System and method for management of health care services

• US 7,493,266 B2
• Filed: 03/20/2002
• Issued: 02/17/2009
• Est. Priority Date: 03/21/2001
• Status: Expired due to Fees

• Current Assignee: Company Acquisition LLC (Hillenbrand Incorporated)
• Original Assignee: Company Financial
• Inventors: Gupta, Amit K.
• Primary Examiner(s): Gilligan; C Luke
• Assistant Examiner(s): KOPPIKAR, VIVEK D
• Application Number:
  US10/103,267
• Publication Number:
  US 20030009355A1
• Time in Patent Office: 2,526 Days
• Field of Search: 705 2- 4
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management

Abstract

The present invention is a system and method for management of consumer services such as health care services which combines new financial structure for health insurance and health benefit plan, payment methods, health plan design, benefit development algorithms, unique procurement methods for health care benefits with and without application to an individual consumer'"'"'s personal state of health, and is integrated with financial services and asset management products, and benefits for an individual consumer'"'"'s future medical and/or retirement savings, for healthcare needs. The method and system employs a combination of the defined benefit and defined contribution approaches which combination is referred to herein as “defined-care.” Defined-care model or the healthcare asset management model has two primary components, one which is referred to herein as a “health management and retirement account”, and the other of which is an infrastructure “connected portal” that interfaces through a technology platform with the health management and retirement accounts and the account holders. The foundation of this infrastructure according to the present invention is a technology platform across which a variety of processes are implemented. In the technology platform for the infrastructure of the present invention, the conventional processes and the new processes are integrated, thereby allowing a change to one process to be adopted by or otherwise accommodated by the other processes.

Claims

1. A system for managing health care assets with a plurality of management strategies comprising:

means for establishing an account for at least one individual;

means for determining an appropriate amount of a defined contribution to establish a health care asset for at least one individual in the account;

means for employer selection of mandatory health care benefits for the at least one individual that includes a mandatory high deductible catastrophic care benefit;

means for determining a proportion of the defined contribution to be allocated for the mandatory health care benefits;

means for automatically deducting the determined proportion from the defined contribution;

means for offering the at least one individual a selection of optional health care benefits the cost of which may be offset in whole or in part by the amount of the defined contribution remaining in the account after the amount of the defined contribution to be allocated for the mandatory health care benefits is deducted;

means for receiving from the at least one individual an identification of one or more of the optional health care benefits; and

means for deducting the cost in whole or in part of the one or more of the optional health care benefits from the account.

2. The system of claim 1 further comprising means for providing the at least one individual with descriptive information and advice concerning the optional health care benefits.

3. The system of claim 1 further comprising means for permitting the at least one individual to invest a proportion of the amount in the account.

4. The system of claim 1 further comprising means for accessing the account over the Internet.

5. The system of claim 1 wherein the means for determining an appropriate amount of the defined contribution includes determining mandatory health care benefits for each of the at least one individual based on a population group and an individual health risk level associated with each of the at least one individual.

6. A computer program product for use with a system for managing health care, the computer program product comprising:

a computer usable medium, having program code embodied in the medium for causing the computer system to interface over a communications medium such as the Internet or another network between at least one consumer of health care services and other stakeholders in health care services, the other stakeholders including at least one health benefits plan, at least one health care services provider, and at least one contributor of a defined contribution to the at least one consumer, wherein the program code;

recognizes a total health care asset amount corresponding to and unique to the at least one consumer;

allocates a proportion of the total health care asset amount for mandatory health care benefits, the mandatory health care benefits including at least a mandatory high deductible catastrophic care benefit, the mandatory catastrophic care benefit selected solely by the at least one contributor of the defined contribution to the at least one consumer;

determines the cost of the mandatory health care benefits;

permits the at least one consumer to select from optional health care benefits;

receives from the consumer a selection of at least one of the optional health care benefits;

calculates the cost of any optional health care benefits selected; and

deducts automatically the cost of the mandatory health care benefits from the total health care asset amount and queries the at least one consumer as to whether the remainder of the total health care asset amount or a portion thereof should be applied to the cost of any optional health care benefits selected; and

after receiving an affirmative response to the query, deducts at least a portion of the cost of any optional health care benefits selected from the remainder of the total health care asset amount.

7. A method of managing the health care assets of a plurality of consumers of health care services comprising:

maintaining a database embodied on a computer, the database containing statistical information that permits characterization of consumers of health care services into population groups based on factors in the group including sex, age and occupation and that permits characterization of a consumer'"'"'s individual health risk level based on factors in the group including personal risk factors and prior and existing medical conditions;

acquiring information about each of the plurality of consumers;

determining, using the database, a total defined contribution amount to be allocated in an account for each of the plurality of consumers;

determining mandatory health care benefits for each of the plurality of consumers based on the population group and individual health risk level associated with each of the plurality of consumers, the mandatory health care benefits including a mandatory high deductible catastrophic care benefit;

determining the cost of the mandatory health care benefits and calculating the difference between the total defined contribution amount and the mandatory health care benefits to identify a defined contribution remainder in each of the plurality of consumers'"'"' accounts;

offering each of the plurality of consumers optional health care benefits for purchase;

if a consumer selects an optional health care benefit, determining the cost of the optional health care benefit;

calculating, for a given optional health care benefit selected by each of the plurality of consumers, whether all or a portion of the cost of the optional health care benefit can be offset by the defined contribution remainder; and

reporting the result of the calculation to each of the plurality of consumers.