Health care incentive apparatus and method

• US 8,670,996 B1
• Filed: 03/14/2013
• Issued: 03/11/2014
• Est. Priority Date: 03/14/2013
• Status: Active Grant

• Current Assignee: Welldynerx, Inc.
• Original Assignee: David I. Weiss
• Inventors: Weiss, David I.
• Primary Examiner(s): Sereboff, Neal
• Assistant Examiner(s): Durant, Jonathan
• Application Number:
  US13/826,037
• Time in Patent Office: 362 Days
• Field of Search: 705/2, 705/3, 705/4, 705/14
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

An embodiment of the invention provides, among other things, a method for providing a cost modification of a health care item for a subject. In an example method, a request is received for a health care item from a point of purchase of the health care item. Cost adjustment data is received from at least one source. The cost adjustment data is used to determine a cost modification for the health care item. The cost modification is communicated to a point of purchase of the health care item.

Claims

1. A method for adjusting a cost for a health care item purchased under a health care plan, the method comprising:

receiving a request for the health care item; and

for at least one product option corresponding to the requested health care item;

receiving a total cost for the product option;

receiving a cost distribution for the total cost, wherein the cost distribution comprises a health care plan cost and a participant cost;

receiving a coupon amount related to the product option;

increasing the participant cost based on the coupon amount;

subtracting the coupon amount from the increased participant cost to provide an adjusted participant cost;

adjusting, using a processor, the cost distribution based on the adjusted participant cost; and

delivering the adjusted cost distribution for the product option to a recipient.

2. The method of claim 1, wherein the adjusting the cost distribution is performed in real time.

3. The method of claim 1, wherein the health care item is a pharmaceutical product;

and

wherein each of the at least one product option is one or more of the requested health care item and therapeutically equivalent options.

4. The method of claim 1, wherein said delivering comprises:

preparing an explanation of benefits (EOB), including the total cost and the adjusted cost distribution for the product option; and

sending the EOB to the recipient.

5. The method of claim 1, further comprising:

for at least one additional product option corresponding to the requested health care item;

receiving a total cost and a cost distribution for the additional product option; and

delivering the cost distribution for the additional product option to the recipient.

6. The method of claim 5, wherein the delivering adjusted cost distribution for the product option comprises:

preparing an explanation of benefits (EOB) including the received total cost and the adjusted cost distribution for the product option; and

sending the EOB to the recipient;

wherein the delivering the adjusted cost distribution for the additional product option comprises;

adding the received total cost and the cost distribution for the additional product option to the prepared EOB before the sending.

7. The method of claim 1, wherein the receiving a cost distribution comprises receiving a health care plan design;

wherein the health plan design comprises the health plan cost and the participant cost.

8. The method of claim 7,

wherein the health care item comprises a pharmaceutical product;

wherein the health care plan further comprises a formulary;

wherein the method further comprises;

selecting each of the at least one product option based on the formulary.

9. The method of claim 1, wherein the request is received from a health care provider.

10. The method of claim 1, wherein the request is received from a health care plan participant;

wherein the request is sent from a point of purchase and/or a web portal.

11. The method of claim 1, wherein the recipient is one of a health care plan participant, a health care provider, and a health care payor.

12. The method of claim 1, further comprising:

receiving subject compliance data; and

further adjusting the cost distribution based on the received subject compliance data.

13. The method of claim 12, wherein the subject compliance data comprises claims information, a medical record, and/or a personal health assessment.

14. The method of claim 12, wherein the further adjusting a cost distribution comprises:

decreasing or increasing the participant cost based on whether the subject compliance information indicates compliance with a health incentive.

15. The method of claim 12, further comprising:

retrieving subject eligibility data; and

wherein the adjusting a cost distribution is further based on the retrieved subject eligibility data.

16. The method of claim 12, wherein said delivering comprises:

preparing an explanation of benefits (EOB), including the received total cost and the adjusted cost distribution for the product option, and a portion of retrieved subject compliance information; and

sending the EOB to the recipient.

17. The method of claim 12, wherein the request is received from a health care plan participant;

wherein the recipient is the health care plan participant;

wherein the request is sent from a web portal;

further comprising;

receiving additional subject compliance data from the health care plan participant;

re-adjusting the cost distribution based on the additional subject compliance data; and

delivering the re-adjusted cost distribution to the health care plan participant.

18. An apparatus for adjusting a cost for a health care item, the apparatus comprising a non-transitory computer-readable medium containing computer-readable instructions for causing a computer to perform a method comprising:

receiving a request for the health care item;

for at least one product option corresponding to the requested health care item;

receiving a total cost for the product option;

receiving a cost distribution for the total cost, wherein the cost distribution comprises a health care plan cost and a participant cost;

receiving a coupon amount related to the product option;

increasing the participant cost based on the coupon amount;

subtracting the coupon amount from the increased participant cost to provide an adjusted participant cost;

adjusting, by a processor, the cost distribution based on the adjusted participant cost; and

delivering the adjusted cost distribution for the product option to a recipient.

19. The apparatus of claim 18, wherein the adjusting the participant cost is dynamic, and wherein the recipient is at a point of purchase for the health care item.

20. An apparatus for providing a cost assessment of a health care product for a subject, the apparatus comprising:

an interface configured to receive a request for a health care product and communicate with a recipient over a network;

a processor configured to perform a method comprising, for at least one product option corresponding to the requested health care product;

receiving a total cost for the product option;

receiving an initial cost distribution for the product option, wherein the cost distribution comprises a health care plan cost and a participant cost;

receiving a coupon amount related to the product option;

increasing the participant cost based on the received total cost, initial cost distribution, and coupon amount;

subtracting the coupon amount from the increased participant cost to provide an adjusted participant cost;

adjusting a cost distribution for the product option based on the adjusted participant cost; and

delivering the adjusted cost distribution for the product option to the recipient over the network via the interface.

21. A method for adjusting a cost for a health care item purchased under a health care plan, the method comprising:

receiving a request for the health care item; and

for at least one product option corresponding to the requested health care item;

receiving a total cost for the product option;

receiving a cost distribution for the total cost, wherein the cost distribution comprises a health care plan cost and a participant cost;

receiving a coupon amount related to the product option;

increasing the participant cost based on the coupon amount;

lowering the health care plan cost based on the coupon amount;

adjusting, using a processor, the cost distribution based on the increased participant cost and the lowered health care plan cost; and

delivering the adjusted cost distribution for the product option to a recipient.