# US 11,113,770 B1 · Machine-learning driven data analysis based on demographics, risk, and need

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- Number: US 11,113,770 B1
- Document ID: US11113770B1
- Status: Granted
- Kind: B1
- Application number: 17/229,020
- Filed: 2021-04-13
- Granted: 2021-09-07
- Earliest claimed: 2021-04-13
- Assignees: Nayya Health, Inc.
- Applicants: Nayya Health, Inc.
- Inventors: Akash Magoon; Aman Magoon; Josh Allen Brown; Lisa Renee Carpenter; Sina Chehrazi
- Web page: https://patentgrep.com/patent/US11113770B1

## CPC

- G06Q 40/08: Insurance
- G06N 20/00: Machine learning
- G06Q 30/0203: Market surveys; Market polls
- G16H 10/60: for patient-specific data, e.g. for electronic patient records
- G06Q: INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06N: COMPUTING ARRANGEMENTS BASED ON SPECIFIC COMPUTATIONAL MODELS
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA

## Abstract

A data processing system for recommending insurance plans implements obtaining an electronic copy of demographic information associated with a user; analyzing the demographic information with a first machine learning model to recommend a bundle of insurance policies based on the demographic information, wherein the first machine learning model is configured to group insured people having similar demographics into clusters and to generate the bundle of insurance policies based on predicted medical insurance consumption associated with a respective group into which the model predicts that the first user falls; customizing the recommended bundle of insurance policies based on the demographic information associated with the user to generate a customized bundle of insurance policies; generating an insurance recommendation report that presents the customized bundle of insurance policies to the user; and causing a user interface of a display of a computing device associated with the user to present the insurance recommendation report.

## Claims

### Claim 1

A data processing system comprising:
a processor; and
a computer-readable medium storing executable instructions that, when executed, cause the processor to perform operations comprising:
obtaining an electronic copy of first demographic information associated with a user, wherein the first demographic information includes demographic information provided by the user, demographic information obtained from one or more third-party data sources, or both;
dynamically generating a plurality of questions to obtain second demographic information for the user by identifying additional demographic information relevant to the user for determining insurance coverage needs of the user using a first machine learning model trained to receive as an input the first demographic information for the user and to predict and output additional information demographic information relevant for determining insurance coverage needs of the user based on the first demographic information;
adding the second demographic information to the first demographic information to create cumulative demographic information for the user;
providing the cumulative demographic information as an input to a second machine learning model;
analyzing the cumulative demographic information with the second machine learning model, wherein the second machine learning model is trained to segment people into clusters of people having similar demographics, wherein the second machine learning model is configured to analyze the cumulative demographic information associated with the user to predict and output a cluster associated with the user and output predicted medical spending information associated with the predicted cluster;
providing the predicted medical spending information to a recommendation engine to generate a comprehensive insurance plan for the user comprising a plurality of insurance policies based on the predicted medical spending information;
customizing the comprehensive insurance plan based on the cumulative demographic information associated with the user to generate a customized bundle of insurance policies;
generating an insurance recommendation report that presents the customized bundle of insurance policies to the user; and
causing a user interface of a display of a computing device associated with the user to present the insurance recommendation report.

### Claim 2 (depends on 1)

The data processing system of claim 1, wherein to dynamically generate a plurality of questions to obtain second demographic information for the user, the computer-readable medium includes instructions configured to cause the processor to perform:
causing to be presented on the display of the computing device associated with the user the plurality of dynamically generated questions for obtaining a first portion of the second demographic information associated with the user, wherein at least a portion of the dynamically generated questions is based at least in part on an answer to a previously presented question of the plurality of dynamically generated questions; and
receiving, from the computing device associated with the user, responses to the plurality of dynamically generated questions as the first portion of the second demographic information associated with the user.

### Claim 3 (depends on 2)

The data processing system of claim 2, wherein the computer-readable medium includes instructions configured to cause the processor to perform:
requesting at least a second portion of the second demographic information from one or more third-party data providers; and
receiving third-party data as the at least the second portion of the second demographic information from the one or more third-party data providers.

### Claim 4 (depends on 3)

The data processing system of claim 3, wherein the computer-readable medium includes instructions configured to cause the processor to perform:
identifying ambiguous data in the third-party data, where at least a portion of the third-party data may not be associated with the user, by performing fuzzy matching with the first portion of the first demographic information and the ambiguous data; and
discarding a portion of the ambiguous data having a correspondence with the first portion of the first demographic information that is less than a threshold.

### Claim 5 (depends on 1)

The data processing system of claim 1, wherein to generate the insurance recommendation report that presents the customized bundle of insurance policies to the user, the computer-readable medium includes instructions configured to cause the processor to perform:
determining a description of each insurance policy included in the bundle of insurance policies;
determining a basis for including each insurance policy included in the bundle of insurance policies, wherein the basis for including the insurance policy may be based at least in part on a cost of the policy, coverage provided by the insurance policy filling a gap in insurance coverage, or both; and
generating the insurance recommendation report to include the description of each insurance policy and the basis for including each insurance policy in the bundle of insurance policies.

### Claim 6 (depends on 5)

The data processing system of claim 5, wherein the computer-readable medium includes instructions configured to cause the processor to perform:
obtaining insurance claims information for claims filed on behalf of the user over a first period of time; and
refining the bundle of insurance policies based on the insurance claims information.

### Claim 7 (depends on 5)

The data processing system of claim 5, wherein the computer-readable medium includes instructions configured to cause the processor to perform:
receiving a request from the computing device associated with the user to obtain the customized bundle of insurance policies recommended in the insurance recommendation report;
sending a request to an insurer associated with each policy included in the customized bundle of insurance policies to obtain insurance coverage on behalf of the user;
receiving a confirmation from each insurer that includes policy information responsive to sending the request; and
generating an insurance summary report that includes the policy information for each policy of the recommended insurance policies.

### Claim 8

A method implemented in a data processing system for recommending insurance plans, the method comprising:
obtaining an electronic copy of first demographic information associated with a user, wherein the first demographic information includes demographic information provided by the user, demographic information obtained from one or more third-party data sources, or both;
dynamically generating a plurality of questions to obtain second demographic information for the user by identifying additional demographic information relevant to the user for determining insurance coverage needs of the user using a first machine learning model trained to receive as an input the first demographic information for the user and to predict and output additional information demographic information relevant for determining insurance coverage needs of the user based on the first demographic information;
adding the second demographic information to the first demographic information to create cumulative demographic information for the user;
providing the cumulative demographic information as an input to a second machine learning model;
analyzing the cumulative demographic information with the second machine learning model, wherein the second machine learning model is trained to segment people into clusters of people having similar demographics, wherein the second machine learning model is configured to analyze the cumulative demographic information associated with the user to predict and output a cluster associated with the user and output predicted medical spending information associated with the predicted cluster;
providing the predicted medical spending information to a recommendation engine to generate a comprehensive insurance plan for the user comprising a plurality of insurance policies based on the predicted medical spending information;
customizing the comprehensive insurance plan based on the cumulative demographic information associated with the user to generate a customized bundle of insurance policies;
generating an insurance recommendation report that presents the customized bundle of insurance policies to the user; and
causing a user interface of a display of a computing device associated with the user to present the insurance recommendation report.

### Claim 9 (depends on 8)

The method of claim 8, wherein to dynamically generate a plurality of questions to obtain second demographic information for the user further comprises:
causing to be presented on the display of the computing device associated with the user the plurality of dynamically generated questions for obtaining a first portion of the second demographic information associated with the user, wherein at least a portion of the dynamically generated questions is based at least in part on an answer to a previously presented question of the plurality of dynamically generated questions; and
receiving, from the computing device associated with the user, responses to the plurality of dynamically generated questions as the first portion of the second demographic information associated with the user.

### Claim 10 (depends on 9)

The method of claim 9, further comprising:
requesting at least a second portion of the second demographic information from one or more third-party data providers; and
receiving third-party data as the at least the second portion of the second demographic information from the one or more third-party data providers.

### Claim 11 (depends on 10)

The method of claim 10, further comprising:
identifying ambiguous data in the third-party data, where at least a portion of the third-party data may not be associated with the user, by performing fuzzy matching with the first portion of the first demographic information and the ambiguous data; and
discarding a portion of the ambiguous data having a correspondence with the first portion of the first demographic information that is less than a threshold.

### Claim 12 (depends on 8)

The method of claim 8, wherein generating the insurance recommendation report that presents the customized bundle of insurance policies to the user further comprises:
determining a description of each insurance policy included in the bundle of insurance policies;
determining a basis for including each insurance policy included in the bundle of insurance policies, wherein the basis for including the insurance policy may be based at least in part on a cost of the policy, coverage provided by the insurance policy filling a gap in insurance coverage, or both; and
generating the insurance recommendation report to include the description of each insurance policy and the basis for including each insurance policy in the bundle of insurance policies.

### Claim 13 (depends on 8)

The method of claim 8, further comprising:
obtaining insurance claims information for claims filed on behalf of the user over a first period of time; and
refining the bundle of insurance policies based on the medical insurance claims.

### Claim 14 (depends on 12)

The method of claim 12, further comprising:
receiving a request from the computing device associated with the user to obtain the customized bundle of insurance policies recommended in the insurance recommendation report;
sending a request to an insurer associated with each policy included in the customized bundle of insurance policies to obtain insurance coverage on behalf of the user;
receiving a confirmation from each insurer that includes policy information responsive to sending the request; and
generating an insurance summary report that includes the policy information for each policy of the recommended insurance policies.

### Claim 15

A non-transitory computer-readable storage medium on which are stored instructions that, when executed, cause a processor of a programmable device to perform operations of:
obtaining an electronic copy of first demographic information associated with a user, wherein the first demographic information includes demographic information provided by the user, demographic information obtained from one or more third-party data sources, or both;
dynamically generating a plurality of questions to obtain second demographic information for the user by identifying additional demographic information relevant to the user for determining insurance coverage needs of the user using a first machine learning model trained to receive as an input the first demographic information for the user and to predict and output additional information demographic information relevant for determining insurance coverage needs of the user based on the first demographic information;
adding the second demographic information to the first demographic information to create cumulative demographic information for the user;
providing the cumulative demographic information as an input to a second machine learning model;
analyzing the cumulative demographic information with the second machine learning model, wherein the second machine learning model is trained to segment people into clusters of people having similar demographics, wherein the second machine learning model is configured to analyze the cumulative demographic information associated with the user to predict and output a cluster associated with the user and output predicted medical spending information associated with the predicted cluster;
providing the predicted medical spending information to a recommendation engine to generate a comprehensive insurance plan for the user comprising a plurality of insurance policies based on the predicted medical spending information;
customizing the comprehensive insurance plan based on the cumulative demographic information associated with the user to generate a customized bundle of insurance policies;
generating an insurance recommendation report that presents the customized bundle of insurance policies to the user; and
causing a user interface of a display of a computing device associated with the user to present the insurance recommendation report.

### Claim 16 (depends on 15)

The computer-readable storage medium of claim 15, wherein to obtain the electronic copy of demographic information associated with an insured user, the computer-readable storage medium includes instructions configured to cause the processor to perform:
causing to be presented on the display of the computing device associated with the user the plurality of dynamically generated questions for obtaining a first portion of the second demographic information associated with the user, wherein at least a portion of the dynamically generated questions is based at least in part on an answer to a previously presented question of the plurality of dynamically generated questions; and
receiving, from the computing device associated with the user, responses to the plurality of dynamically generated questions as the first portion of the second demographic information associated with the user.

### Claim 17 (depends on 16)

The computer-readable storage medium of claim 16, wherein the computer-readable medium includes instructions configured to cause the processor to perform:
requesting at least a second portion of the second demographic information from one or more third-party data providers; and
receiving third-party data as the at least the second portion of the second demographic information from the one or more third-party data providers.

### Claim 18 (depends on 17)

The computer-readable storage medium of claim 17, wherein the computer-readable medium includes instructions configured to cause the processor to perform:
identifying ambiguous data in the third-party data, where at least a portion of the third-party data may not be associated with the user, by performing fuzzy matching with the first portion of the first demographic information and the ambiguous data; and
discarding a portion of the ambiguous data having a correspondence with the first portion of the first demographic information that is less than a threshold.

### Claim 19 (depends on 15)

The computer-readable storage medium of claim 15, wherein to generate the insurance recommendation report that presents the customized bundle of insurance policies to the user, the computer-readable storage medium includes instructions configured to cause the processor to perform:
determining a description of each insurance policy included in the bundle of insurance policies;
determining a basis for including each insurance policy included the bundle of insurance policies, wherein the basis for including the insurance policy may be based at least in part on the cost of the policy, the coverage provided by the insurance policy filling a gap in insurance coverage, or both; and
generating the insurance recommendation report to include the description of each insurance policy and the basis for including each insurance policy in the bundle of insurance policies.

### Claim 20 (depends on 19)

The computer-readable storage medium of claim 19, wherein the computer-readable medium includes instructions configured to cause the processor to perform:
receiving a request from the computing device associated with the user to obtain the customized bundle of insurance policies recommended in the insurance recommendation report;
sending a request to an insurer associated with each policy included in the customized bundle of insurance policies to obtain insurance coverage on behalf of the user;
receiving a confirmation from each insurer that includes policy information responsive to sending the request; and
generating an insurance summary report that includes the policy information for each policy of the recommended insurance policies.