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Healthcare Cost Containment Solutions for Payors | HMS

Offering cost containment services for healthcare payors, ensuring accurate claims payment & program integrity. We cater to federal, state, commercial programs & provide COB coordination. Ride the Medicaid growth wave & upsell to existing customers.

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Healthcare Cost Containment Solutions for Payors | HMS

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  1. BOAML 2011 Health Care ConferenceMay 11, 2011Bill Lucia, CEOWalter Hosp, CFOContact:Christine Saenzcsaenz@hms.com212.857.5986

  2. What We Do • We provide cost containment services for healthcare payors. • We help ensure that claims are paid by the responsible party (Coordination of Benefits), and accurately (Program Integrity). As a result, our clients spend more of their healthcare dollars on the people entitled to them.

  3. Who We Serve Federal Programs Centers for Medicare & Medicaid Services Veterans Administration Department of Defense State Programs • Medicaid agencies • CHIPs (Children’s Health Insurance Programs) • Child Support agencies • State Employee Benefit Plans Commercial Programs • Medicaid Managed Care Organizations (MCOs) • Medicare Advantage • Employers

  4. Coordination of Benefits MILITARY$105 billion 15 million lives MEDICAID$466 billion 62 million lives UNINSURED52 million lives COMMERCIAL$864 billion161 million lives MEDICARE$548 billion 48 million lives Source: CMS, Updated NHE Projections 2009-2019, September 2010; VA.gov; Congressional Budget Office, Oct. 2010

  5. How We Grow Capture more lives Ride the Medicaid growth wave Add new products, enter new markets Upsell to existing customers

  6. Capture More Medicaid Lives Sources: HMS; 2009 CMS Office of the Actuary; Updated NHE Projections September 2010

  7. Ride the Medicaid Growth Wave Actual Projected 1995-2008 data, 2008 CMS Office of the Actuary 2009-2019, CMS, Updated NHE Projections, September 2010

  8. Add New Services, Enter New Markets Medicare Market Service Medicare Advantage Employers Prepayment audit solutions • Healthcare reform • products Program Integrity launched Behavioral health audits RAC services Real-time COB CHIP Enrollment integrity CMS Long-term care audits Employer plan claim audits Managed Care Premium assistance Hospital audits Clinical review Pharmacy audits Dependent eligibilityaudits COORDINATION OF BENEFITS 2005 2006 2007 2008 2009 2010 & Beyond

  9. Upsell to Existing Customers Claim Types Audit Types Markets

  10. Affordable Care Act

  11. Healthcare Financing Today MILITARY$105 billion 15 million lives MEDICAID$466 billion 62 million lives UNINSURED52 million lives COMMERCIAL$864 billion161 million lives MEDICARE$548 billion 48 million lives Source: CMS, Updated NHE Projections 2009-2019, September 2010; VA.gov; Congressional Budget Office, Oct. 2010

  12. Healthcare Financing 2019 UNINSURED 24 million lives MILITARY$155 billion MEDICAID$896 billion 82 million lives COMMERCIAL$1,241 billion 165 million lives MEDICARE$891 billion 61 million lives Source: CMS, Updated NHE Projections 2009-2019, September 2010; VA.gov; Congressional Budget Office, Oct. 2010

  13. ACA Activity 2011-2014 • Early adoption of reform • Managed care expansion • Program compliance

  14. Early Adoption of Reform Medicaid expansion Exchange activity

  15. Managed Care Expansion

  16. Program Compliance • Exchanges • Employers • Plan audits • Claim audits • Third-level appeals • Managed care program integrity • Federal focus on fraud, waste, and abuse • Medicaid RAC

  17. Medicaid RAC

  18. Investment considerations

  19. Revenue Diversity and Growth $ Millions $ Millions

  20. Key Financial IndicatorsRolling Four Quarters

  21. Why HMSY? Proprietary, high growth core business with significant barriers to entry Rapidly growing, early stage program integrity business Market leadership in Medicaid RAC ACA is a growth accelerator Multiple new growth opportunities Strong financial position

  22. 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 statements give our expectations or forecasts of future events; they do not relate strictly to historical or current facts. Forward-looking statements can be identified by words such as “anticipates,” “estimates,” “expects,” “projects,” “intends,” “plans,” “believes,” “will,” “target,” “seeks,” “forecast” and similar expressions. In particular, these include statements relating to future actions, business plans, objects and prospects, and future operating or financial performance. Forward-looking statements are based on our current expectations and assumptions regarding our business, the economy and other future conditions. Should known or unknown risks or uncertainties materialize, or should underlying assumptions prove inaccurate, actual results could differ materially from past results and those anticipated, estimated or projected. We caution you therefore against relying on any of these forward-looking statements. Factors that could cause or contribute to such differences include, but are not limited to: the development by competitors of new or superior services or products or the entry into the market of new competitors; all the risks inherent in the development, introduction, and implementation of new products and services; the loss of a major customer, customer dissatisfaction or early termination of customer contracts triggering significant costs or liabilities; variations in our results of operations; negative results of government reviews, audits or investigations to verify our compliance with contracts and applicable laws and regulations; changing conditions in the healthcare environment, particularly as they relate to current healthcare reform initiatives; government regulatory, political and budgetary pressures that could affect the procurement practices and operations of healthcare organizations, reducing the demand for our services; and, our failure to comply with laws and regulations governing health data or to protect such data from theft and misuse. A further description of risks, uncertainties, and other matters can be found in the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2010, a copy of which may be obtained from the Company’s website at www.hms.com under the “Investor Relations” tab. Any forward-looking statements made by us in this Presentation speak only as of the date of this Presentation. Factors or events that could cause actual results to differ may emerge from time to time and it is not possible for us to predict all of them. We undertake no obligation to publicly update forward-looking statements, whether as a result of new information, future events or otherwise, except as may be required by law.

  23. NASDAQ: HMSY

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