Patent Application Titled “Systems and Methods for Placing a Participant in a Disease Prevention, Monitoring Program Milestones, and Third Party…

Patent Application Titled "Systems and Methods for Placing a Participant in a Disease Prevention, Monitoring Program Milestones, and Third Party Reporting and Payment" Published Online (USPTO 20180075208)

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- According to news reporting originating from Washington, D.C., by NewsRx journalists, a patent application by the inventors Schmidt, Brenda (Phoenix, AZ); Prevallet, James (Phoenix, AZ), filed on October 13, 2017, was made available online on March 22, 2018 (see also Patent Application).

No assignee for this patent application has been made.

Reporters obtained the following quote from the background information supplied by the inventors: "The evolving U.S. health care system presents opportunities for improving population health. By reversing the escalating epidemic of chronic diseases such as obesity, diabetes, and cardiovascular disease, population health offers better care for individual patients, improved aggregate health for the population, and lower overall healthcare costs. A key component of population health involves linking clinical care with community-based prevention programs and related social services. Traditional medical education, research, and practice have focused on the care of the individual. Shifting the emphasis to embracing population-based principles can have a greater effect on long term health and wellness, particularly in the prevention of chronic disease.

"At present, healthcare providers supply their eligible patients with a list of non-medical organizations offering a disease prevention program ('DPP'), relying on the patient to follow up directly with a community based organization ('CBO'). Unfortunately, this this type of 'opt-in' approach tends to result in significantly lower enrollment, in part because prevention programs offered by CBOs are typically not covered by health insurance plans. More recently, some health insurance plans have begun to include certain DPPs as covered benefits for their insured members. However, most DPP providers lack the infrastructure to submit medical claims for their services, and it would be cumbersome and costly for health plans to independently contract with each DPP, whether it is a community-based non-medical organization or a virtual (e.g., on-line) DPP provider.

"It is also known that patient behavior is a key metric in the success of chronic disease prevention programs. Consequently, disease prevention programs should strive to deliver against patients' needs, preferences and expectations. 'One size fits all' programs and delivery methods have had limited success because all patients are not alike--even when they share a common health condition.

"Presently known chronic disease prevention program delivery models lack sufficient understanding of consumer preferences and how to effectively influence their choices.

"Systems and methods are thus needed which overcome these limitations. Various desirable features and characteristics will also become apparent from the subsequent detailed description and the appended claims, taken in conjunction with the accompanying drawings and this background section."

In addition to obtaining background information on this patent application, NewsRx editors also obtained the inventors' summary information for this patent application: "The present invention provides a computer implemented, integrated transaction architecture for placing a participant in a disease prevention program ('DPP'), monitoring program milestones, and remitting milestone payments to the DPP provider. Various embodiments include reporting the completed milestones to a third party payer, and receiving payments from the payer for the completed milestones.

"Some embodiments employ a three-sided marketplace metaphor, in which an integrator facilitates a series of transactions for ordering, fulfilling, and paying for disease prevention programs. In this model the consumers, program providers, and payers interface with the integrator at different times from enrollment through completion of and payment for the DPP.

"Various embodiments provide systems and methods for selecting a DPP and an optimal DPP provider based on a consumer risk assessment and individual consumer preferences, including the application of predictive analytics to determine the best-fit DPP and the optimal DPP provider.

"Exemplary integrator systems employ a series of algorithms and/or branched logic to determine one or more 'best match' programs for each program participant, allowing the consumer to explore options based on his or her expressed preferences. Successful application of these insights can positively drive program engagement and influence health and wellness behaviors, and support ongoing retention and successful program completion.

"In an embodiment, the integrator system includes a database which stores a diverse network of program providers, each delivering similar evidence-based programs having variations in how the programs are delivered. Participant preferences (which may be programmatically weighted) are applied to the database. Using predictive analytics, the integrator system determines the profile of the 'ideal participant' for each program provider based on the foregoing variables and individual participant characteristics. This profile represents a hypothetical participant most likely to be successful in each program based on delivery methodology.

"After matching participant-specific data to various ideal participant profiles, the integrator system algorithmically selects the DPP provider best suited to the consumer. In this context, the consumer personal profile data may include, for example, patient contact information (including zip code), demographics, socio-economic factors, psychographics, health information, health care utilization, claims data, electronic medical record data, prescription history, and purchasing data.

"The integrator system may also be configured to track meaningful engagement between the participant and the assigned DPP. For example, meaningful engagement contemplates the satisfaction of predetermined milestones associated with the DPP, which can then be used to trigger a milestone payment from the payer to the DPP program provider (e.g., a CBO). Accordingly, meaningful engagement is an event, which initiates an action. For example, upon meaningful engagement, the DPP provider is sent a payment. For example, upon meaningful engagement, a claim is sent to the payer. Meaningful engagement metrics can be tracked for a plurality of participants and a plurality of CBOs to improve the system.

"Various other embodiments, aspects and features are described in greater detail below."

For more information, see this patent application: Schmidt, Brenda; Prevallet, James. Systems and Methods for Placing a Participant in a Disease Prevention, Monitoring Program Milestones, and Third Party Reporting and Payment. Filed October 13, 2017 and posted March 22, 2018. Patent URL: http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%2220180075208%22.PGNR.&OS=DN/20180075208&RS=DN/20180075208

Keywords for this news article include: Epidemiology, Chronic Disease, Health Insurance, Machine Learning, Disease Attributes, Patent Application, Health and Medicine, Risk and Prevention, Predictive Analytics, Emerging Technologies.

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