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.

That's where we come in.

No single, integrated source existed.

So, LEVERAGE created one.

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 FACTS & FIGURES

WA OR CA NV ID MT WY UT AZ CO NM TX OK KS NE SD ND MN IA MO AR LA WI IL MI IN OH KY TN MS AL GA FL SC NC VA WV PA NY ME AK HI VT NH MA CT RI NJ MD DE
%

All Covered Lives Distribution By Market Sub-Segments Across US And States

+

Market Sub-Segments across Commercial & Government

%

Detailed profiles by state on markets, operations, regulations, coverage & access

%+

Of Fully Insured, MA, MCO Covered Lives Coverage & Access information

%+

Of all commercial employer sponsored lives coverage & access information from 270+ employers

+

Attributes of Health Plans, Markets, Payors, Coverage & Benefits

+

Source Objects over multiple years across all US market sub-segments

+

Large Employers with 80%+ lives of the commercial employer sponsored market

+

Health Insurance carriers detailed market profiles by line of business and geography

+

Health Systems / IDNs Market profiles with associated Hospital & Payor Mix

MA – Medicare Advantage ; MCO – Medicaid Managed Care Organizations | IDN = Integrated Delivery Networks

Large Employer Sponsored include Government Employers, Non Government Employers, Unions and Taft Hartley Plans

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 4,500+ Formularies associated with plan designs(includes spl.) 5,400+ Plan Designs 1,100+ Plan Offerings across270+ employersin AXIACI *Source objects in AXIACI refer to plan designs, formularies/specialty, EOC’s, filings, requirements and criteria and other 270K+ Source Objects* over multiple years in9+ market segmentsin AXIACI 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 82.47k providergroups 4.51k acute carehospitals 53 states, D.C.,& territories 100s of relationshipmappings 12+ ancillaryservices 7 key sourcesof revenue IntegratedDeliveryNetworks 127 dHive

our difference

We go beyond the traditional to

improve your line of sight

When looking for existing sources that applied the lens of actual bottom-up patient and system experience across stakeholders in healthcare to use, integrate, enrich, transform, and apply...we realized there was none.

So, we created one!

Resource Creation

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Create and maintain a new, centralized source that differentiates between unstructured and structured data, to use, integrate, enrich, and transform.

Advanced Engine

Optimized, interactive rules; processes; and extraction engine developed by cross-sector experts to support varied user needs and ranges of detail level.

Centralized Repository

Refined information repository, maintained and enhanced, with actionable insights and intel already developed to access and use.

Expertise & Technology

Enabled technology platform providing clarity at varied levels of granularity with cross-sector expert consulting services to leverage as needed.

application areas

Differentiating solutions with varied areas of application, based on your challenge at hand

LEVERAGE can help

From Fortune 500 companies in biopharma and health care to policymakers and researchers, we have been helping achieve desired results. Below are our industry verticals and areas of application where our solutions helped organizations.

Please Connect with us to understand more about how our solutions have helped organizations or use cases, case studies and reports.

Biopharma

Market Opportunity & Investments

Product Commercialization & Launch

Targeting & Pull Through

Market Access & Contracting

Patient Affordability & Support

Pricing & Forecasting

PDEOR – Payor Desired Economics & Outcomes Research

Policy, Research & Advocacy

Patient Access & Advocacy

Coverage Barriers & Transparency

Policy Evaluations & Assessments

Impact Analysis – Legislative & Regulatory

Stakeholder Engagement

Research & Advisory

Health System Dynamics

Healthcare (Other)

Biotech Investment-ROI Evaluations

Consumer Health Portfolio Assessments

Legal Advisory – Litigation, Corporate

Payor Markets – Opportunity Assessment

Employer Sponsored Health Benefit Dynamics

IDN/Health Systems Profiling & Analysis

PBM/Specialty Sourcing & Networking

Frequently Asked Questions

Want to know more about how our solutions can help your organization succeed?

Our FAQs address a few common questions we've received over the years.

As Plato said millennia ago, necessity is the mother of invention. We simply could not find an integrated, single source with the detailed coverage and access information and data we needed to rapidly respond to our partners‚ business challenges. So, we created one.

  • We built an expanding library of source objects across all commercial and government health insurance products and offerings in all market segments and programs, from all payer types.
  • We developed a cataloging system and methods tying them to the associated number of covered lives at the national and state level.
  • We established an attribute creation and extraction engine necessary to develop the detailed coverage and access data points and insights our public and private partners required.
  • We created a refined, centralized information repository with actionable insights and intel developed and ready to use
  • We built a user-friendly platform to access the continually growing data sets and visualizations of key insights our partners need to inform critical strategic decisions.

Partially.
There is a wide array of public data sources and organizations from which some of the data in AXIACI is available. To date, we have not found a single, integrated resource ready to be leveraged for information and insights from either a top-down or bottom-up actual patient, provider, and other stakeholders‚ experience.
AXIACI was created because in our consulting work, we needed to look across commercial and government market segments and subsegments, find the answers to detailed coverage and access questions and tie together covered lives, states, carriers and employers to determine prevalence at the state and national level. We tried to find an existing source.
There are many data sets and information repositories, but they suffer in the same way our entire system suffers, as they are fragmented with multi-year lag times and the underlying sources they draw from are generally in response to a specific regulatory or transactional purpose for single/multiple stakeholders. The underlying data and information are gathered in a variety of ways -- self-reported, survey, operational transactions. There are limited ways to connect disparate data sets. Equally important, there is no integrated library of underlying source objects that can be easily accessed. Product developers, service providers, researchers, and policy makers have been working around these gaps to inform critical decisions for decades.
AXIACI is unique because it is a centralized and integrated resource through which public and private decision makers, analysts and researchers can access new, ready to use data, information, insights and intel on coverage and access to health care services prescription drugs beyond what is currently available from traditional and transactional data sources‚ and through which they can commission extractions for specific services and drugs.

No. There are many established sources that provide data and information on "what has happened."‚ through transactional and sales data. AXIACI focuses on access and coverage constructs and provides information, insights, and intel to establish possible market shifts, potential opportunities, or other "what can happen" scenarios and/or to help identify the factors that might explain "why and how" something happened.

No.
We do not rely on survey data.
We do not do surveys.

No. We source data and information that are in public domain and are both unstructured and structured.

Depends. Based on your purpose and needs, you can determine whether this new data is best used to augment or replace existing data. In many situations leveraging both existing transactional data and the new data in AXIACI can significantly enhance strategic decision making across multiple functions

Generally, yes, depending on the level of integration.
There are industry-specific identifiers that are normally used across solution modules of AXIACI that you can leverage.

The data is internally updated year round based on the cycle of each market segment. Release schedules call for updates on average of every 2-3 months.

LEVERAGE cross-sector experts with proven private and public experience across health care industries, regulatory agencies, and payor organizations developed the rules, methods, extraction and interactive engine.

No. It is available at both national and state level.

AXIACI market segments include:

  • Commercial:
    • Fully Insured - Health Insurer Carrier Individual and Small Group (On/Off Exchange), and Large Group
    • Non-Federal Government Employer Sponsored Insurance (ESI) (State Government, Local/Municipal, School/District)
    • Federal Government ESI
    • Union/Taft-Hartley
    • Non-Government ESI
  • Government:
    • Medicare and Medicare Advantage
    • Medicaid and Medicaid Managed Care
    • Tricare

Yes. By State/Geography and Market Sub-Segments. Leverage the Market Maven Solution in AXIACI Terminal.

Yes, you can. Leverage the iScope ECG Solution in AXIACI Terminal.

Yes. Leverage the nCASA I3 Solution in AXIACI Terminal.

Yes. Leverage the Market Maven, iScope ECG and nCASA I3 Solutions in AXIACI Terminal.

Yes. Leverage the Payer/PBM/Specialty module or Sourcing & Networks elements of the nCASA I3 Solution in AXIACI Terminal.

Yes. Leverage the Coverage elements of the nCASA I3 Solution in AXIACI Terminal.

Yes. Leverage the dHive Solution in AXIACI Terminal.

Yes. It provides deductible, maximum out-of-pocket (MOOP), co-pay and co-insurance rates. For employer-sponsored insurance (ESI), it also includes employee premium contribution where available.

Licensing the AXIACI Terminal Solutions or/and Specific Solution on a multi-year basis.

Yes. You can identify specific solution modules based on the established licensing model.

Yes. The platform can be customized with associated services cost to append to the licensed base

Cost is calculated based on the pricing model for the licensed solution modules of AXIACI Terminal (for example, the number of states, market segments, services, drugs or any other customization).

Yes. We provide training and technical support on the use of the platform. We also provide training on the use of the information and data and strategic consulting support

Yes. We have detailed operating and technical manuals for AXIACI and a sourcing guide.

Absolutely! The source objects in AXIACI have a massive amount of unstructured information to be mined. Our consulting services team at LEVERAGE will work with you to understand your needs, determine whether they can be met, and establish what additional information is needed along with the rules and logic necessary to extract the data. We have developed a process which includes a collaborative effort with you and your team during which the extraction approach will be defined, tested, and validated.

Yes. Our LEVERAGE team has extensive cross-sector expertise and has been providing strategic consulting services in the private and public sectors for over a decade.

Yes. Strategic decisions about Commercialization, Pricing of drug at launch, and R&D portfolio and pipeline investment can be enhanced with the data, information and intel in AXIACI

Many. Because this is the first time our client partners have had access to this type of intel, our initial engagements generally involve in-depth exploration of the business questions they face in different functional and strategic areas, as well as which areas of intel and information in AXIACI are best positioned to support them. Some examples of proven areas where we have seen it applied include:

  • Strategy
  • market access and coverage
  • patient affordability
  • opportunity and investments
  • geo targeting
  • marketing and sales
  • pricing and forecasting
  • patient payer health economics and outcomes research (P2HEOR)

Evaluate real-market opportunity based on area of investment; Validate and/or Enhance modeling and analysis to determine actual ROI; Identify areas for investments based on factual insights and intel driven by on-the-ground potential and use.

Yes. All the solutions of AXIACI are based on your specific purpose and need.

A Lot. The data information and intel can help you:

  • Develop or enhance federal or state specific strategies for advocacy
  • Evaluate the potential impact of legislative and regulatory proposals including how many people they would affect at a more granular level
  • Determine their impact post-enactment and if they have not achieved results, evaluate why.
  • Respond to changes in state, federal or payor policies.
  • Analyze and identify specific barriers to patient access to services and drugs and coverage at state and payor levels

Yes. We have current partners directly accessing the sources in the AXIACI library and the platform extraction capabilities for federal grant funded research and others for whom we perform the initial extraction of data from AXIACI source objects and provide analysis tools and support.

Yes. The information and intelligence provides easy access to how covered lives are distributed in a state, how the state compares to others, differences coverage criteria for services and drugs by carrier/PBM, comparisons of coverage of government, non-government and small business insurance, prevalence of mental health, obesity and abortion coverage, and many other areas. We will respond to individual reporters where available.
Media outlets at the state or national level can license aspects of the platform on an annual basis and/or on an issue by issue time-limited basis to provide access to reporters and investigative reporters

It depends. One of the most helpful things it can provide is a rapid comparison of your state to others across multiple functional areas (an issue that often comes up with the governor and legislature!). You can either license access to the platform to do your own analysis or commission an analysis from our team. Depending on the issue, the turn-around time can be as little as two weeks. Examples include:

  • aspects of state employee benefits such as:
    • differences in pharmacy and specialty pharmacy benefit management
    • range of plan choices
    • employee cost sharing and premium contributions pooling of school districts and municipal employers
    • coverage of specific services
    • and more
  • management of pharmacy benefits in states with Medicaid-managed care (MMC)
  • cross section of ESI information on plan management and coverage of specific services and drugs (all exempt from state regulation)
  • a full state landscape of behavioral health coverage across market segments (fully-insured, ESI, Medicare Advantage, or MMC)
  • a landscape of the reach of carriers and PBMs across all market segments in the state
  • many other areas

Yes.We have client partners for whom we provide strategic consulting and advisory services at a variety of levels and who use our data to refine their discovery and litigation strategies

Yes. We work in a variety of ways with policy partners interested in specific issues. Some use the platform to access the original source objects and use the extraction capabilities to do the research and extraction themselves; others use our consulting services to do the extraction and help with the analysis.

Yes. It provides carrier, employer, PBM, Spec PBM and other third-Party relationships such as BHOs; identifies when medical and pharmacy benefits are split in ESI and other key issues

Still have questions? Our team is ready to answer them.

CONNECT

UNFOLDING THE FUTURE TOGETHER

Client Partners are seeking supplemental information and unique perspectives to take advantage of changing business models, consumer needs, and uncertain legislative and regulatory environments. They are exploring alternatives to enhance and/or shift traditional approaches that are not achieving desired levels of return on investment.

connect@leveragegc.com 1 (609) 608-0990

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WHY WAS CREATED?

Background

AXIACI was created because in our consulting work, we needed to look across commercial and government market segments and subsegments, find the answers to detailed coverage and access questions, and tie together covered lives, states, carriers, pharmacy benefit managers (PBMs) and non-government and government employers in order to determine prevalence at the state and national level. We tried to find an existing source that met these needs but have not found a single, integrated resource ready to be leveraged for information and insights from either a top-down or bottom-up patient, provider, or other stakeholder's experience.

There are many data sets and information repositories, but they suffer in the same way our entire health care system suffers: they are fragmented with multiyear lag times and the underlying sources they draw from are generally in response to a specific set of transactional or regulatory purposes for single or multiple stakeholders.

The data and information are gathered in a variety of ways (self-report, survey, operational transactions, and more). There are limited ways to connect disparate data sets. Equally important, there is no integrated library of underlying source documents that can be easily accessed. Product developers, service providers, researchers, and policy makers have been working around these gaps to inform critical decisions for decades.

We simply could not find an integrated, single source with the detailed coverage and access information and data that we needed to rapidly respond to our partners’ business challenges.

So, We Created One!

Unique Features

  • An expanding library of source objects across all commercial and government health insurance products and offerings, in all market segments and programs, from all payer types
  • Cataloging system and methods tying them to the associated number of covered lives at the national and state level
  • Attribute creation and extraction engine necessary to develop the detailed coverage and access data points and insights that our public and private partners have required
  • A refined, centralized information repository with actionable insights and intel already developed and ready to use
  • A user-friendly platform to access the continually growing data sets and visualizations of key insights our partners need to inform their critical strategic decisions
  • Ready to use information, data, insights and intel on coverage and access to health care services, prescription drugs, and devices, beyond what is currently available from traditional and transactional data sources

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