# Contract with Harmony Health Plans for Healthllm --- ## Terms 1. **Agreement Effective Date**: This contract is effective as of January 25, 2025. 2. **Duration**: This agreement will remain in effect for a term of 24 months, concluding on January 24, 2027. 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. 4. **Member Coverage**: Professional Tier supports up to 50,000 covered members. Harmony currently covers 38,000 members across 3 states. 5. **Payment Terms**: Payments are due on the 5th of each month via wire transfer. Late payments incur a 2% monthly penalty. 6. **User Licenses**: Contract includes 60 named user licenses. Additional licenses available at $150/month per user. 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. --- ## Renewal 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. 2. **Price Protection**: Pricing increases capped at 6% annually for first two renewal periods. 3. **Volume Discounts**: If member count exceeds 75,000 at renewal, Harmony receives 10% discount on incremental cost. --- ## Features 1. **Access to Professional Tier Features**: Harmony Health Plans will have comprehensive access to: - Intelligent Plan Design with AI-powered optimization - Real-Time Eligibility Verification with provider network integration - AI-Driven Claims Adjudication with automated processing - **Predictive Healthcare Analytics** for population health management - Provider Network Management with contract optimization - Member Engagement Platform with mobile-first design - **Advanced Medication Management** with PBM integration - Regulatory Compliance Engine with ACA and state mandate tracking - **Enhanced Analytics** with predictive modeling 2. **Predictive Healthcare Analytics:** - High-risk member identification for care management - Disease progression modeling (diabetes, hypertension, CHF) - Hospital readmission prediction - Emergency department overutilization alerts - Care gap identification for quality measures (HEDIS) - Preventive care intervention recommendations - Cost trend forecasting and budget planning 3. **Advanced Medication Management:** - Complete formulary management and tier optimization - Prior authorization automation with clinical criteria - Step therapy enforcement - Medication adherence scoring and intervention triggers - Drug interaction checking with severity classification - Generic substitution recommendations with savings calculations - Specialty pharmacy management - Medication therapy management (MTM) program support 4. **Value-Based Care Tools:** - ACO (Accountable Care Organization) performance tracking - Shared savings calculation - Quality measure monitoring (HEDIS, STAR ratings) - Provider pay-for-performance scorecards - Risk adjustment and HCC coding support 5. **Care Management Platform:** - Case management workflows for high-cost members - Disease management program support - Care coordinator tools and dashboards - Member outreach campaign management - Social determinants of health (SDOH) screening --- ## Support 1. **Technical Support**: Harmony Health Plans will receive priority support: - Dedicated support team available 24/7 for critical issues - Standard support Monday-Saturday 6 AM - 9 PM EST - Response time: 4 hours for critical, 8 hours for high priority, 24 hours for standard - Named technical support engineer familiar with Harmony's environment - Private support portal with ticket tracking 2. **Training**: Comprehensive training program: - 6-week implementation with dedicated project manager - Training for up to 40 staff members (60 hours total training) - Role-specific tracks: claims processors, case managers, provider relations, IT, executives - Quarterly advanced training webinars - Annual refresher certification program - Unlimited access to online learning platform with 75+ courses - Custom training materials for Harmony's specific workflows 3. **Updates and Maintenance**: - Monthly platform updates with new features and enhancements - Bi-weekly security patches and bug fixes - Regulatory updates as healthcare laws change (ACA, state mandates) - Maintenance windows: Saturday 10 PM - Sunday 3 AM EST - 96-hour advance notice for major updates - Staging environment for testing updates before production 4. **Account Management**: - Named Senior Customer Success Manager with bi-weekly check-ins - Quarterly executive business reviews with ROI analysis - Annual strategic planning session with product roadmap preview - Direct escalation path to VP of Customer Success - Industry benchmarking reports comparing Harmony to similar plans 5. **Integration Support**: Comprehensive integration assistance: - Integration with Harmony's core systems: - HealthRules policy administration system - Provider credentialing platform - Express Scripts PBM - Availity clearinghouse for claims - Member portal and mobile app - Salesforce CRM - Dedicated integration specialist (30% FTE allocation) - Quarterly integration health checks and optimization - API monitoring and performance tuning 6. **Analytics and Reporting:** - Custom dashboard development (up to 10 dashboards) - Automated reporting suite (daily, weekly, monthly, quarterly) - Ad-hoc analytics requests (up to 15 per month) - Predictive modeling consultation (monthly sessions) - Benchmark reports against regional health plans - Data export capabilities in multiple formats 7. **Compliance and Regulatory Support:** - Quarterly compliance reviews - Annual HIPAA security risk assessment - ACA reporting assistance (1094/1095 forms, MLR reporting) - State filing support for form and rate approvals - Quality measure calculation support (HEDIS, STAR) - Audit preparation and documentation assistance --- **Signatures:** _________________________________ **Sarah Chen** **Title**: Vice President of Sales **Insurellm, Inc.** **Date**: January 25, 2025 _________________________________ **Dr. Karen Phillips** **Title**: President & Chief Executive Officer **Harmony Health Plans** **Date**: January 25, 2025 --- *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.*