Method and system for evaluating a cost for health care coverage for an entity

• US 20050288968A1
• Filed: 06/29/2004
• Published: 12/29/2005
• Est. Priority Date: 06/29/2004
• Status: Abandoned Application

• Current Assignee: higi SH llc (Babylon Holdings Ltd.)
• Original Assignee: higi SH llc (Babylon Holdings Ltd.)
• Inventors: Collins, John
• Application Number:
  US10/882,139
• Publication Number:
  US 20050288968A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

A method for evaluating a cost payable by an entity to secure a specific health care coverage. The method includes the steps of: obtaining starting information relative to at least one health-related attribute for the entity; based on the starting information, making an initial health risk assessment for the entity; charging the entity a first calculated amount for the specific health care coverage for an agreed term based upon the initial health risk assessment; before the end of the agreed term, making an updated health risk assessment based on updated information relative to at least one quantifiable health-related attribute for the entity; and determining whether an adjustment to the first calculated amount is warranted based on the updated health risk assessment.

Claims

1. A method for evaluating a cost payable by an entity to secure a specific health care coverage, the method comprising the steps of:

obtaining starting information relative to at least one health-related attribute for the entity;

based on the starting information, making an initial health risk assessment for the entity;

charging the entity a first calculated amount for the specific health care coverage for an agreed term based upon the initial health risk assessment;

before the end of the agreed term, making an updated health risk assessment based on updated information relative to at least one quantifiable health-related attribute for the entity; and

determining whether an adjustment to the first calculated amount is warranted based on the updated health risk assessment.

2. The method for evaluating a cost payable by an entity to secure a specific health care coverage according to claim 1 wherein the step of obtaining starting information comprises requiring the generation of quantitative starting information relative to at least one health-related attribute.

3. The method for evaluating a cost payable by an entity to secure an specific coverage according to claim 2 wherein the step of requiring the generation of quantitative starting information comprises requiring use of an instrument to take at least one measurement to generate data representative of a state for at least one health-related attribute.

4. The method for evaluating a cost payable by an entity to secure an specific coverage according to claim 1 wherein the step of obtaining starting information comprises obtaining starting information relative to an entity'"'"'s heart condition.

5. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 wherein the step of obtaining starting information comprises obtaining starting information relative to an entity'"'"'s body composition.

6. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 wherein the step of obtaining starting information comprises obtaining starting information relative to an entity'"'"'s blood sugar level.

7. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 further comprising the step of adjusting the first calculated amount based upon the updated health risk assessment.

8. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 further comprising the step of requiring that the entity submit for consideration quantitative updated information relative to at least one health-related attribute at a specific time within the agreed term to facilitate the step of determining whether an adjustment to the first calculated amount is warranted.

9. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 further comprising the step of maintaining a database for the entity in which the starting and updated information is stored.

10. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 8 further comprising the step of providing a web-enabled system through which updated information can be directed to the database for analysis.

11. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 8 wherein the step of obtaining starting information comprises requiring the generation of quantitative starting information through an instrument that is capable of communicating the starting information to the database.

12. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 8 wherein the step of obtaining starting information comprises requiring the generation of quantitative information through an instrument that is web-enabled and capable of communicating the starting information to the database over the Internet.

13. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 8 wherein the step of obtaining updated information comprises requiring the generation of quantifiable updated information through an instrument that is capable of communicating the updated information to the database.

14. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 11 wherein the step of obtaining updated information comprises requiring the generation of quantifiable updated information using the same type of instrument that is used to generate the quantitative starting information.

15. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 12 wherein the step of obtaining updated information comprises requiring the generation of quantitative information through the same type of instrument that is used to generate the quantitative starting information.

16. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 8 further comprising the step of requiring use of at least one instrument to generate data that is representative of the starting and updated information.

17. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 16 further comprising the steps of maintaining a database for the entity in which the data representative of the starting and updated information can be stored and requiring that the data generated by the at least one instrument can be communicated though te instrument to the database.

18. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 17 further comprising the step of verifying that the data representative of the starting and updated information is generated for the same entity.

19. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 further comprising the step of pre-establishing parameters for determining whether an adjustment to the first calculated amount is warranted.

20. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 17 further comprising the step of linking the at least one instrument to the database through the Internet whereby the data can be generated remotely and conveyed to the database.

21. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 17 further comprising the step of requiring that the entity verify the integrity of the data representative of the starting and/or updated information.

22. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 16 further comprising the step of spot checking the integrity of the data representative of the starting and/or updated information by using at least one instrument to generate test data that is representative of the starting and/or updated information and making a comparison between the test data and the data representative of the starting and updated information that was communicated to the database.

23. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 further comprising the step of providing web-accessible, health-related information for the entity.

24. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 further comprising the step of providing a web-accessible database to which the starting and/or updated information is communicated via the Internet.

25. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 23 further comprising the step of providing a server to which the data is communicated and containing general health-related information which is accessible by the entity.

26. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 25 further comprising the step of providing customized health-related information to the entity based upon data communicated by the entity to the server.

27. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 3 further comprising the step of providing a server and wherein the step of requiring use of an instrument comprises requiring use of an instrument that is capable of taking a measurement and generating a signal to the server that is not in human readable form and causing the signal to be converted by the server to a human readable form.

28. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 wherein the first calculated amount is at least one of (a) a co-payment amount, (b) a deductible, and (c) a premium.

29. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 wherein the entity comprises a single person.

30. The method for evaluating a cost payable by an entity to secure a specific coverage according to claim 1 wherein the entity comprises a plurality of persons.

31. A system for evaluating cost payable by an entity to secure a specific health care coverage, the system comprising:

a server at a first site; and

an instrument at a second site capable of taking at least one measurement and generating a signal representative of a state for at least one health-related attribute for an entity to the server,

the server capable of processing a signal representative of a state for the at least one health-related attribute for the entity and calculating a first recommended amount to be paid by the entity to secure the specific health care coverage based upon a reference amount developed using a reference state for the at least one health-related attribute.

32. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 31 wherein the signal generated by the instrument is in non-human readable form and is converted by the server to a human readable form.

33. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 31 wherein the server is a web server.

34. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 33 wherein the web server communicates health-related information to the entity.

35. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 34 wherein the web server communicates customized health-related information to the entity based upon the signals generated to the web server.

36. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 31 wherein the web server processes different signals representative of the state for the at least one health-related attribute for the entity at different time periods and processes the different signals to calculate a recommended updated amount appropriate for the entity in the event that a later signal indicates that there is a change in the state for the at least one health-related attribute for the entity from a state for the at least one health-related attribute for the at least one entity based on a signal representative of the state for the at least one health-related attribute for the entity that is generated and communicated to the web server prior in time to the communication of the later signal to the web server.

37. A system for evaluating cost payable by an entity to secure a specific health care coverage, the system comprising:

a server to which data relative to at least one health-related attribute for an entity can be communicated,

the server capable of processing the data communicated by the entity to facilitate risk analysis so as to allow a quantified analysis of an appropriate amount to be paid by the entity for specific health care coverage, based on the communicated information, to be made; and

an instrument for taking at least one measurement to generate data representative of a state for at least one health-related attribute that is communicated to the server.

38. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 37 wherein the instrument generates a signal that is not in human readable form and is converted by the server to a human readable form.

39. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 37 wherein the server communicates health-related information to the entity.

40. The for evaluating cost payable by an entity to secure a specific health care coverage according to claim 37 wherein the server communicates customized health-related information to the entity based upon the signals generated to the server.

41. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 37 wherein the server processes different signals representative of the state for the at least one health-related attribute for the entity at different time periods and processes the different signals to calculate a recommended updated amount appropriate for the entity in the event that a later signal indicates that there is a change in the state for the at least one health-related attribute for the entity from a state for the at least one health-related attribute for the at least one entity based on a signal representative of the state for the at least one health-related attribute for the entity that is generated and communicated to the web server prior in time to the communication of the later signal to the web server.

42. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 37 wherein the sever communicates health-related information to the entity in response to a query from the entity.

43. The system for evaluating cost payable by an entity to secure a specific health care coverage according to claim 37 wherein the server is a web-based server.

44. A method of evaluating a cost payable by one individual in a group, consisting of a plurality of individuals, to secure a specific health care coverage, the method comprising the steps of:

obtaining starting information relative to at least one health-related attribute for the plurality of individuals including the one individual;

based on the starting information making an initial health risk assessment for each of the plurality of individuals including the one individual;

at one point in time charging the one individual a first, calculated amount for the specific health care coverage based upon the initial health risk assessment and compared to the initial health risk assessment for the other individual or individuals in the group;

establishing criteria for the one individual to be able to secure the specific health coverage by paying the first calculated amount; and

at a second point in time, after the first point in time, determining whether the one individual has met the established criteria.

45. The method of evaluating a cost payable by an entity to secure a specific health care coverage according to claim 44 wherein the step of establishing criteria comprises setting health-related goals for the one individual.

46. The method of evaluating a cost payable by an entity to secure a specific health care coverage according to claim 45 wherein the step of setting health-related goals comprises requiring the one individual to achieve specific quantifiable results relative to at least one health-related attribute.

47. The method of evaluating a cost payable by an entity to secure a specific health care coverage according to claim 45 wherein the step of setting health-related goals comprises requiring the one individual to embark upon a specific health-related regimen.

48. The method of evaluating a cost payable by an entity to secure a specific health care coverage according to claim 44 further comprising the steps of obtaining updated information relative to at least one health-related attribute for the one individual, based on the updated information making an updated health risk assessment for the one individual, and charging the one individual a second, calculated amount for the specific health care coverage, that is different than the first, calculated amount, based upon the difference in the initial and updated health risk assessments for the one individual.