TABS™ Transparent Accountability & Benchmarking System

A business plan for

TABS™ Transparent Accountability & Benchmarking System

Brian P. Crowley Founder & CEO (561) 358-7307

brian.crowley@integraenterprizes.com

Company Confidential – This business plan is intended for the individual or entity to which it is addressed and contains privileged and confidential information. Any unauthorized use; disclosure, distribution or copying of this report by anyone other than the intended recipient is strictly prohibited. By reading this and accepting this document herein, either you, individually, and as the entity or entities you represent, its agents, affiliates or related individuals or entities herein known as "prospect", hereby agree to keep confidential all related materials and are prohibited to share, distribute, copy, implement or manipulate in any manner for your benefit or disclose to third parties, without expressed written authorization from Integra Enterprizes. Your signature confirms your understanding and agreement of such.

April 1st, 2016

Dear reader,

Due to the very short notice (one day) about this contest, we hereby submit this plan for consideration.

The people and the technologies are already built. We simply need to configure the model to represent this presentation and scale it up.

PRODUCT DESCRIPTION

TABS™ (Transparent Accountability & Benchmarking System)

TABS ™ is a cognitive intelligence system that offers real-time tracking and analytics of treatment standards and protocols to determine appropriate levels of care, adequate medical necessity and cost benefits analysis of industry wide treatment, testing utilization, billing and payments.

From an insurance payer’s perspective TABS™ can immediately eliminate testing and treatment over-utilization abuses and fraud, billing miscoding and immediately verify test ordering and utilization, ensuring providers accurately follow payer and provider agreed guidelines.

TABS™ can reduce employing extensive resources and expense in prior authorizations, denial reviews and appeals. Payers systems are limited to monitoring static thresholds (testing maximums) and alerting humans about irregularities in frequency and drug selection, which then takes additional time and money to respond to.

From a hospitals perspective, TABS ™ can dramatically decrease ER costs by reducing readmissions of substance abuse patients. TABS ™ can virtually train healthcare staff on determining how to handle and substance abuse patient and refer them to a mental and substance use treatment center.

Key Features:

TABS™ employs a Software-as-a-Service artificial intelligence interactive analytics tool, offering secured access in analyzing medical, clinical and lifestyle health data networks.

TABS™ is Cognitive Physicians Assistant™ module called the Dr. B. Once configured, Dr. B is not only capable of tracking, analyzing and alerting on testing utilization, it has the ability to learn the complex correlations between diagnosis code, treatment plan and testing requirements to deliver sound logical decisions for test method, drug selection and frequency, based on level of care, testing technology and a host of other patient variables that may impact a clinician’s decision.

With the TABS Fundamentals™ Training module Medical and Clinical professionals are trained on the fundamentals of having conversation with substance abusers coming in hospital ER’s on how to identify the indicators of risk and determine the appropriate level of care and what recommendations are allowable, based on payer and facility guidelines.

If a clinician wishes to overturn the TABS™ recommendation, the provider is required to proactively deliver justification within a predefined period of time. Under the covenants of TABS™, payers are then required to response accordingly within a predefined period of time also. Both stakeholders will have the capability to respond and process claims, denials and disputes in real-time, more accurately and have evidence-based activity reports to support their case.

Technology Innovation

The TABS™ platform also has the capability to perform the following functions:

• Analyze patient data across multiple payer and provider networks while maintaining privacy. For example: regional segmentation analysis by treatment modality, facility, laboratory, patient diagnosis, regardless of the patient’s insurance or provider. • Capable of providing a five-year comprehensive care continuum patient outlook, regardless of insurance plan. • Allow patients to share “designated” personal health data with pre-determined professionals for as long as they wish. • Ability to define notifications or rapidly design new monitoring programs to stay ahead of new fraudulent schemes.

The case for TABS™

The cost benefit potential of TABS™ is five fold for a payer:

• Eliminate fraud and abuses in physician offices and independent labs. • Identify operational and ethical violations in real time. • Put responsibility back on provider and patient. • Benchmark patient lifestyle history against treatment effectiveness. • Create a hybrid solution that brings Out-of-Network providers, In-Network.

BUSINESS MODEL

This is an existing proven model that we can expand nationally with the expansion of our existing technologies.

1. Train the physical health sector on how to talk to people with mental health and addiction issues upon ER admission.
2. Provide integrated resources that can place and track patient care and utilization of services through out multiple networks.
3. Improve outpatient engagement and medication compliance.
4. Extend engagement recovery management training, resources and tracking.
5. Dramatically reduce hospital readmissions by utilizing technology to close the “Digital loop” and improve service collaboration.

MARKET OPPORTUNITY & STRATEGY

Why Behavioral Health Matters?

The additional annual national spend in hospitals from behavioral health comorbidities is $293BN.

This is a dramatic patient mismatch in the physical health sector and the behavioral health sectors. There is 80% of BH patients in the physical health sector and only 5% practicing BH specialists. There is 20% of BH patients in the behavioral health sectors and 95% of the BH specialists.

There is a 30%-70% higher number of hospital readmits from patients with BH issues.

SCALING THE BUSINESS

As stated, the model, the people and the technology exist; just not at the level of integration to demonstrate the solution for this contest.

Each element of the model can stand on its own currently.

Here are the key elements.

• Clinical Expertize Gosnod Drug Treatment Facility, MA Ray Tamaisi, CEO

• Technology Research & Analytics Platform Wavefront Health Technologies, FL Michael Gregson, CEO

• TABS Program Integra Health Partners, FL Brian Crowley, CEO

• Training Software and platform Socratic Arts, FL Roger Schank, CEO

Demo training - http://www.socraticarts.com/demos/delivering-serious-news

Due to time constraints, team background will be forwarded if this project merits further investigation.

Thank you for your consideration.

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