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22nd Annual Piper Jaffray Health Care Conference November 30 , 2010 Walter Hosp, CFO Contact: Christine Saenz csaenz@hms.com 212.857.5986. What We Do. We provide cost containment services for healthcare payors .

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What we do

22nd Annual Piper JaffrayHealth Care Conference November 30, 2010Walter Hosp, CFOContact:Christine Saenzcsaenz@hms.com212.857.5986

What we do
What We Do

  • We provide cost containment services for healthcare payors.

  • We help ensure that claims are paid correctly (Program Integrity) and by the responsible party (Coordination of Benefits).

    As a result, our clients spend more of their healthcare dollars on the people entitled to them.

Who we serve
Who We Serve

Federal Programs

Centers for Medicare & Medicaid Services

Veterans Administration

State Programs

  • Medicaid agencies

  • CHIPs (Children’s Health Insurance Programs)

  • Child Support agencies

Commercial Programs

  • Medicaid Managed Care Organizations (MCOs)

  • Commercial Plans

  • Employers

What we do

Coordination of Benefits

UNINSURED46 million lives

MEDICAID$436 billion 57 million lives

COMMERCIAL$847 billion164 million lives

MEDICARE$515.5 billion 47 million lives

Source: 2009 CMS Office of the Actuary


How we grow
How We Grow

Capture more lives

Ride the Medicaid growth wave

Add new products, enter new markets

Upsell to existing customers



Capture more medicaid lives
Capture More Medicaid Lives

Sources: HMS & 2009 CMS Office of the Actuary.


Ride the medicaid growth wave
Ride the Medicaid Growth Wave

Actual Projected

With reform

1995-2008 data, 2008 CMS Office of the Actuary

2010-2019 data, 2009 CMS Office of the Actuary

Add new products enter new markets
Add New Products, Enter New Markets

Acquired AMG

Acquired Chapman Kelly



Commercial Insures

Dependent Eligibility Audits

New Product Development

Healthcare Reform Products

M & A



Acquired BSPA

Premium Assistance

Real-time COB

Acquired PrudentRx

Federal MIC

Clinical Review

2005 2006 2007 2008 2009 2010 & Beyond

Acquired IntegriGuard

Acquired Verify Solutions

Behavioral Health

Long-term Care Audits

Pharmacy Audits

Acquired Permedion

Hospital Audits

CHIP Enrollment Integrity

Managed Care

Impact of health reform law
Impact of Health Reform Law

  • Medicaid/Medicare expansion

  • New pathways to coverage

  • Emphasis on program integrity

  • Employer requirements

What we do

Medicaid/Medicare Expansion

MEDICAID$436 billion 57 million lives

UNINSURED46 million lives

COMMERCIAL$847 billion164 million lives

MEDICARE$515.5 billion 47 million lives

Source: 2009 CMS Office of the Actuary


What we do

Medicaid/Medicare 2019

UNINSURED16 million lives

MEDICAID$994 billion 83 million lives

COMMERCIAL$1335 billion 168 million lives

MEDICARE$904 billion 60.5 million lives

Source: 2019 Estimates, 2009 CMS Office of the Actuary.

New pathways to coverage
New Pathways to Coverage

  • State and Regional exchanges

  • Tax credits and cost-sharing assistance

  • Eligibility in multiple plans

  • Coordination of benefits with Medicaid

  • Find the “Right Insurance Home”

Emphasis on program integrity
Emphasis on Program Integrity

  • Increase in funding

  • Expansion of RAC program to Medicaid

  • Data, technology and services needed to support reductions in fraud, waste, and abuse

Employer requirements
Employer Requirements

  • New coverage requirements and employer penalties

  • Automatic enrollment of employees into health plans

  • Reporting mandates

Revenue diversity and growth
Revenue Diversity and Growth

$ Millions

$ Millions

Key financial indicators rolling four quarters
Key Financial IndicatorsRolling Four Quarters

Investment considerations
Investment Considerations

Low risk, high growth core business

Proprietary data and technologies

High barriers to entry

High growth Program integrity business in early stage

Well positioned in current healthcare environment

Multiple new growth opportunities

- Products - Acquisitions - Markets

Recurring, transparent and diversified revenue

Strong financial position



Safe harbor statement
Safe Harbor Statement

Certain statements in this presentation constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995 (the “Reform Act”). Such forward-looking statements involve known and unknown risks, uncertainties, and other factors that may cause the actual results, performance, or achievements of HMSY, or industry results, to be materially different from any future results, performance, or achievements expressed or implied by such forward-looking statements. The important factors that could cause actual results to differ materially from those indicated by such forward-looking statements include, but are not limited to (i) the information being of a preliminary nature and therefore subject to further adjustment; (ii) the uncertainties of litigation; (iii) HMSY’s dependence on significant customers; (iv) changing conditions in the healthcare industry which could simplify the reimbursement process and adversely affect HMSY’s business; (v) government regulatory and political pressures which could reduce the rate of growth of healthcare expenditures and/or discourage the assertion of claims for reimbursement against and delay the ultimate receipt of payment from third party payors; (vi) competitive actions by other companies, including the development by competitors of new or superior services or products or the entry into the market of new competitors; (vii) all the risks inherent in the development, introduction, and implementation of new products and services; and (viii) other risk factors described from time to time in HMSY’s filings with the SEC, including HMSY’s Form 10-K for the year ended December 31, 2009. HMSY assumes no responsibility to update the forward-looking statements contained in this release as a result of new information, future events or otherwise. When/if used in this presentation, the words “ focus,”“ believe, ”“ confident, ”“ anticipate, ”“ expected, ”“ strong, ”“ potential, ” and similar expressions are intended to identify forward-looking statements, and the above described risks inherent therein.