
Reclaim Intro | Macquarie
Reclaim Health
Created on September 19, 2024
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Transcript
Proactively engage plan members to optimize their coverage and save on healthcare spend through Reclaim's claims-driven healthcare financial advocacy platform.
Reclaim Health
Proposed agenda.
AGENDA
- Introductions (Keith): 5 min
- Recap Previous Call (Keith): 5 min
- Demo User Experience (Nataly): 15 min
- Discuss Analytics (Dogu): 15 min
- Questions and Discussion (All): 15 min
- Next Steps (Keith): 5 min
CRO | Commercial leader
Scott Fillenworth
CTO | Tech leader
Chris Quirk
CEO, Board Director
Nataly Youssef
Chief Strategy Officer Health expert
Dogu Celebi
Board DirectorPartnerPillar VC
Jamie Goldstein
Chief Data Science Board DirecorAnalytics Chair at MIT
Dimitris Bertsimas
Board DirectorFormer COO CVS Health
Jon Roberts
VP Business Ops
Michele Lowe
Reclaim's vision was created by a team of health, insurance, and technology experts who also happen to be patients and caregivers. We are empowered by software and algorithms designed and built by MIT researchers.
Reclaim was spun out of MIT with the purpose of helping families manage their healthcare dollars and optimize their health coverage.
STORY AND LEADERSHIP
Recap previous conversation
background
- Introduced to Reclaim through Emperyan
- Currently using HDMS, which is being sunsetted
- Aetna is medical, dental, and vision
- Have MSK, 2nd MD, Spring Health, Maven, Calm, FitOn, Fidelity, LearnLux, Sleepio/Daylight, Big Health.
- Requirements Doc Shared
Claims-driven billing, spend, underwriting and coverage insights
Simulation optimization personalizing recommendations
RECLAIM overview
AI-generated health events and bill savings
Itemized medical & Rx claims
track every dollar
Bill corrections, reversals, and reimbursements
OPTIMIZE COVERAGE
Voluntary payouts, ancillary programs, network savings.
select right coverage
Save $950 by switching to the low cost plan
Claims-driven. AI-DRIVEN. Proactive.
Collaborative filtering predicting care utilization over time
From buying the right health insurance to saving on their healthcare bills.
Reclaim is an AI-powered healthcare financial advocacy platform helping families manage their health spend.
Reclaim proactively reviews the user's healthcare bills and highlights ways they can save on cost.
save on bills
RECLAIM overview
Reclaim proactively reviews the user's healthcare bills and highlights ways they can save on cost.
RECLAIM overview
save on bills
RECLAIM overview
OPTIMIZE coverage
Reclaim personalizes coverage recommendations in the context of the user's own recent health visits.
RECLAIM overview
OPTIMIZE coverage
Reclaim personalizes coverage recommendations in the context of the user's own recent health visits.
- 74.1% activated for new groups
- 84.8% activated for existing groups
Page 2
High activation rates unlock our proactive engagement throughout the year.
Reclaim is offered to ALL plan members. Reclaim accesses employees across patient cohorts, demographic segments, and coverage needs.
78.8% of employees activated Reclaim across all groups (new or existing).
High activation rates
Page 3
- 1 -
60.1% of engaged employees adopt Reclaim's recommendations.
Reclaim Health Get started with Livongo today
Hi Taylor, we reviewed your bill for your Aug 5 visit. No charges other than your copay. Tap here to review the details and get started on a personalized action plan with Livongo, completely free of charge to you.
Reclaim proactively engages members throughout the year in the context of their own claims/bills, highlighting voluntary payouts, care management programs, and other ancillary programs and network considerations.
Of those activated, 70.5% employees proactively engaged throughout the year in the context of their bills.
High engagement rates
Here's a breakdown of prominent types of bill savings, per employee with 2023 qualifying events:
- $2,630 in voluntary benefit payouts
- $770 in bill corrections.
- $580 in reimbursements by providers for reversed claim charges
Reclaim Health Hospital payout has been approved!
IMPACT ON EMPLOYEES 1/2
Hi Taylor, Brenda here from Reclaim. I have some great news: your $1,100 hospital payout has been approved! The funds should show up directly in your bank account within 5 business days. Tap here to chat if you have questions!
Oh my absolute pleasure! I am working on reviewing the services billed by Dr. Johnson for your March 5th visit. Some of the charges were recently reversed by your insurance. I will get back to you shortly with next steps.
$1,960 in average employee bill savings per employee for qualifying events.
OMG!!! Thank you!!
Employees save money
Page 5
Compare these savings to:
- $1,606.7 overpaid overall on current plan for employees that are yet to activate Reclaim.
- $937.6 overpaid overall on current plan for activated employees that have not run a recommendation.
IMPACT ON EMPLOYEES 2/2
$753 in average employee overall savings per employee trusting Reclaim's recommendations.
Employees save money
Page 6
- For network-efficient plans (tiered, reference-based), 6x increase in adoption, with 95.6% retention rate (84.8% for those yet to activate Reclaim)
- Proactively linking 78.0% of employees with diabetes and 80.2% with asthma to care management programs, in the context of bills related to their asthma/diabetes care.
IMPACT ON EMPLOYERS 1/2
87% increase in 2024 cost-effective plan adoption compared to adoption before Reclaim rollout.
Improved benefit utilization
average cost differential across all employees: ~$23 PMPM
average cost differential across all employees: ~$57 PEPM
- We've followed a cohort of employees across groups that were fully covered by their employer coverage for both 2022 and 2023.
- We do not attribute these claim savings to Reclaim. Rather, we are highlighting correlations, not cause and effect. This is most likely the effect of amplifying the employer's benefit and cost containment strategies, combined with Reclaim's deployment to ALL plan members and high engagement rates.
IMPACT ON EMPLOYERS 2/2
Engaged employees exhibit lower cost trends compared to those yet to activate or adopt Reclaim recommendations.
Amplify cost containment strategies
Engage your team and employer clients with real-time access to activation and engagement insights and actionable targeted member communications.
Optimize member communications informed by actionable savings opportunities.
TO YOU AND employers
Targeted communications
Integrating detailed claims data for each of your employer clients, Reclaim's offers aggregate insights and sensitivity analysis to simulate product-member fit to personalize your benefit offering to your own plan members needs.
Simulate your healthcare benefitdesign given your plan members' specific needs.
TO YOU AND employers
Simulate benefit strategies
RECLAIM OVERVIEW
AI algorithms highlighting billing and/or adjudication errors given event context.
SAVING TRIGGERS
AI-generated health events and bill savings
Uncover billing and adjudication errors
MEDICAL & RX CLAIMS DATA
Incl. diagnosis, service, location, denial codes. Direct from carriers via data agreements.
In partnership with large employers, we ingest claims for all covered members, including 3-5 years of historicals and ongoing incremental data.
It all starts with the detailed medical and Rx claims data.
DATA INGEST
Detailed claims data
AI-DRIVEN
Contextualize claims into health events
AI-generated health events and bill savings
MEDICAL & RX CLAIMS DATA
RECLAIM OVERVIEW
Collaborative filtering ALGORITHM predicting care needs over time
Takes attributes of recent events as features. ML yields distribution of evolving care needs.
COLLABORATIVE FILTERING
Match to people with similar health events
AI proactively recommends actions through the lens of people like me.
simulation optimization recommending health coverage
AI-generated health events and bill savings