SYSTEM, METHOD AND COMPUTER PROGRAM PRODUCT FOR PROVIDING A HEALTHCARE USER INTERFACE AND INCENTIVES

• US 20150235006A1
• Filed: 02/14/2014
• Published: 08/20/2015
• Est. Priority Date: 02/14/2014
• Status: Active Grant

• Current Assignee: Optum Incorporated (UnitedHealth Group Incorporated)
• Original Assignee: Optum Incorporated (UnitedHealth Group Incorporated)
• Inventors: Nichols, Matt
• Granted Patent: US 9,633,174 B2
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 70/60 relating to pathologies

Abstract

Actively engaging members in managing their own healthcare, improving their health, and reducing healthcare costs to the payer involves providing a unified interface for member engagement. The interface may be communicatively coupled with a healthcare system, may be personalized to the member, and may offer multiple possible rewards to the member to encourage member behavior to effectively reduce healthcare costs and improve the quality of healthcare plans. The interface may provide the member with a pathway guiding the member to engage in activities to achieve short-term, intermediate and long-term goals for which actions are presented. Goals or actions may be predefined and may additionally be selected by the member. When member-engagement in the actions is verified, rewards may be granted to the member'"'"'s account. In connection with such member engagement, the healthcare system collects member information, applies rules to that information, and generates alerts from those rules.

Claims

1. A computer-implemented method of encouraging healthy behavior, the method comprising the steps of:

receiving, at a server, health-related member information with respect to a member of a health plan;

applying evidence-based medicine rules to the received member information to identify actions to improve the member'"'"'s health or health risk;

comparing the received member information with the identified actions to determine whether the actions are completed; and

for completed actions, granting rewards under a rewards program, the rewards program comprising a sequence of steps including at least one action that is verifiable and at least one action that is non-verifiable, each step in the sequence being associated with a reward;

wherein granting rewards for the at least one verifiable action, comprises verifying completion of the action by;

obtaining, from a medical provider, medical information for the member that confirms or denies completion of the action;

obtaining, from a third party, at least some medical provider information that confirms or denies completion of the action;

or

obtaining biometric data from an authenticated device that confirms or denies completion of the action; and

granting rewards based on verification of the completed verifiable action;

wherein granting rewards for the at least one non-verifiable action comprises receiving non-verifiable medical information or self-reported member data and granting rewards based thereon; and

wherein the completed verified action is granted a first level of reward and the completed non-verifiable action is granted a second level of reward having a lesser value relative to the first.

2. The method of claim 1, further comprising, prior to granting rewards for self-reported member data, verifying actions associated with the self-reported member data are completed using member information received from a secondary source.

3. The method of claim 1, further comprising identifying open actions and presenting the open actions to the member on a user interface.

4. The method of claim 3, wherein

the step of presenting the user interface includes:

presenting at least a portion of the sequence of steps under the rewards program, each step presented associated with rewards;

receiving self-reported member planned activities as input from the member to create at least one of the steps; and

receiving self-reported member data as input from the member with respect to activity with respect to the at least one of the steps.

5. The method of claim 1, wherein the health-related member information received with respect to the member comprises one or more of pre-adjudicated medical claims, pharmacy claims, adjudicated medical claims or clinical data.

6. The method of claim 5, wherein the clinical data received comprises clinical data received from provider systems including one or more of electronic medical records or HL7 messages.

7. The method of claim 1, wherein the one or more actions identified are HEDIS-based measures, accountable care organization (“

ACO”

) measures, Medicaid guidelines, patient-centered medical home (“

PCMH”

) measures, health plan-specific measures, employer-specific measures, Medicare risk-based measures or Medicare quality measures.

8. The method of claim 1, wherein the rewards can be accumulated and exchanged for items of value to the member.

9. The method of claim 8, further comprising:

determining a degree to which the member is engaged in the rewards program; and

adjusting a level of reward in response to the degree to which the member is engaged.

10. The method of claim 1, further comprising tracking performance of quality measures under the health plan of the member.

11. The method of claim 1, further comprising notifying a payer of the completed action and of the health plan for the member.

12. The method of claim 1, further comprising:

determining, in response to receiving said health-related information, a projected cost associated with said member; and

determining, in response to identifying completed actions, a reduction in the projected cost.

13. The method of claim 12, wherein the identified completed actions comprise at least one change to the member'"'"'s health-related information that is indicative of improving the member'"'"'s health or health risk.

14. The method of claim 12, wherein the determined projected cost associated with said member is a lifetime cost based on actuarial cost curves.

15. The method of claim 14, wherein the health-related information comprises one or more of initial biometrics, initial health conditions, age or gender of the member.

16. The method of claim 15, wherein the determined reduction in the projected costs is based on updates to the initial biometrics or updates to the initial health conditions of the member.

17. A computer system, the system comprising:

one more servers configured to;

receive health-related member information with respect to a member of a health plan;

apply evidence-based medicine rules to the received health-related member information to determine one or more actions to address the health of the member;

compare the health-related member information and self-reported member data of the member with the one or more actions to identify completion of one or more actions;

grant rewards for completion of the actions under a rewards program, the rewards program comprising a sequence of steps including at least one action that is verifiable and at least one action that is non-verifiable, wherein each step in the sequence is associated with a reward, wherein the completed verifiable action is granted a first level of reward and the completed non-verifiable action is granted a second level of reward having a lesser value relative to the first.

18. The system of claim 17, wherein the one or more servers is further configured to:

determine, in response to receiving said health-related information, a projected lifetime healthcare cost for the member; and

determining, in response to identifying completed actions, a cost savings in the projected lifetime healthcare cost for the member.

19. A non-transitory computer readable medium storing instructions that when executed by a computer cause the computer to perform operations comprising:

initiating a rewards program comprising a sequence of steps including at least one action that is verifiable and at least one action that is non-verifiable, wherein each step in the sequence is associated with a reward;

for the at least one verifiable action, verifying the completion of the action to satisfy one or more of the sequence of steps, wherein verifying comprise one or more of;

obtaining, from a medical provider, medical information for the member that confirms or denies completion of the step;

obtaining, from a third party, at least some medical provider information that confirms or denies completion of the step;

or

obtaining biometric data from an authenticated device that confirms or denies completion of the step;

for the at least one non-verifiable action, receiving non-verifiable medical information or self-reported member data to satisfy completion of one or more of the sequence of steps; and

granting rewards under the rewards program, wherein the completed verifiable action is granted a first level of reward and the completed non-verifiable action is granted a second level of reward having a lesser value relative to the first.

20. The non-transitory computer readable medium of claim 19, further operable to cause the computer to perform operations comprising:

determining, in response to receiving said health-related information, a projected lifetime healthcare cost for the member; and

determining, in response to identifying completed actions, a cost savings in the projected lifetime healthcare cost for the member.