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LLM_Engineering_OLD/week5/knowledge-base/contracts/Contract with Harmony Health Plans for Healthllm.md
Edward Donner e5c3fcab46 Updated Week 5 with November version
2025-11-04 07:26:42 -05:00

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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.

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