Solving Challenges for Healthcare with Data and Analytics

29 July, 2016

Civica Company Overview - Group Performance

Civica Company Overview

Civica Company Overview - Healthcare Northern Hemisphere

200

200 NHS Trusts using

Civica Systems

£40billion

£40 billion of NHS Funds

processed annually

Cloud Delivery to more

than 20,000 Clinicians

Annual Care Billing of

over £3 billion

200 million documents &

images scanned annually

ColdharbourPart of the Civica Group

Civica Health Solutions

CivicaHealth Solutions - Australia

33%PHI Policies

25%ECLIPSE Online Eligibility Checks (OEC)

42%OSHC Policies

Focus on:• PHI Solutions• OSHC Solutions• OVHC Solutions• Automation• Industry Solutions

$5.9 BillionBenefits Paid

5 MillionActive Customers

$6.2 BillionReceipts

2.5 MillionActive Policies

‹#›

Revenue: US$4.8 bn

EBIT: US$1.2 bn

Market Cap: c.£14.3 bn

In top 50 of FTSE-100

Employees: c.17,000

Offices in 39 countries

Largest markets: US, Brazil, UK

For the year ending 31 March 2014

…helping organisations and consumers derive insights and make informed decisions

Experian Company Overview

‹#›

Global Network

Expertise

Platforms

Analytics

Data

Management

Data

Throughout the world, we help organisations and consumers

derive insights and make informed decisions

ExperianGlobal information services leader

‹#›

Data

Analytics and Workflow

Consumermarketing

c. 270mhouseholds

globally

US Healthcaredatabase

c. 1.2b annual health visits in US

Businesscredit

c. 99m businesses

globally

Consumercredit

800m+consumers

globally

Consumer segmentation

2.3b consumers

Vehicledata

c. 700mvehicles in

U.S. and UK

Consumer purchasing behaviour

c. 100mU.S. households

Depth and Breadth of our Data Assets

Australian healthcaredatabase

Visibility to

significant

portion of US

healthcare

activity

Possible callout of AUS

or Civica data assets

‹#›

Experian HealthTrusted by payers and providers to solve complex challenges

Facilitate system

wide movement of

money and data

Pool benefits data on

130m patients for

efficient management

Qualify patients for

charity care or financing

Segment patients for

marketing, communication,

and risk stratification

Link data from across

healthcare to single

individual

Detect and prevent

wide range of fraud

activity

‹#›

US Healthcare MarketSize and complexity represent opportunity for data and analytics

Experian Health solutions use connectivity, data, and analytics to

optimise flow of payments between patients, providers, and payers

~$1.6 trillion in hospital and physician services

US Healthcare payment flows:

Patients

Point of service

Remaining balance

6.5%

5.5%

37%

51%

Premiums

Claims

Commercial

Payers

(Private

funds)

PremiumsEmployers

Patients

GovernmentPayers

Providers

Premiums

Claims

‹#›

Magnitude of US Healthcare FraudMassive and growing problem, with medical data now targeted by hackers

$300 billion estimated losses due to some form of fraud in US healthcare

112 million health records stolen in 2015, often

precursor to insurance fraud

20xvalue of stolen health record,

versus credit card account

Reasons healthcare is targeted

$571 million Federal budget allocated exclusively

to investigating healthcare fraud

‹#›

Healthcare Fraud, Waste, and AbuseBlurred lines make detection and measurement difficult

Waste Abuse FraudLow High

Intent to Deceive

WasteDirect or indirect negligent

or wasteful acts that result

in unnecessary costs.

AbuseDirect or indirect act that

results in unnecessary costs

without intent to receive

an improper payment

FraudIntentional act or

misrepresentation to receive

improper payment or

benefit.

Separated by intent, but can be addressed by the same solutions

~$30 billion~$270 billion

‹#›

Multi-Layer Approach to Reducing LossesKey is pooling and linking of data assets

Big data

analytics

fueled by

identity and

data

foundation

Universal Identity Management

Essential foundation to analysis

Fraud: identity theft; outright intent to deceive

Prevent through industry-wide data sharing

Abuse: such as excessive prescription use or intentional

duplicate testing

Waste: poor coordination; avoidable errors

‹#›

Healthcare Fraud

Bureau

Universal Identity ManagementIdentifier that persists across providers and funds is key to fighting fraud

Private Fund

Civica and other 3rd Party Data

Experian data

Universal Identity Management

Pooling and linking disparate data assets creates powerful fraud fighting tool

► Cross-industry analysis

► Enrich with 3rd-party data

► Analyze trends and velocity

‹#›

RecoveryDetection

Screening for Fraud/Waste/AbuseMedDetective – Investigate claims before payment

Prevention

Low returns from “pay and

chase model”

In 2013, US recovered <1%

Experian MedDetective

MedDetective scores provider fraud risk at

enrollment and monitors continuously,

leveraging broad Experian data assets: Commercial credit and firmagraphics

Small business owner links and consumer credit

Medical license data

Fraud database

Device intelligence and geo-location

‹#›

Fraud PreventionMedDetective solution dashboard

‹#›

Emerging Trends in US Payer MarketOther uses of Experian data to solve emerging healthcare needs

Financing large obligations

Credit underwriting to make

payment more convenient

Marketing segmentation to

enhance communication

Payers moving into patient payment

stream to earn additional revenue

and deepen relationship

TREND

OPPORTUNITYBetter serve most

valuable plan members:

Online portals allowing access to

patient records being targeted by

hackers for use in fraud schemes

Providers and payers are

implementing bank-level identity

verification to secure access

points, such as: Benefits enrollment

Patient portals and records

ePrescribing

Telehealth services

‹#›