System and method for selecting healthcare management
AssigneeThe TriZetto Group, Inc.
InventorVal Dean
Life of this patent
Estimating the term…
Abstract
The present invention is directed to a system and method which allows a prospective insured to make an informed decision on healthcare insurance or a specific health care management decision by using a current medical profile to assist in their selection. Based on past medical care, as obtained from payor data, a number of different plans, each having different providers, different deductibles, different maximums, different reimbursement policies, etc., a person can make an informed decision. When a family has different payors for different family members, a proper blend of payors can be more easily selected since the payors (or a single payor) has a medical profile of each family member and also has information on providers in the network, prescription policies, deductibles, maximums, etc.
Claims24
A method for guiding a user in the selection of a health related plan, said method comprising:
- obtaining a medical and medical cost profile of said user;
- obtaining parameters of a plurality of health related plans;
- and
- providing a set of comparisons of said plans based on said obtained medical profile of said user.
A method for assisting a user in selecting a medical reimbursement plan, said method comprising:
- abstracting information coming to a payor from medical providers, said information pertaining to a particular patient and coming from diverse locations and from diverse disciplines;
- storing said abstracted information over a period of time on a patient-by-patient basis;
- and
- upon a request from a user providing at least pertinent portions of said stored information for comparisons with medical reimbursement plans, said pertinent portions based upon the totality of the information provided to said payor pertaining to a particular patient.
A system for providing medical management to a patient, said system comprising:
- means for obtaining data necessary to process payments to medical providers for a particular patient;
- means for abstracting certain data from said obtained payment data;
- means for creating a medical profile for a patient based upon said abstracted certain data;
- and
- means for sending at least a portion of said created medical profile for a patient for comparison with payment parameters of medical management plans contemplated by said patient.
A medical management system comprising:
- a database for storing medical data on a patient-by-patient basis, said medical data pertaining to provider diagnosis, provider visits, patient prescriptions and patient lab results;
- a rules engine for reviewing data stored in said database on a patient-by-patient basis for creating a medical profile of each said patient;
- an analysis for comparing created medical data for a patient against parameters of health insurance related plans;
- and
- based upon said comparing, providing to said patient a set of comparisons of said plans.
A method for assisting a patient with medical management;
- said method comprising:
- determining combinations of providers and facilities that can advantageously handle a particular procedure for a patient using information obtained from healthcare providers and healthcare facilities serviced by a medical plan available to a patient;
- and
- providing a list of options to said patient ranked according to a specific criteria.
Dependencies are inferred from the claim text.