Health care incentive system and method for operating a health care incentive system

• US 20060136258A1
• Filed: 12/17/2004
• Published: 06/22/2006
• Est. Priority Date: 12/17/2004
• Status: Abandoned Application

• Current Assignee: Priority Health (Spectrum Health System)
• Original Assignee: Priority Health (Spectrum Health System)
• Inventors: Osentoski, Cheryl Ann, Horn, Kimberly K., Southwell, Jodie E.
• Application Number:
  US11/015,108
• Publication Number:
  US 20060136258A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/0214 Referral reward systems
• CPC Class Codes: G06Q 30/0235 constrained by time limit or expiration date
• CPC Class Codes: G16H 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

A health care incentive system comprises a means for accumulating health care information and means for analyzing the health care information in order to develop a set of commitments for the individual in the health incentive program. If the individual achieves the commitments over a predetermined period of time, an incentive is provided to the individual.

Claims

1. A health care incentive system for providing an incentive to an individual participating in a health care plan comprising:

a data warehouse for storing a health claim information and an individual commitment; and

a software means for comparing the health claim information with the individual commitment to determine whether the individual commitment was fulfilled.

2. The health care incentive system of claim 1 further comprising a health claim information system for providing the health claim information to the data warehouse.

3. The health care incentive system of claim 2 where the data warehouse stores a health quotient information.

4. The health care incentive system of claim 3 further comprising a health quotient information system for providing the health quotient information to the data warehouse.

5. The health care incentive system of claim 4 where the data warehouse further stores a group commitment.

6. The health care incentive system of claim 5 further comprising the individual commitment generation means for deriving the individual commitment from the group commitment information and the health quotient information.

7. The health care incentive system of claim 6 where the individual commitment generation means further includes a health knowledge system for determining if the individual has a managed disease.

8. The health care incentive system of claim 7 further comprising verification means for determining whether the individual fulfilled the individual commitment.

9. The health care incentive system of claim 8 where the verification means further comprises a claims accumulator for accumulating the claims information.

10. The health care incentive system of claim 9 where the verification means further comprises determining means for determining from the claims information whether the individual fulfilled the individual commitment.

11. A method for operating a health care incentive system to provide an incentive to an individual in a health care plan comprising:

determining a commitment for the individual;

tracking a performance of the individual relative to the commitment by analyzing health claim information;

and providing the incentive to the individual if the individual attains the commitment.

12. The method for operating a health care incentive system of claim 11 where the step of determining a commitment for the individual comprises:

by the individual, completing a on-line health assessment.

13. The method for operating a health care incentive system of claim 12 where the step of determining a commitment for the individual comprises:

obtaining a group commitment.

14. The method for operating a health care incentive system of claim 13 where the step of tracking the performance of the individual relative to the commitment by analyzing health claim information comprises:

accumulating health claim information;

analyzing the health claim information to determine if the individual has a managed diseases; and

further analyzing the health claim information to determine if the individual is obtaining treatment for the managed disease.

15. An information model comprising:

a commitment object maintaining a commitment of an individual; and

a member commitment status object for maintaining a status of the commitment with respect to the individual.

16. The information model of claim 15 further comprising:

a commitment version object maintaining a version of the commitment object.

17. The information model of claim 16 further comprising an incentive object for maintaining incentives for the individual.

18. The information model of claim 17 further comprising an employee class object.

19. The information model of claim 18 further comprising a commitment version object indicating a version of the commitment object associated with the individual.

20. The information model of claim 19 further comprising a goal object.

21. A method of operating a health care incentive system comprising:

setting a commitment for an individual in a health plan;

storing the commitment in a data warehouse;

obtaining claim information for the individual;

analyzing the claim information to determine if the individual obtained the commitment; and

providing an incentive to the individual is the individual obtained the commitment.

22. The method of claim 21 where the step of analyzing the claim information to determine if the individual obtained the commitment is performed by a computer software program.

23. The method of claim 22 where the claim information includes health care provider claim information.

24. The method of claim 23 where the claim information includes pharmacy claim information.

25. The method of claim 24 where the step of setting a commitment for an individual in a health plan includes the individual completing a health assessment survey.

26. The method of claim 25 where the step of setting a commitment for an individual includes having an employer of the individual determine an employer commitment.

27. The method of claim 26 where the employer commitment is stored in the data warehouse.

28. The method of claim 27 further comprising the step of determining if the individual has a managed disease.

29. The method of claim 28 where the step of analyzing the claim information to determine if the individual obtained the commitment comprises analyzing claim information.

30. The method of claim 29 where the step of analyzing claim information comprises analyzing health care provider claim information and pharmacy claim information.