Managing utilization

• US 7,890,351 B2
• Filed: 03/31/2008
• Issued: 02/15/2011
• Est. Priority Date: 10/02/2007
• Status: Active Grant

• Current Assignee: American Well Corporation (Amwell Incorporated)
• Original Assignee: American Well Corporation (Amwell Incorporated)
• Inventors: Schoenberg, Roy
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): ALTSCHUL, AMBER L
• Application Number:
  US12/059,292
• Publication Number:
  US 20090089085A1
• Time in Patent Office: 1,051 Days
• Field of Search: 705/2, 705/3, 705/4
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 30/0641 Shopping interfaces
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A computer-implemented method includes receiving a request from a consumer of medical services to engage with a provider of medical services in real time over the Internet using a computer-based brokerage system, accessing stored information related to past engagements of the consumer using the computer-based brokerage system, and determining allocation of a fee between the consumer and a third party for an engagement between the consumer and the provider based at least in part on the information related to the past engagements of the consumer.

Claims

1. A computer-implemented method, comprising:

receiving by a computer a request from a consumer of medical services to engage with a provider of medical services in real time over the Internet using a computer-based brokerage system;

determining by the computer a fee for an engagement between the consumer and the provider;

accessing stored information related to past engagements of the consumer using the computer-based brokerage system;

accessing stored information related to a medical history of the consumer;

accessing stored information related to insurance covering care for the consumer; and

determining by the computer an allocation of the fee between the consumer and a third party for the engagement between the consumer and the provider based at least in part on the information related to the past engagements of the consumer, the information related to the medical history of the consumer, and the information related to the insurance covering the consumer;

displaying a price associated with consulting with a particular service provider to the consumer on a user interface, wherein displaying the price comprises displaying a total cost, displaying an amount to be paid by the insurance company, and displaying an amount to be paid by the consumer.

2. The method of claim 1, wherein the information related to past engagements comprises a total number of engagements by the consumer during a period of time.

3. The method of claim 1, wherein the information related to past engagements comprises a total financial expenditure of an insurance company during a period of time.

4. The method of claim 1, wherein determining the allocation of the fee between the consumer and a third party comprises determining a percentage of a total cost to be paid by the consumer.

5. The method of claim 1, wherein determining the allocation of the fee between the consumer and a third party comprises allocating the entire fee to the consumer if an amount paid by the third party is greater than a threshold set by the third party.

6. The method of claim 1, wherein the third party comprises an insurance carrier.

7. The method of claim 1, further comprising:

receiving a payment scale from the insurance company.

8. The method of claim 1, determining the distribution of cost between the consumer and the insurance company comprises:

determining a total amount the insurance company has paid for a particular consumer using the system during a period of time prior to receiving the request; and

comparing the total amount to a maximum amount an insurance company will provide in co-payments;

if the total amount exceeds the maximum amount the insurance company will provide in co-payments, providing an indication to the consumer that the consumer will be responsible for the entire cost.

9. The method of claim 1, further comprising:

identifying one or more service providers satisfying at least some of attributes in the request from the consumer;

sorting the identified one or more service providers based on a cost to the consumer; and

displaying the identified one or more service providers in an order based, at least in part, on the cost to the consumer; and

displaying the determined distribution of cost between the consumer and an insurance company on the user interface.

10. A computer implemented method for managing utilization of a brokerage system that connects consumers of medical services with providers of medical services over the Internet, comprising:

receiving a request from a consumer of medical services to consult with a service provider over the Internet;

accessing, by a computer, information associated with usage of the brokerage system by the consumer;

determining by the computer, a distribution of cost between the consumer of medical services and an insurance carrier, the distribution being based at least in part on the usage of the brokerage system by the consumer such that the cost to the consumer for an engagement increases with increased usage of the brokerage system by the consumer.

11. A computer-implemented method, comprising:

receiving a request from a consumer to consult with a service provider using a computer-based system for connecting consumers of medical services with providers of medical services in real time over the Internet;

accessing, by a computer, information about past interactions of the consumer with medical service providers using the computer-based system;

accessing, by the computer, information associated with medical history of the consumer;

accessing, by the computer, information related to an insurance of the consumer;

determining, by the computer, a distribution of cost between the consumer and an insurance company, the distribution of cost being based at least in part on a type of service requested by the consumer, information about past interactions of the consumer with medical service providers using the computer-based system, information related to the medical history of the consumer, and information related to an insurance of the consumer.

12. The method of claim 11, further comprising displaying a price associated with consulting with a particular service provider to the consumer on the user interface.

13. The method of claim 12, wherein displaying the price comprises displaying a total cost, displaying an amount to be paid by the insurance company, and displaying an amount to be paid by the consumer.

14. The method of claim 11, further comprising:

receiving, from the consumer, a payment for a portion of the cost allocated to the consumer prior to connecting the consumer to the medical service provider.

15. The method of claim 11, wherein determining the distribution of cost comprises determining a distribution to limit overuse of the system.

16. The method of claim 11, wherein determining the distribution of cost between the consumer and the insurance company comprises:

determining a number of times the consumer has interacted with medical service providers using the system during a period of time prior to receiving the request; and

comparing the number of times the consumer has interacted with the medical service providers using the system to a maximum number of times an insurance company will provide a co-payment;

if the number of times the consumer has interacted with the medical service providers using the system exceeds the maximum number of times an insurance company will provide a co-payment, providing an indication to the consumer that the consumer will be responsible for the entire cost.

17. A computer program product residing on a computer readable medium for providing broker services to consumers and service providers, the computer program product comprising instructions for causing a computer to:

receive a request from a consumer of medical services to engage with a provider of medical services in real time over the Internet using a computer-based brokerage system;

determine a fee for an engagement between the consumer and the provider;

access stored information related to past engagements of the consumer using the computer-based brokerage system;

access stored information related to a medical history of the consumer;

access stored information related to insurance covering care for the consumer; and

determine an allocation of a fee between the consumer and a third party for an engagement between the consumer and the provider based at least in part on the information related to the past engagements of the consumer, the information related to the medical history of the consumer, and the information related to the insurance covering the consumer.

18. An apparatus comprising:

a processor; and

a computer program product residing on a computer readable medium for providing broker services to consumers and service providers, the computer program product comprising instructions for causing the processor to;

access stored information related to past engagements of the consumer using the computer-based brokerage system;

access stored information related to a medical history of the consumer;

access stored information related to insurance covering the consumer; and

determine an allocation of a fee between the consumer and a third party for an engagement between the consumer and the provider based at least in part on the information related to the past engagements of the consumer, the information related to the medical history of the consumer, and the information related to the insurance covering the consumer.

19. A computer program product residing on a computer readable medium for providing broker services to consumers and service providers, the computer program product comprising instructions for causing a computer to:

receive a request from a consumer of medical services to consult with a service provider over the Internet;

access information associated with usage of the brokerage system by the consumer;

determine a distribution of cost between the consumer of medical services and an insurance carrier, the distribution being based at least in part on the usage of the brokerage system by the consumer such that the cost to the consumer for an engagement increases with increased usage of the brokerage system by the consumer.

20. A computer program product residing on a computer readable medium for providing broker services to consumers and service providers, the computer program product comprising instructions for causing a computer to:

receive a request from a consumer to consult with a service provider using a computer-based system for connecting consumers of medical services with providers of medical services in real time over the Internet;

access information about past interactions of the consumer with medical service providers using the computer-based system;

access information associated with medical history of the consumer;

access information related to an insurance of the consumer;

determine a distribution of cost between the consumer and an insurance company, the distribution of cost being based at least in part on a type of service requested by the consumer, information about past interactions of the consumer with medical service providers using the computer-based system, information related to the medical history of the consumer, and information related to an insurance of the consumer.

21. An apparatus comprising:

a processor; and

a computer program product residing on a computer readable medium for providing broker services to consumers and service providers, the computer program product comprising instructions for causing the processor to;

receive a request from a consumer of medical services to consult with a service provider over the Internet;

access information associated with usage of the brokerage system by the consumer;

determine a distribution of cost between the consumer of medical services and an insurance carrier, the distribution being based at least in part on the usage of the brokerage system by the consumer such that the cost to the consumer for an engagement increases with increased usage of the brokerage system by the consumer.

22. An apparatus comprising:

a processor; and

a computer program product residing on a computer readable medium for providing broker services to consumers and service providers, the computer program product comprising instructions for causing the processor to;

receive a request from a consumer to consult with a service provider using a computer-based system for connecting consumers of medical services with providers of medical services in real time over the Internet;

access information about past interactions of the consumer with medical service providers using the computer-based system;

access information associated with medical history of the consumer;

access information related to an insurance of the consumer;

determine a distribution of cost between the consumer and an insurance company, the distribution of cost being based at least in part on a type of service requested by the consumer, information about past interactions of the consumer with medical service providers using the computer-based system, information related to the medical history of the consumer, and information related to an insurance of the consumer.