health cost iq

Company Overview

Our Value Proposition

Decision analytics

Risk Stratification and Predictive

Modeling

Population Health, Wellness and Risk

Assessment

Health Cost IQ (HCQ) is leading innovation in predictive modeling, cost and population health management analytics, risk stratification and data-driven, evidence-based business decision support for organizations such as payers, self-funded and self-insured employers, independent brokers, medical management companies, professional employer organizations, hospitals, health systems, ACOs, and other risk-holding fiduciaries.

© 2018 Health Cost IQ. All Rights Reserved. CONFIDENTIAL

Opportunity discovery

© 2018 Health Cost IQ. All Rights Reserved.

1. BETTER HEALTH

2. BETTER OUTCOMES

3. IMPROVED BOTTOM LINES

High Level Goals: Triple Aim

Focused Goals

1. Preemptive identification of chronic conditions and risk factors

2. Improved Rx adherence with treatment

3. Reduction of unnecessary utilization and associated costs

4. Reduction in overall member risk


Risk Holders

Manage cost

Increase employee engagement & responsibility

Explore new options

Add value

▪ Reduce or Eliminate Coverage

▪ Direct Contracting

▪ Explore Future Cost Savings

▪ High Performance Formulary

▪ Increased Spousal Costs

▪ Increased Incidents of disease

▪ Price / Quality Transparency

▪ Employer Accounts (HSA)

▪ Healthy Work Culture

▪ Mobile Applications

▪ Data Availability

▪ Centers of Excellence

▪ Telemedicine


Top Employer Trends *

* Towers Watson Employer Survey January 2015

Where HCQ comes in…

Population health

We deliver sophisticated longitudinal analysis based on the Johns Hopkins ACG® System and HCQ’s DataIQ predictive algorithm to predict future risk in patients and employer groups and evaluate the financial impact to the risk holders. Displays both aggregate and patient level detail to drive behavior change, leading to improved health and financial outcomes.

Data management

Sophisticated, proprietary data acquisition and management methodologies facilitate quick and efficient implementation and onboarding of new clients. Deep experience in acquiring data from major national and regional carriers, including Express Scripts, UHA, Anthem, United Healthcare, Medical Mutual, Allied Benefits, LDI Pharmaceuticals, and more.

Cost and Risk modeling

We have integrated medical, Rx, dental and vision claims with premium data, demographics, and patient risk assessment factors to create proprietary models that stratify and predict medical and financial risk, future cost and utilization as well as enabling the efficient monitoring, tracking, trending, and coaching of patients to better health outcomes.

Opportunity discovery

Our actionable decision analytics employ hundreds of proprietary algorithms to help organizations uncover wasteful inefficiencies and discover potential cost savings in their population’s medical and pharmacy utilization, leading to improved plan design, lower overall cost, improved care outcomes and enhanced ROI on their total healthcare spend.


How HCQ Delivers…

A TRUSTED PARTNER

1

2

4

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TransparentOur dashboards and reports set a standard in transparency, providing clarity and insight into your data to drive evidence-based decisions.

focusedOur multidimensional Risk Profiling and Predictive Modeling process allow you to focus on those areas that specifically impact cost and quality.

agileWe are responsive, near real-time, flexible and iterative. Healthcare is not static; you have to adapt continually to the changing conditions.

actionableOur solutions provide senior leaders and their staff with tools and resources that convert opportunities into value-driven and measurable results.


Our Flagship Software Product:

SaaS-based cost and health Management Platform

A comprehensive, cloud-based SaaS

platform that equips organizations of all

kinds to more efficiently manage their

population’s risk, cost, utilization, and

care outcomes. Backed by the Johns

Hopkins ACG® System and HCQ’s

proprietary DataIQ risk adjustment

algorithm and predictive model.


Determines at a glance the financial risk facing an organization’s health plan and insured population.Tracks historical and ongoing risk trends and predicts future risk and cost 12 months in advance.Clearly identifies individuals and groups most at risk to guarantee timely and cost-effective intervention.Highlights the efficacy or lack thereof of employer managed incentives and health management programs so corrections can be made to avoid waste.Provides clear, data-driven and evidence-based ROI metrics on all health-related spending, and more.

Additional Software Products

Rx Claims Inefficiency & Opportunity Discovery

Our Opportunity Discovery module

utilizes proprietary algorithms to help

organizations easily discover ways to

gain in Rx efficiency, uncover potentially

significant Rx cost savings, optimize

plan design, and enhance ROI and

bottom lines on total Rx spend and

drug utilization.

Provider-based Enterprise Analytics Suite

A comprehensive, provider-facing

analytics module with actionable

performance metrics that cut across

clinical, financial, management, and

administrative domains. Backed by

HCQ’s powerful data warehouse of

publicly available Medicare

administrative and claims data.


Provider-facing, comprehensive data warehouse of all Medicare administrative claims & cost data.Unlimited performance metrics to help hospitals and providers stay ahead of Medicare penalties.Proprietary algorithms that identify costly and unnecessary inefficiencies in pharmacy spend.Concrete recommendations to optimize formulary and plan design, potentially saving millions.

Brand Name Analytics - Scaled without being Cost Prohibitive

Deep Integration with the highly-regarded Johns Hopkins ACG® System

Sophisticated illness, cost, and risk forecasting 12 months into the future

Proven, accurate risk stratification of all types of patient populations

Evidence-based, peer-reviewed risk identification and intervention strategies


Our Trademarked* 3-step PIA® Methodology

predict interpret act


Predict health cost, disease burden, and future risk for your health plan groups

Act quickly and intervene to lower risk, reduce cost, and improve outcomes

Interpret the results of our risk stratification and predictive modeling

Our trademark for the Predict. Interpret. Act. process establishes our 3-step methodology as unique in the health care IT and population health management space.

Sample Analytic Dashboard: Utilization Cost


Review high-level risk profile for your entire population, including past spend and future predicted medical and Rx spend.Review the stratification of your entire population into distinct risk categories along with their past & predicted future cost.Click on any risk category to drill down to patient level data and unlock more granular insights regarding risk drivers and more.Review best case and worst case scenarios for future cost & risk for each member on your plan.

Sample Analytic Dashboard: Large Claims Spotlight


Review total premiums received and compare them to medical and Rx claims paid out for any given period of time.Evaluate which individuals or groups within your population are profitable or losing money.Correlate claims paid with current and future risk, drilling down to individual members and groups if necessary.Determine which locations and member behaviors are most responsible for the bulk of your medical and Rx claims cost.

Sample Analytic Dashboard: High Cost Members


Review at a glance all members of your population ranked by future medical and Rx risk.Evaluate 12-month predicted medical & Rx cost to determine possible need for intervention, such as raising premiums or increasing plan deductibles.Review best case and worst case scenarios for future cost & risk for each member on your plan and make changes accordingly to prevent catastrophic losses.

* Note: All names displayed on this page are derived from demo data created for demonstration purposes only.

Success Stories


▪ Client 1: Medical Management Company

– Quicker access to predictive and analytic insights in just over 10 months have helped save this client nearly $200K in unnecessary labor and hiring costs by maintaining staffing levels.

– Client self-reported reduction in “dead time” for administrative nurses of over 30%, resulting in an additional $100K in savings.

– Total savings for client: over $300K in less than a year.

▪ Client 2: Professional Employer Organization (PEO)

– In late 2018, HCQ’s proprietary data validation protocol identified over $2 million in overpayments by the client’s medical and pharmacy carrier in just over 2 years.

– These overpayments caused the client’s stop-loss coverage to increase substantially, resulting in additional, unnecessary costs for secondary insurance coverage running into several hundreds of thousands of dollars.

– Client has confronted its carrier with our findings and is forcing a settlement with them as well as contractual changes to carrier’s business practices based on our findings.

– Potential savings for client: over $2.5 million.

The PlatformHCQ’s flagship product suite simplifies the management of healthare costs and outcomes for:

• Medical Management Companies

• Benefit Consultants and Brokers

• Payers, including TPA’s and Insurers

• Self-insured & self-funded Employers

• Professional employer organizations

• Hospitals, Health Systems and Providers

• Public School consortiums and districts


Stress-free Client Onboarding

No maintenance fees

No end-user license fees

No training fees

Only PEPM or PMPM costs


Existing Data Vendor AgreementsPartial list of vendors and carriers that we currently maintain data share agreements with

Once we have a BAA signed with a data vendor or carrier, most new clients never have to lift a finger during their initial implementation until their dashboards are deployed and ready for use, typically within weeks.


Upcoming Product Modules for 2019

Version 3.0

LABs

Er vISITS

Predictivemodels

Opioids

New lab markers

• Diabetes• Dyslipidemia• Deficiency Anemia• Kidney Disease

New Er Visit Classification

• Non-emergent• Emergent• Injury• Behavioral health• Substance abuse• Unclassified

Opioid Use and abuse

• Chronic User• Concomitant User• Opioid Dependent

CMS-HCC ModelsA new CMS Hierarchical Condition Category (HCC) model will allow Medicare Advantage health plans to examine the CMS risk of their beneficiaries.


Pharmacy savings Discovery

• Branded Generics• Generic Equivalents• Best Buy Generics• Generic Therapeutic Alternatives

Pharmacy savings

Contact Information

Jude Odu, CEO

1820 E. ray rd, chandler, az 85225

(928) 608-5868

(800) 526-3540

[email protected]

www.healthcostiq.com

health cost iq

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