Techniques for improving loss ratios
First Claim
1. A method comprising:
- maintaining a database of compliance information of individual medical patients;
analyzing a database for compliance trends and history for the individual patients;
providing information about the trends and history to an organization from the set consisting of an insurance company, a payer and a managed-care organization;
wherein the organization uses the information to structure incentives to improve compliance performance of the individual patients.
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Abstract
Techniques and systems are described hereafter for reducing medical non-compliance by (1) developing the compliance-profile of a member, (2) using the profile to automatically generate a set of interventions, (3) categorizing, prioritizing and selecting the interventions, (4) incorporating the selected interventions into a personalized member user interface page, (5) serving the selected interventions to the member at the appropriate times via multiple channels, (6) observing and measuring member responses, (7) recording member responses in a database and analyzing the responses, (8) adapting the interventions, based on the analysis, to keep the member actively engaged, (9) escalating the interventions if the member response is inadequate, (10) updating the member'"'"'s compliance profile based on analysis of the database, (11) providing member reports to authorized parties for purposes of paying member incentives, predicting member'"'"'s utilization of high-cost healthcare services, etc., and (12) providing aggregate de-identified reports for purposes of predicting future risk reserve set asides, drug production and supply chain replenishment requirements.
157 Citations
2 Claims
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1. A method comprising:
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maintaining a database of compliance information of individual medical patients;
analyzing a database for compliance trends and history for the individual patients;
providing information about the trends and history to an organization from the set consisting of an insurance company, a payer and a managed-care organization;
wherein the organization uses the information to structure incentives to improve compliance performance of the individual patients.
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2. A method for reducing medical non-compliance, the method comprising:
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developing the compliance-profile of a member, using the profile to automatically generate a set of interventions, categorizing, prioritizing and selecting the interventions, incorporating the selected interventions into a personalized member user interface page, serving the selected interventions to the member at the appropriate times via multiple channels, observing and measuring member responses, recording member responses in a database and analyzing the responses, adapting the interventions, based on the analysis, to keep the member actively engaged, escalating the interventions if the member response is inadequate, and updating the member'"'"'s compliance profile based on analysis of the database.
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Specification