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US 8,620,830 B2Granted
System and method for benefit plan cost estimation
AssigneeExpress Scripts, Inc.
InventorsSteve Melnick, Agnes Rey-Giraud
Life of this patent
Estimating the term…
Abstract
A computer-based method and system to enable a benefit plan sponsor to design a plurality of benefit plans to be offered to a given participant population and for determining the cost of sponsoring the plans for the participant population by predicting utilization for each of the plans based upon historical utilization data for the population, projected plan selections based upon presumed participant objectives, and/or survey or historical data from a sample of the given population or from preexisting statistical samples exhibiting analogous demographic characteristics to the given participant population relating to expected benefit utilization and plan preference criteria.
Claims15
A method comprising:
- accessing, on a computer processor, past prescription drug utilization associated with at least some of a plurality of plan participants, the past prescription drug utilization including identification and quantity of a plurality of prescription drugs used by a particular plan participant of at least some of the plurality of plan participants;
- accessing, on the computer processor, drug utilization trend information reflecting changes to prescription drug cost;
- projecting, on the computer processor, for each of the plurality of plan participants a projected prescription drug utilization based on the past prescription drug utilization and the drug utilization trend information;
- accessing, on the computer processor, a statistical sample taken from the plurality of plan participants of a plan preference of a first proposed design plan or a second proposed design plan;
- accessing, on the computer processor, historical plan selection decision data associated with at least a portion of the plurality of plan participants;
- accessing, on the computer processor, selection preference data associated with a population segment having a similar grouping characteristic to the plurality of plan participants, the population segment including a plurality of persons that are not among the plurality of plan participants;
- determining, on the computer processor, for each of the plurality of plan participants a perceived plan preference of a first proposed design plan or a second proposed design plan based on a presumed participant objective to minimize participant cost, the statistical sample taken of the plan preference, the historical plan selection decision data, and the selection preference data associated with the population segment having the similar grouping characteristic;
- determining, on the computer processor, an estimated cost for participation of each of the plurality of plan participants in either the first proposed design plan or the second proposed design plan based on a determination of the perceived plan preference;
- aggregating, on the computer processor, the estimated cost for the plurality of plan participants to calculate a total estimated cost for the participation of each of the plurality of plan participants in either the first proposed design plan or the second proposed design plan;
- accessing, on the computer processor, a total target cost for the plurality of plan participants to participate in either the first proposed design plan or the second proposed design plan;
- determining, on the computer processor, a difference between the total estimated cost and the total target cost;
- automatically adjusting, on the computer processor, the first plurality of plan design options associated with the first prescription drug benefit plan and the second plurality of plan design options associated with the second prescription drug benefit plan based on a determination of the difference;
- assembling, on the computer processor, the adjusted first plurality of plan design options into a first adjusted proposed design plan;
- assembling, on the computer processor, the second adjusted plurality of plan design options into a second adjusted proposed design plan, the second adjusted plurality of plan design options being different than the first adjusted plurality of plan design options;
- determining, on the computer processor, for each of the plurality of plan participants a perceived plan preference of the first adjusted proposed design plan or the second adjusted proposed design plan based on the presumed participant objective to minimize participant cost, the statistical sample taken of the plan preference, the historical plan selection decision data, and the selection preference data associated with the population segment having the similar grouping characteristic;
- determining, on the computer processor, an adjusted estimated cost for participation of each of the plurality of plan participants in either the first adjusted proposed design plan or the second adjusted proposed design plan based on a determination of the perceived plan preference;
- and
- aggregating, on the computer processor, the adjusted estimated cost for the plurality of plan participants to calculate a total adjusted estimated cost for the participation of each of the plurality of plan participants in either the first adjusted proposed design plan or the second adjusted proposed design plan.
15 more elements
A non-transitory computer readable medium comprising instructions, which when implemented by one or more processors perform the following operations:
- access past prescription drug utilization associated with at least some of a plurality of plan participants, the past prescription drug utilization including identification and quantity of a plurality of prescription drugs used by a particular plan participant of at least some of the plurality of plan participants;
- access drug utilization trend information reflecting changes to prescription drug cost;
- project for each of the plurality of plan participants a projected prescription drug utilization based on the past prescription drug utilization and the drug utilization trend information;
- access a statistical sample taken from the plurality of plan participants of a plan preference of a first proposed design plan or a second proposed design plan;
- access historical plan selection decision data associated with at least a portion of the plurality of plan participants;
- access selection preference data associated with a population segment having a similar grouping characteristic to the plurality of plan participants, the population segment including a plurality of persons that are not among the plurality of plan participants;
- determine for each of the plurality of plan participants a perceived plan preference of a first proposed design plan or a second proposed design plan based on a presumed participant objective to minimize participant cost, the statistical sample taken of the plan preference, the historical plan selection decision data, and the selection preference data associated with the population segment having the similar grouping characteristic;
- determine an estimated cost for participation of each of the plurality of plan participants in either the first proposed design plan or the second proposed design plan based on a determination of the perceived plan preference;
- aggregate the estimated cost for the plurality of plan participants to calculate a total estimated cost for the participation of each of the plurality of plan participants in either the first proposed design plan or the second proposed design plan;
- access a total target cost for the plurality of plan participants to participate in either the first proposed design plan or the second proposed design plan;
- determine a difference between the total estimated cost and the total target cost;
- automatically adjust, on the computer processor, the first plurality of plan design options associated with the first prescription drug benefit plan and the second plurality of plan design options associated with the second prescription drug benefit plan based on a determination of the difference;
- assemble the adjusted first plurality of plan design options into a first adjusted proposed design plan;
- assemble the second adjusted plurality of plan design options into a second adjusted proposed design plan, the second adjusted plurality of plan design options being different than the first adjusted plurality of plan design options;
- determine for each of the plurality of plan participants a perceived plan preference of the first adjusted proposed design plan or the second adjusted proposed design plan based on the presumed participant objective to minimize participant cost, the statistical sample taken of the plan preference, the historical plan selection decision data, and the selection preference data associated with the population segment having the similar grouping characteristic;
- determine an adjusted estimated cost for participation of each of the plurality of plan participants in either the first adjusted proposed design plan or the second adjusted proposed design plan based on a determination of the perceived plan preference;
- and
- aggregate the adjusted estimated cost for the plurality of plan participants to calculate a total adjusted estimated cost for the participation of each of the plurality of plan participants in either the first adjusted proposed design plan or the second adjusted proposed design plan.
15 more elements
A system comprising:
- a storage to store data;
- and
- a processor to retrieve, from the storage, past prescription drug utilization associated with at least some of a plurality of plan participants, the past prescription drug utilization including identification and quantity of a plurality of prescription drugs used by a particular plan participant of at least some of the plurality of plan participants;
- access, from the storage, drug utilization trend information reflecting changes to prescription drug cost;
- project for each of the plurality of plan participants a projected prescription drug utilization based on the past prescription drug utilization and the drug utilization trend information;
- access, from the storage, a statistical sample taken from the plurality of plan participants of a plan preference of a first proposed design plan or a second proposed design plan;
- access, from the storage, historical plan selection decision data associated with at least a portion of the plurality of plan participants;
- access, from the storage, selection preference data associated with a population segment having a similar grouping characteristic to the plurality of plan participants, the population segment including a plurality of persons that are not among the plurality of plan participants;
- determine for each of the plurality of plan participants a perceived plan preference of a first proposed design plan or a second proposed design plan based on a presumed participant objective to minimize participant cost, the statistical sample taken of the plan preference, the historical plan selection decision data, and the selection preference data associated with the population segment having the similar grouping characteristic;
- determine an estimated cost for participation of each of the plurality of plan participants in either the first proposed design plan or the second proposed design plan based on a determination of the perceived plan preference;
- aggregate the estimated cost for the plurality of plan participants to calculate a total estimated cost for the participation of each of the plurality of plan participants in either the first proposed design plan or the second proposed design plan;
- access a total target cost for the plurality of plan participants to participate in either the first proposed design plan or the second proposed design plan;
- determine a difference between the total estimated cost and the total target cost;
- automatically adjust, on the computer processor, the first plurality of plan design options associated with the first prescription drug benefit plan and the second plurality of plan design options associated with the second prescription drug benefit plan based on a determination of the difference;
- assemble the adjusted first plurality of plan design options into a first adjusted proposed design plan;
- assemble the second adjusted plurality of plan design options into a second adjusted proposed design plan, the second adjusted plurality of plan design options being different than the first adjusted plurality of plan design options;
- determine for each of the plurality of plan participants a perceived plan preference of the first adjusted proposed design plan or the second adjusted proposed design plan based on the presumed participant objective to minimize participant cost, the statistical sample taken of the plan preference, the historical plan selection decision data, and the selection preference data associated with the population segment having the similar grouping characteristic;
- determine an adjusted estimated cost for participation of each of the plurality of plan participants in either the first adjusted proposed design plan or the second adjusted proposed design plan based on a determination of the perceived plan preference;
- and
- aggregate the adjusted estimated cost for the plurality of plan participants to calculate a total adjusted estimated cost for the participation of each of the plurality of plan participants in either the first adjusted proposed design plan or the second adjusted proposed design plan.
17 more elements
Dependencies are inferred from the claim text.