22nd Annual Piper Jaffray Health Care Conference November 30, 2010 Walter Hosp, CFO Contact: Christine Saenz
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. 2
Who We Serve Federal Programs –Centers for Medicare & Medicaid Services –Veterans Administration 3 State Programs –Medicaid agencies –CHIPs (Children’s Health Insurance Programs) –Child Support agencies Commercial Programs –Medicaid Managed Care Organizations (MCOs) –Commercial Plans –Employers
COMMERCIAL $847 billion 164 million lives Source: 2009 CMS Office of the Actuary 4 MEDICARE $515.5 billion 47 million lives MEDICAID $436 billion 57 million lives UNINSURED 46 million lives Coordination of Benefits
5 How We Grow 5 5 Capture more lives Ride the Medicaid growth wave Add new products, enter new markets Upsell to existing customers
Capture More Medicaid Lives Sources: HMS & 2009 CMS Office of the Actuary. 6
Ride the Medicaid Growth Wave Actual Projected data, 2008 CMS Office of the Actuary data, 2009 CMS Office of the Actuary With reform
& Beyond Acquired Permedion Hospital Audits CHIP Enrollment Integrity Acquired BSPA Premium Assistance Real-time COB Managed Care Acquired PrudentRx Federal MIC Clinical Review M & A Market Service Acquired IntegriGuard Acquired Verify Solutions Behavioral Health Long-term Care Audits Pharmacy Audits Acquired AMG Acquired Chapman Kelly Medicare Employers Commercial Insures Dependent Eligibility Audits New Product Development Healthcare Reform Products Add New Products, Enter New Markets
Upsell to existing customers
Impact of Health Reform Law Medicaid/Medicare expansion New pathways to coverage Emphasis on program integrity Employer requirements 12
COMMERCIAL $847 billion 164 million lives Source: 2009 CMS Office of the Actuary 13 MEDICARE $515.5 billion 47 million lives MEDICAID $436 billion 57 million lives UNINSURED 46 million lives Medicaid/Medicare Expansion
COMMERCIAL $1335 billion 168 million lives Source: 2019 Estimates, 2009 CMS Office of the Actuary. MEDICARE $904 billion 60.5 million lives 14 UNINSURED 16 million lives MEDICAID $994 billion 83 million lives Medicaid/Medicare 2019
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” 15
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 16
Employer Requirements New coverage requirements and employer penalties Automatic enrollment of employees into health plans Reporting mandates 17
Revenue Diversity and Growth 18 $ Millions
Key Financial Indicators Rolling Four Quarters 19
Guidance Revenue $$300.0$370.0 % change y/y30.9%23.0% Operating Profit $$66.9$85.0 % change y/y29.0%26.8% Margin22.3%23.0% GAAP EPS $$1.40$1.74 % change y/y28.7%23.6% Adjusted EPS $$1.68$2.03 % change y/y25.9%20.1% 20
21 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 21
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 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, 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.
23 NASDAQ: HMSY