Method and system for managing a membership based health care program not utilizing primary care insurance

• US 20060053033A1
• Filed: 08/27/2004
• Published: 03/09/2006
• Est. Priority Date: 08/27/2004
• Status: Abandoned Application

• Current Assignee: Victor Wood
• Original Assignee: Victor Wood
• Inventors: Wood, Victor
• Application Number:
  US10/927,877
• Publication Number:
  US 20060053033A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A system and method for managing an electronically-implemented membership based health care program without utilizing primary care medical insurance includes providing a health clinic having doctors to provide medical services to its members. An electronic database which may be connected to computer network manages member records, including a purchase arrangement by which services may be obtained. Enrolled members in good payment standing may receive primary care medical services from the clinic, including unlimited office visits. Clinic employees receive the medical services as an employee benefit. The clinic may be owned by another company not related to health care and having employees who also receive the medical services, the company paying the clinic according to the purchase arrangement. Neither the clinic nor its members utilize primary care insurance. The method results in dramatically decreased healthcare costs and higher effective employee compensation.

Claims

1. An electronically-implemented method for providing and managing a membership healthcare program not utilizing primary care insurance, said method comprising the steps of:

providing a health care clinic for administering the membership health care program, said clinic employing at least one doctor and a plurality of clinic employees for providing medical services to members of the program without utilizing primary care medical insurance;

providing an electronic database having a plurality of member records, each member record having a member identifier and a purchase arrangement data field;

enrolling new members into the program by transacting a predetermined purchase arrangement between said new members and said clinic, said step of enrolling new members including receiving a predetermined fee and establishing a schedule of level-pay fees;

storing a respective member identifier and purchase arrangement data in a respective member record for each enrolled member; and

rendering said medical services to a respective enrolled member when a corresponding purchase arrangement data field is indicative of paid fees, whereby said medical services are provided at a cost to said clinic and said members that is comparatively lower than a cost thereto when utilizing primary care health insurance.

2. The method as in claim 1 wherein each member record includes an employment data field, said method further including the steps of:

determining during enrollment whether a prospective member is employed by said clinic;

storing employment status data in a corresponding employment data field of a corresponding member record associated with said prospective member; and

if said prospective member is employed by said clinic, waiving all fees associated with said purchase arrangement and automatically setting said purchase arrangement data field associated with said prospective member to indicate paid fees.

3. The method as in claim 2 further comprising the step of proceeding with said step of rendering said medical services to a respective member if a corresponding employment data field associated with said respective member is indicative that said respective member is not employed by said clinic but that a corresponding purchase arrangement data field associated with said respective member is indicative of paid fees.

4. The method as in claim 1 wherein said medical services include primary care medical services, unlimited office visits, labs, x-ray, and predetermined in-clinic procedures.

5. The method as in claim 1 wherein said purchase arrangement includes predetermined individual and family level-pay fee arrangements.

6. The method as in claim 1 wherein said method includes notifying said members regarding availability of supplemental catastrophic and hospitalization insurance.

7. The method as in claim 1 wherein:

said clinic is owned by a company not otherwise associated with health care and having a plurality of company employees;

said method further comprising the step of automatically setting respective purchase arrangement data fields of respective member records associated with said company employees to indicate paid fees.

8. The method as in claim 7 further comprising the step of said company paying to said clinic all fees associated with respective purchase arrangements of said company employees;

and

wherein said step of enrolling new members includes electronically receiving enrollment data through a computer network.

9. The method as in claim 8 wherein said step of paying said respective fees includes paying said respective fees by electronic funds transfer.

10. The method as in claim 2 wherein:

said clinic is owned by a company not otherwise associated with health care and having a plurality of company employees; and

said plurality of clinic employees of said clinic includes said company employees, wherein respective employment data fields of respective member records associated with said company employees are set to indicate employment by said clinic such that all purchase arrangement fees are waived.

11. A system for managing a membership healthcare program not utilizing primary care insurance, comprising:

an electronic information management system having a central processing unit (“

CPU”

) and a database electrically connected to said CPU, said database having a plurality of member records, each member record having a member identifier and a purchase arrangement data field;

a health clinic for utilizing said information management system to administer the program, said clinic employing at least one doctor and a plurality of clinic employees for providing a predetermined set of medical services to a plurality of members of the program, said clinic establishing a purchase arrangement by which said medical services may be obtained by said members;

means for enrolling a new member into the program by transacting said purchase arrangement between said clinic and said new member, said means for enrolling said new member including means for receiving payment of a predetermined fee and establishing a schedule of level-pay fees;

means in said CPU for storing a respective member identifier and purchase arrangement in a respective member record of said database for each enrolled member;

wherein said doctor is authorized to render said medical services to a respective member when a corresponding purchase arrangement data field associated with said respective member is indicative of paid fees, whereby said medical services are rendered at reduced cost to said members and said clinic by not utilizing primary care insurance.

12. The system as in claim 11 wherein said enrolling means includes means for electronically transacting said purchase arrangement and means for electronically receiving payment of said predetermined fees.

13. The system as in claim 11 further comprising means in said CPU for setting respective purchase arrangement data fields associated with said clinic employees to indicate paid fees, wherein said medical services are provided to said clinic employees as an employee benefit.

14. The system as in claim 11 wherein:

said health clinic is owned by a company not otherwise associated with health care and having a plurality of company employees;

said system further comprising means in said CPU for setting respective purchase arrangement data fields of respective member records associated with said company employees to indicate paid fees, whereby membership in the program is given to said company employees as a company employee benefit.

15. The system as in claim 14 further comprising means in said CPU for electronically receiving funds from said company corresponding to purchase arrangement fees associated with said company employees, whereby said company pays said purchase arrangement fees to said clinic.

16. The system as in claim 11 wherein:

said health clinic is a network of health clinics employing a plurality of network doctors and a plurality of network employees;

said information management system is electrically connected to a wide-area network for electronic communication between said network of health clinics, said database including respective member records corresponding to said network of health clinics.

17. The system as in claim 16 wherein each member record includes a clinic identifier for identifying a respective clinic is associated with a respective member.