Helm provides a Dynamic Copay Platform that enables TPAs and carriers to implement value-driven benefit designs for health plan members. The platform utilizes upfront pricing to encourage member engagement and informed decision-making regarding healthcare utilization. It facilitates smart claim bundling to offer members guaranteed prices while maintaining standard provider fee-for-service reimbursement.
Funding
$10.5M raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
EFounders
Product
Problem
Many health insurance plans lack transparency in pricing, leading to unexpected out-of-pocket costs for members. Traditional fixed copays do not account for variations in provider cost and quality, potentially incentivizing members to choose more expensive or lower-value care options. Employers also face challenges in managing healthcare premiums due to the lack of cost control and predictability.
Solution
Helm provides a platform that integrates with existing claims systems to enable Dynamic Copay products, offering members upfront pricing based on provider cost and quality. The platform dynamically adjusts copays, incentivizing members to select cost-effective and high-quality providers. By bundling claims to match the upfront price quoted to the member, Helm ensures price transparency and predictability. This approach results in lower out-of-pocket costs for members and reduced premiums for employers.
Target Audience
The primary customers are Third-Party Administrators (TPAs) and carriers looking to offer Dynamic Copay products to their members.
Features
- Copay Algorithm: Dynamically sets copays based on provider cost and quality data.
- Copay Pricer: Bundles claims to match the price quoted upfront to the member.
- Shopping Tool: Provides members and navigators with an intuitive search experience to compare providers and costs.
- Integration with existing claims systems and workflows.
- Value-based coverage that dynamically changes based on provider cost and quality.
- Simple, upfront prices that are known in advance and cover an entire visit.