Updated Week 5 with November version
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Edward Donner
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# Contract with Harmony Health Plans for Healthllm
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---
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## Terms
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1. **Agreement Effective Date**: This contract is effective as of January 25, 2025.
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2. **Duration**: This agreement will remain in effect for a term of 24 months, concluding on January 24, 2027.
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3. **Subscription Type**: Harmony Health Plans agrees to subscribe to the **Professional Tier** of Healthllm, at a cost of $15,000/month, totaling $360,000 for the duration of this contract.
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4. **Member Coverage**: Professional Tier supports up to 50,000 covered members. Harmony currently covers 38,000 members across 3 states.
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5. **Payment Terms**: Payments are due on the 5th of each month via wire transfer. Late payments incur a 2% monthly penalty.
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6. **User Licenses**: Contract includes 60 named user licenses. Additional licenses available at $150/month per user.
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7. **Termination Clause**: Either party may terminate with 90 days' written notice. Early termination after month 12 has no penalty; before month 12 requires 25% of remaining contract value.
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---
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## Renewal
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1. **Automatic Renewal**: This agreement will automatically renew for an additional 24-month term unless either party provides written notice of non-renewal at least 90 days before expiration.
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2. **Price Protection**: Pricing increases capped at 6% annually for first two renewal periods.
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3. **Volume Discounts**: If member count exceeds 75,000 at renewal, Harmony receives 10% discount on incremental cost.
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---
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## Features
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1. **Access to Professional Tier Features**: Harmony Health Plans will have comprehensive access to:
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- Intelligent Plan Design with AI-powered optimization
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- Real-Time Eligibility Verification with provider network integration
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- AI-Driven Claims Adjudication with automated processing
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- **Predictive Healthcare Analytics** for population health management
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- Provider Network Management with contract optimization
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- Member Engagement Platform with mobile-first design
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- **Advanced Medication Management** with PBM integration
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- Regulatory Compliance Engine with ACA and state mandate tracking
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- **Enhanced Analytics** with predictive modeling
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2. **Predictive Healthcare Analytics:**
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- High-risk member identification for care management
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- Disease progression modeling (diabetes, hypertension, CHF)
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- Hospital readmission prediction
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- Emergency department overutilization alerts
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- Care gap identification for quality measures (HEDIS)
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- Preventive care intervention recommendations
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- Cost trend forecasting and budget planning
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3. **Advanced Medication Management:**
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- Complete formulary management and tier optimization
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- Prior authorization automation with clinical criteria
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- Step therapy enforcement
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- Medication adherence scoring and intervention triggers
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- Drug interaction checking with severity classification
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- Generic substitution recommendations with savings calculations
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- Specialty pharmacy management
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- Medication therapy management (MTM) program support
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4. **Value-Based Care Tools:**
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- ACO (Accountable Care Organization) performance tracking
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- Shared savings calculation
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- Quality measure monitoring (HEDIS, STAR ratings)
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- Provider pay-for-performance scorecards
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- Risk adjustment and HCC coding support
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5. **Care Management Platform:**
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- Case management workflows for high-cost members
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- Disease management program support
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- Care coordinator tools and dashboards
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- Member outreach campaign management
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- Social determinants of health (SDOH) screening
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---
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## Support
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1. **Technical Support**: Harmony Health Plans will receive priority support:
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- Dedicated support team available 24/7 for critical issues
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- Standard support Monday-Saturday 6 AM - 9 PM EST
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- Response time: 4 hours for critical, 8 hours for high priority, 24 hours for standard
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- Named technical support engineer familiar with Harmony's environment
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- Private support portal with ticket tracking
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2. **Training**: Comprehensive training program:
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- 6-week implementation with dedicated project manager
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- Training for up to 40 staff members (60 hours total training)
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- Role-specific tracks: claims processors, case managers, provider relations, IT, executives
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- Quarterly advanced training webinars
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- Annual refresher certification program
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- Unlimited access to online learning platform with 75+ courses
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- Custom training materials for Harmony's specific workflows
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3. **Updates and Maintenance**:
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- Monthly platform updates with new features and enhancements
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- Bi-weekly security patches and bug fixes
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- Regulatory updates as healthcare laws change (ACA, state mandates)
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- Maintenance windows: Saturday 10 PM - Sunday 3 AM EST
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- 96-hour advance notice for major updates
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- Staging environment for testing updates before production
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4. **Account Management**:
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- Named Senior Customer Success Manager with bi-weekly check-ins
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- Quarterly executive business reviews with ROI analysis
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- Annual strategic planning session with product roadmap preview
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- Direct escalation path to VP of Customer Success
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- Industry benchmarking reports comparing Harmony to similar plans
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5. **Integration Support**: Comprehensive integration assistance:
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- Integration with Harmony's core systems:
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- HealthRules policy administration system
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- Provider credentialing platform
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- Express Scripts PBM
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- Availity clearinghouse for claims
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- Member portal and mobile app
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- Salesforce CRM
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- Dedicated integration specialist (30% FTE allocation)
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- Quarterly integration health checks and optimization
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- API monitoring and performance tuning
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6. **Analytics and Reporting:**
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- Custom dashboard development (up to 10 dashboards)
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- Automated reporting suite (daily, weekly, monthly, quarterly)
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- Ad-hoc analytics requests (up to 15 per month)
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- Predictive modeling consultation (monthly sessions)
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- Benchmark reports against regional health plans
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- Data export capabilities in multiple formats
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7. **Compliance and Regulatory Support:**
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- Quarterly compliance reviews
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- Annual HIPAA security risk assessment
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- ACA reporting assistance (1094/1095 forms, MLR reporting)
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- State filing support for form and rate approvals
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- Quality measure calculation support (HEDIS, STAR)
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- Audit preparation and documentation assistance
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---
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**Signatures:**
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_________________________________
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**Sarah Chen**
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**Title**: Vice President of Sales
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**Insurellm, Inc.**
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**Date**: January 25, 2025
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_________________________________
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**Dr. Karen Phillips**
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**Title**: President & Chief Executive Officer
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**Harmony Health Plans**
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**Date**: January 25, 2025
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---
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*This contract establishes Harmony Health Plans as a strategic partner leveraging Healthllm's advanced AI and predictive analytics to improve member outcomes while managing costs effectively.*
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