RWJF OBESITY COVERAGE NEXUS

Unleashing the power of missing intel for healthcare

We provide leaders with information, intelligence, and insights into how health care services, drugs, and devices are accessed and covered through health insurance, across both markets and payers

We have developed a unique, guided resource to provide a more transparent line of sight into actual patient and system experience for cross-sector stakeholders

Health care is complicated.

Our solutions provide clarity.

Existing health care data sets and information repositories draw from a variety of sources primarily created for specific transactional or regulatory purposes.

They can’t provide an integrated, comprehensive portrait across markets of how specific services and drugs are covered.

Product developers, service providers, researchers, and policy makers have been working around these data challenges for decades.

Decision makers need more advanced, actionable intel to inform key business and policy decisions, understand patient experience, and evaluate health equity, outcomes and system performance.

No single, integrated source existed.

So, LEVERAGE created one.

That's where we come in.

our solutions

Introducing

VALUE

FROM

HEALTH

INVESTMENTS

AXIACI is a novel, guided platform enabled by the largest and most representative, centralized source database and a unique information repository and enabling technology platform for information, data-driven insights, and intel at varying degrees of granularity across markets.

RESOURCE

Resource developed to:

  • Establish “what can happen” and/or identify “ why and how it happened”
  • Understand real-world patient experience based on how they get their health care coverage
  • Identify coverage variations and restrictions across markets and geography that influences the use and access to products or/and services

EMPOWER

Empower health care stakeholders to:

  • Maximize patient access to treatment and enhance value of products and services
  • Evaluate current approaches not yielding desired results
  • Identify specific barriers across markets, geography, and payer levels
  • Refine or/and develop specific strategies for access and coverage

ADVANCE

Advance information needs by:

  • Determining critical and useful from disparate unstructured and structured data sources
  • Developing a source which is resource intensive and time-consuming to identify and build for use by stakeholders
  • Providing an expanding list of already extracted and derived information and intel what “real-world” transactional / traditional sources cannot

LEVERAGE

Leverage the varied levels of:

  • Actionable information, insights and intel on coverage and access of products or/and services
  • The terminal platform with solutions focused on access and coverage across markets, states, payors, employers, pbm’s and providers
  • Data and information capabilities for additional attributes creation, extraction, derivation and application

AXIACI SOLUTIONS TERMINAL

Administrative Footprint PAYORS OPERATIONAL PROFILE CARVE - OUTS Characteristics STATE PROFILE ) ) ) EVALUATION, ANALYSIS,& APPLICATION Segmentation / Composition MARKETPROFILE Market Opportunity & Investments Access & Affordability Stakeholders & Administration Policy & Advocacy Legal & Regulatory GeographyLine of BusinessStakeholder Footprint Distribution by Line of BusinessPayor, PBM/Specialty, Third Party, Provider FootprintMarket Composition & VariationsState Insurance Regulation & Medicaid/Medicare Government Employers PoolingPayor Level of ControlDominance & Segment CrossoverPharmacy/Specialty Management 270K plan designsacross all U.S. market segements 9,000 formulariesassociated with plan designs PayerProfiles Next page as of Feb 1, 2023 HQ: Pittsburgh, PA | NAIC GROUP CODE: 812 HIGHMARK HEALTH States of Operation Market Share by LOB Guest User 10% Medicare 41% Fully-Insured 16% Medicaid 33% Self-Insured Operations Offerings Markets Overview Administration Commercial out of 360 carriers nationwide(2023) 13 th Government out of 360 carriers nationwide(2023) 16 th Operating states:9*Covered lives:3.2 M** **covered lives estimate reflects enrollment in major medical only and does notinclude ancillary products (e.g., tricare, dental, stand-alone PDPs, critical illness, etc.) *four out of nine operating states account for over 99% of total covered lives. 360+healthinsurancecarriers 540+large public& privateemployers % of totalcoveredlives(2023) 51% (1.62M lives) Decision Maker 49% (1.58 M lives) Administrator Level of Control vs Key Relationships Employers Carve-Outs Providers SPPs UM Network PBMs Numerous factors to consider based on situation and purpose that affect access, coverage, affordability, utilizations and outcomes across markets and geography Plan Variations (by market, type, deductible, MOOP)Tier Placements (by ne tworks, drugs, services)Plan OOP - Co-pay / Co-Insurance (by tiers, drugs, services)Plan Administration (Co-pay Maximizers, Accumulators, Other) Affordability Carve-Outs (by drug class, specialty area, service type)Sourcing Spread (by site of care, acquisition, product type)Network Spread (by PBM, Specialty Pharmacy/ Networks, Programs) Preference (by therapeutic area, benefit type, drug brand & competitors)Positioning (by drug list, tier placement, inclusions, exclusions)Criteria (by area, benefit type, services - Inclusions/Exclusions)Potential (by market, geography, payor, PBM/Specialty, network) Coverage Medical, Pharmacy, Integrated, SpecialtyUtilization ManagementOfferings - Plans, Drug Lists - Pharmacy, Specialty, MedicalPolices & Criteria - Coverage, Reimbursement Benefit variations, coverage criteria and restrictions, and affordability metrics for key therapeutic areas by payer Variations in access to products and services by therapeutic area or disease state, based on the source of health care coverage Multiple plan benefit designs and associated formulary offerings by product types and payers by market sub-segments and geography *Source objects in AXIACI refer to plan designs, formularies/specialty, EOC’s, filings, requirements and criteria and other Disaggregated view of product and service access avenues by source of coverage for novel or complex therapeutic areas Provider relationships among individual providers, provider groups, hospitals, and health systems Groups & Providers hospitals and outpatient offices owned by or affiliated with health systems Hospitals & Clinics health systems operating in each state, including multi-state systems Operating States organization of health system subsidiaries and employees Organizational Structure additional offerings such as home infusion, telemedicine, or hospice care Ancillary Services revenue by line of business and primary payer (for medical services) Revenue Streams Health Systems health systems that own or jointly offer one or more health plans (i.e., “IDN”s) are able to control the full healthcare dollar for a segment of their patients Integrated Delivery Networks 127 IDNs 637 health systems 82.47k provider groups 4.51k acute carehospitals 53 states, D.C.,& territories 100s of relationshipmappings 12+ ancillary servicecategories 7 key sourcesof revenue
MARKET PROFILE Segmentation / Composition Characteristics Administrative Footprint Payors & Policies Carve-Outs STATE PROFILE OPERATIONAL PROFILE EVALUATION, ANALYSIS, &APPLICATION Market Maven PayerProfiles 360+ healthinsurancecarriers 540+ large public& privateemployers Operations Offerings Markets Administration Overview iScope ECG Affordability Sourcing & Networks Benefit Designs Coverage nCASA I³ Health Systems 637