Reclaim Intro | Kwiktrip

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Reclaim Health

Proactively engage plan members to optimize their coverage and save on healthcare spend through Reclaim's AI-based, claims-driven healthcare advisory and advocacy platform.

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STORY AND LEADERSHIP

Reclaim was spun out of MIT with the purpose of helping families manage their healthcare dollars and optimize their health coverage.

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.

Michele Lowe

VP Business Ops

Jon Roberts

Board DirectorFormer COO CVS Health

Dimitris Bertsimas

Chief Data Science Board DirecorAnalytics Chair at MIT

Jamie Goldstein

Board DirectorPartner Pillar VC

Dogu Celebi

Chief Strategy Officer Health expert

Nataly Youssef

CEO, Board Director

Chris Quirk

CTO | Tech leader

Scott Fillenworth

CRO | Commercial leader

landscape

Healthcare costs are the top concern for insured Americans, even outweighing worries about inflation and daily expenses.

3 in 4 worry about medical cost

March 2024 KFF poll

1 in 2 struggled to pay for medical treatment

$1,900+ overbilled or owed

2024 Gallup and West Health

to families with complex health visits.

45% skipped care because of cost

$1,607 overspent

on overall out of pocket cost including premiums and costs at the point of care.

2024 Gallup and West Health

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landscape

Medical costs continue to be a major concern for self-insured employers, with significant impact to their margins. Despite investing in benefits designed to mitigate rising cost, these benefits are often underutilized.

33% engaged[2]

in wellness benefits specifically designed for cost containment.

Self-funded employers spend more than $16K per employee per year on healthcare[1]. A 15K-employee group faces a $240M in annual healthcare spend.

< 10% switch plans[3]

Employees tend to renew their existing plan, often lacking an understanding of their options and financial implications of them.

+8% cost trend[4]

[1] Aug 2024 Aon projections

2x inflation rate.

[2] Employee Benefit News

[3] Aug 2024 SHRM

[4] 2024 PwC’s Health Research Institute (HRI)

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Bill corrections, reversals, and reimbursements

track every dollar

Voluntary payouts, ancillary programs, network savings.

OPTIMIZE COVERAGE

solution

Reclaim is an AI-powered healthcare advisory and advocacy platform helping employees and self-funded employers manage their health spend and optimize their benefits.

Analytics insights

Claims-driven billing, spend, underwriting and coverage insights

Coverage advisory

Simulation optimization personalizing recommendations

Proactive. AI-based. Claims-driven. Tech first, human supported.

Billing advocacy

AI-generated health event evaluation and bill savings

Save $950 by switching to the low cost plan

select right coverage

Itemized medical & Rx claims

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RECLAIM OVERVIEW

simulation optimization recommending health coverage

Collaborative filtering ALGORITHM predicting care needs over time

It all starts with the detailed medical and Rx claims data.

AI-generated health events and bill savings

MEDICAL & RX CLAIMS DATA

In partnership with large employers, we ingest claims for all covered members, including 3-5 years of historicals and ongoing incremental data.

AI-DRIVEN

DATA INGEST

SAVING TRIGGERS

Detailed claims data

Contextualize claims bills into health events

Uncover billing and adjudication errors

AI algorithms highlighting billing and/or adjudication errors given event context.

Incl. diagnosis, service, location, denial codes. Direct from carriers via data agreements.

AI-generated health events and bill savings

IMPACT ON EMPLOYEES

MEDICAL & RX CLAIMS DATA

save on bills

Hi Taylor, Brenda here from Reclaim. I have some great news: your $3,770 appeal has been approved! Your recent hospital bill is now down to your $250 copay for St. Francis Hospital!

Reclaim Health
Hospital stay amount reduced!

AI-powered healthcare financial advocacy platform.

24/7/365 Reclaim reviews all members' claims from the smallest to the largest and identifies overbilling cases. Reclaim human advocates proactively resolve the overbilling case on behalf of the member.

OMG!! Thank you!!

mar 16 2024

JAN 25 2024

apr 10 2024

Reclaim AI reviews the claims bills

Pain in left leg Emergency visit

Now let's get your hospital coverage payout through your Securian Hospital Plan. I will get the process started for you.

$3,770 saved through appeal

Reclaim uncovers adjudication error and the advocate takes action on behalf of the member.

Admitted to the hospital for sepsis and cellulitis

The member receives an update from the advocate and a reduction in the amount owed.

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IMPACT ON EMPLOYEES

save on bills - human Advocates

Hi Taylor, Brenda here again from Reclaim. I have more great news: your $1,200 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!

Reclaim Health
Hospital payout has been approved!

$1,960 average employee bill savings per employee for qualifying events.

Examples of prominent types of bill savings:

• Voluntary benefit payouts

• Bill corrections

• Reimbursements by providers for reversed claim charges

Thank you so much!!

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 an update.

AI-generated health events and bill savings

MEDICAL & RX CLAIMS DATA

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IMPACT ON EMPLOYEES

save on bills

Reclaim proactively reviews the user's healthcare bills and highlights ways they can save on cost.

AI-generated health events and bill savings

MEDICAL & RX CLAIMS DATA

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IMPACT ON EMPLOYEES

Collaborative filtering ALGORITHM predicting care needs over time

OPTIMIZE coverage

AI-generated health events and bill savings

AI proactively recommends actions through the lens of people like me.

MEDICAL & RX CLAIMS DATA

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OPTION 2

OPTION 3

COLLABORATIVE FILTERING

SIMULation optimization

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Match to people with similar health events

Optimize recommendations and minimize financial risk

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Takes attributes of recent events as features. ML yields distribution of evolving care needs.

Simulation optimization computes out of pocket cost for utilization scenarios across distribution of similar patients.

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IMPACT ON EMPLOYEES

OPTIMIZE coverage

Reclaim personalizes recommendations in the context of the member's own recent health visits.

60.1% of engaged employees adopt Reclaim's recommendations.$753 in average employee savings.

Collaborative filtering ALGORITHM predicting care needs over time

AI-generated health events and bill savings

MEDICAL & RX CLAIMS DATA

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IMPACT ON EMPLOYERS

High activation rates

78.8% of employees activated Reclaim across all groups (new or existing).

Reclaim is offered to ALL plan members. Reclaim accesses employees across patient cohorts, demographic segments, and coverage needs.

High activation rates unlock our proactive engagement throughout the year.

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IMPACT ON EMPLOYERS

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 Health
Get started with Livongo today

High engagement rates

Of those activated, 70.5% employees proactively engaged throughout the year in the context of their bills.

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.

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IMPACT ON EMPLOYERS

Improved Benefit Utilization

Employers see an 87% increase in cost-effective plan adoption

• For network-efficient plans (tiered, reference-based), 6x increase in adoption, with 95.6% retention rate

• Proactively linking employees to chronic condition management programs in the context of their bills. For example: 78% of employees with diabetes 80% with asthma.

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impact on Employers

Targeted Communications

Optimize member communications informed by actionable savings opportunities.

Real-time access to activation and engagement insights and actionable targeted member communications.

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impact on employers

Simulate Benefit Strategies

Simulate your healthcare benefit design based on plan members' specific needs.

Integrating detailed claims data for all of your members, including sub-cohorts. Reclaim provides insights and sensitivity analysis. You can simulate product-member fit and tailor your benefit offerings.

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case study

outcomes & impact

How a leading services company with over 20,000 employees increased the adoption of its newly offered reference-base pricing plans by 2.68x.

detailed claims data

After launching with Reclaim at open enrollment, Reclaim increased RBP plan adoption among activated employees by 2.68x. RBP plan adoption increased from 14.4% to 36.8%.

Partnering with the group health plan, Reclaim analyzed both historical and current healthcare claims data for all covered members across three different carriers.

79.4% of employees activated at open enrollment in partnership with the benefit administrator.

pre-oe simulations

Given the membership claims data and benefit design features, Reclaim conducted a simulation of its benefit recommendations before launch.

2023 RBP plan adoption

employee activation

14.4%

challenge.

A leading commercial and residential services company struggled to achieve desirable adoption rates of a dozen reference-base pricing (RBP) plans designed to contain cost for both the employer and their employees in 2023. Despite running an extensive communication campaigns during their 2023 open enrollment, only 14.4% of the employees choose these plans.

In partnership with the benefit administrator, Reclaim ingested employee plan eligibility. At open enrollment, Reclaim activated employees with a simple prompt.

Reclaim Impact

2024 RBP plan adoption

Review your recent bills and your current plan cost before enrolling in next year's coverage.

36.8%

current plan review

solution

Employees review their recent bills and their current plan performance, helping them understand whether they are overinsured, underinsured or well insured.

2.68x

Ahead of its 2024 open enrollment season, the company sought a solution to boost RBP plan adoption. The company identified Reclaim's claims-driven healthcare financial advocacy platform as a unique value proposition. Reclaim's platform empowers employees to better understand their plan options and the impact on out of pocket expenses, all within the context of their own care needs.

RBP plan adoption 2 weeks after rollout.

95.6%

personalized Employee Cost Estimates

Matching members to patients like them, employees review their likely out of pocket costs for all eligible plans before finalizing their benefit elections.

RBP plan retention rate for activated employees vs 84.8% for those yet to activate Reclaim.

Claims data elements →

Activation at open enrollment →

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Increased HSA plan adoption

employee activation

Over 3 years, adoption of HSA plans increased by 58.5%, driven by high engagement rates across all employees.

In partnership with the benefit administrator, Reclaim ingested employee plan eligibility. At open enrollment, Reclaim activated employees with a simple prompt.

case study

HSA plan adoption before Reclaim rollout

A leading consulting firm with 15,000 employees has successfully curbed rising medical costs by increasing the adoption and utilization of cost-effective health plans and ancillary benefits.

39.7%

personalized recommendations

HSA plan adoption 3 years after Reclaim rollout

Employees review their recent bills, their current plan performance, and their personalized likely out of pocket costs before finalizing their elections.

59.8%

70% of employees accepted our recommendations.

proactive advocacy and savings

Employees who activated Reclaim saw substantial out-of-pocket savings, and overall medical costs were notably lower among those engaged with the platform.

Reclaim proactively reviews the user's healthcare bills and highlights ways they can save on cost by taking advantage of their benefits and coverage.

Significant employee savings

challenge

optimize coverage year-over-year

$1,123

$523

The employer has introduced innovative health plan designs and supplemental benefits that have been proven to control medical costs and generate significant savings for both employees and employers. However, adoption and engagement with these benefits have been disappointingly low. This lack of participation is preventing both employers and employees from realizing the substantial cost savings that these plans are designed to deliver.

In the context of their recent bills, employees review their current plan performance, and compare cost and care access implications if they were to consider switching to a more cost effective coverage option.

saved per bill qualified for overcharge resolution or voluntary payouts, on average.

in overall cost (premiums and out-of-pocket expenses) for engaged employees.

Significant lower cost trend

outcomes & impact

Most importantly, engaged employees exhibited a significantly lower year-over-year overall cost trend compared to those who were not activated.

After implementing Reclaim’s financial advocacy platform for over three years, the employer achieved significant increases in employee adoption and engagement with cost-effective health plans and supplemental benefits.

solution

The plans and benefits work. Find a way to increase adoption and engagement.

Medical cost trend (%)

11.57%

Not yet activated

Remarkable activation rate

To address low adoption and engagement with their innovative health plans, the employer turned to Reclaim's financial advocacy platform. Reclaim proactively engages employees by leveraging their personal healthcare data, ensuring they fully utilize the benefits designed to deliver significant cost savings for both employees and the employer.

Activated and engaged

2.79%

The overall activation rate reached an remarkable 87.1%

The results evidently demonstrate Reclaim's effectiveness in driving cost savings and employee participation.

Activation was also high among employees with chronic illnesses - 85.6% for diabetics and 90.7% for asthmatics.

Activation at OE

Activation while enrolling in benefits yields 78.8% activation rates across our groups.

Light integration with benefit admin collecting consent at enrollment.

• Easy rollout for employers,
• High activation rates; and
• Proactive consent for Reclaim to review and take action on past and future bills on behalf of employee and their dependents.

Claims data elements

~70,000+ ICD 10 and DRG diagnosis codes, incl. diagnosis severity and injury situational details.

~25,000+ service codes (CPT, HCPCS, Revenue), incl. screening, diagnosis, and treatment services.

~50+ location and network codes, incl. inpatient, observation, urgent, emergency, and others.

Billing and rendering provider national identifiers, their specialties and primary care indicators.

Billed charges, covered charges, copay, deductible, coinsurance, reversed charges, denials and their codes

Reclaim receives detailed claim line by claim line information.

Best known as UB04 (hospital claims) and HCFA 1500 (professional claims).

• Existing data use agreements with all national payors, multiple regional payors and claims administrators.

• We follow the lead of our employer clients and expand our data use agreements with new TPAs as needed.