identification of cost and risk drivers

• Dynamic cohort building

• ROI tracking to measure intervention effectiveness

zAnalytics Case Study Results

• $20 Million savings in Rx

• 67% members increased PCP visit

• 13% decrease in ER usage

zConnect: Unified Member Experience

Unified Data Platform

Predictive analytics and algorithms to identify gaps in care, cost drivers, risk drivers, etc.

Personalization

Use data driven technology & CRM to personalize member experience and interactions

Asynchronous Multi-Touch Communication

Digital assistant available 24/7 to support members in their day to day queries, issues and easily connect to human touch

Artificial Intelligence

Pro-actively promote appropriate behaviour e.g. close gaps in care, make PCP appointments, use alternative places of care

Predictive analytics and algorithms to identify gaps in care, cost drivers, risk drivers, etc. Nudges

zConnect Cost Estimator Tool Solution

• zConnect is a dynamic, embedded multi-touch mobile provider search tool configurable to any plan design and network design

• zConnect allows members to search and compare the prices for healthcare services at different places of care based on contracted network negotiated rates

About Us

We believe in a better way to price, explain, and pay for healthcare on behalf of insurers and their members.

As the leading payments company in healthcare, we price, pay and explain healthcare for payers, providers, and healthcare consumers. Zelis was founded on a belief there is a better way to determine the cost of a healthcare claim, manage payment-related data, and make the payment because more affordable and transparent care is good for all of us.

Why Zelis?

We partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, 1.5 million providers and millions of members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and an integrated pre-payment through payments platform to manage the complete payment process.

Zelis brings efficient, purpose-built solutions backed by a passionate team and agile technology to harmonize the complete payment process in healthcare.

Zelis has been recognized as an INC 5000 Fastest Growing Company annually for the past 11 years, and is a certified Great Place to Work.

MDI NetworX

Medical Review Institute of America

Paydhealth LLC

Sharecare

Vitable Health

WellDyne