153 lines
6.7 KiB
Markdown
153 lines
6.7 KiB
Markdown
# 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.*
|