Patent Issued for Interactive algorithm for determining negotiated healthcare price rates (USPTO 11288749): Angheloiu George O.

2022 APR 15 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Angheloiu George O. (Lancaster, Pennsylvania, United States) has been issued patent number 11288749, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Angheloiu, George O. (Dubois, PA, US), Angheloiu, Nicoleta A. (Dubois, PA, US), Angheloiu, Viorel (Vancouver, WA, US), Haiduc, Ovidiu (Woodridge, IL, US), Subramany, Narayana (Ridgway, PA, US).

This patent was filed on February 27, 2015 and was published online on March 29, 2022.

From the background information supplied by the inventors, news correspondents obtained the following quote: “Charges for health care services have been increasing dramatically in the past two decades, much faster than predicted by the average inflation rate. In addition to an aging population and advanced and more expensive services potentially being delivered, an interplay between the hospitals’ charge and insurance companies’ negotiated reimbursement systems have possibly contributed as well to this price evolution.

“There several inventions to date known to have as objective the negotiation or prediction of medical prices. In the first instance U.S. Pat. No. 8,095,384 by Firminger et al., projects finding the best communication between a patient with a specific medical problem and the best provider, finding the best suited provider at the best cost and finding the best medical algorithm to treat that particular problem. This approach lacks the ability to predict what particular specific acute problem might arise in the near or far future, in order for the potential patients to plan for it and price-negotiate it in advance. Hence acute care such as hospitalizations, surgeries, acute medical treatments, emergency visits, and other less semi-acute, semi-elective operations and medical visits or treatments will be possibly not included in a one-at-a-time algorithm, exposing the potential patient to possible high medical costs.

“Another invention by Henley et al., U.S. Pat. No. 7,657,479 B2, advises a similar algorithm where one or more providers offer in an auction system one or more services, from which individual patients can select and negotiate in an auction system a purchasing price. The service selling and buying process however is not exhaustive and refers only to buying only one medical care item with no long-time future contract, leaving in this way a particular patient exposed to eventual high medical costs for acute care in the future.

“In a rather similar invention, by George Smith, “A system and a method for purchasing healthcare products”, the inventor teaches a method of selling healthcare products packages based on a voucher method, linked to various electronic devices, that lends to a negotiated system. No details are put forward regarding the criteria that lead to a negotiated price. At the same time the method targets only individual healthcare products or packages that need consumed at an individual point in time, leaving the potential patient vulnerable to unforeseeable high costs in the future.

“Yet another application by Lieberman Ser. No. 11/420,678 (United States Patent Application 20070276695), as well as Eaton et al. (WO2006069065) teach a method of price variation by a healthcare provider depending on the need of his/her services on the local medical market place. There is no interaction or feedback from the interested potential patients or payers, and hence no real negotiation process is actually entertained; at the same time the provider cannot receive an accurate approximation of the present or future healthcare need in the local market in order to closely gauge the negotiated price.

“Two other inventions, U.S. Pat. No. 8,498,885, by Vanderzee et al., and US patent application 20120232936 by Dena Bravata provide cost prediction for health care services of interest, with a final purpose of predicting out-of-pocket costs for health care services or offering reference prices for third-party payers. It does not allow direct negotiation of prices that would eventually allow receiving health services later on at the negotiated rate.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “In order to reestablish the individual patient’s ability to better negotiate all out-of-pocket and other prices for all health care services and medications/devices for a period of time in the future or immediate past, we propose an algorithm that would insure such a negotiation process between health care providers and pharmacies/pharmaceutical or medical device manufacturers on one side and individual patients or groups of patients on the opposite side, resulting into a contract and then eventual application of the contract agreement with every occasion the potential patients will need services or medications or medical devices that constitute the object of the particular negotiation. By health care providers is understood any of the following: hospitals, solo or multi-physician practices either private or owned by other medical organizations, laboratories, offices of rehabilitation or physical therapy, nursing homes, offices of dental care, companies selling durable medical equipment and other health care providers that perform medical tests, procedures, medical visits and consults.

“This particular system will allow access of potential patients at any time in a comprehensive exhaustive manner to negotiated prices of all possible categories of medical services, medications and devices, without the need to target a specific physician, period of time, or certain type of service, medication or device. This is an important feature for two reasons. First of all health or sickness are aleatory phenomena, which for the most part are difficult to predict. Hence the time to use a negotiated service, medication or device is hard to decide. Second the type of service, medication or device needed or provider needed will be similarity difficult to choose in absence of a magic mirror that will predict the medical event possible to happen in the future. This type of assured negotiated rate will grant access to all categories of health care in a timely manner and for an acceptable price at any time or in any circumstance without the need of picking the correct time, category, provider or source of medication or device.

“Interested negotiating parties. Potential patients interested in such a negotiation process are potential patients with no insurance, potential patients with partial insurance covering only a certain number of tests, procedures, consults or medical visits, potential patients with high insurance deductible or high co-pays, potential patients in search or in need of medical services in an area outside of geographical area of insurance coverage, potential patients with no or only partial local medical insurance traveling from abroad, and patients with denied insurance claims. Other parties that might be interested in negotiating health care services, medications or devices prices are any company and in addition also health insurance organizations on behalf of their employees and members respectively.

“Interested health care providers or manufacturers and pharmacies. Interested health care providers or pharmacies and pharmaceutical or medical device manufacturers are those in need to increase their client basis by offering negotiated prices of the services or manufactured/sold goods.

“The objective of this algorithm is the negotiation of health care/pharmaceutical prices to levels lower that the initial tag price posted by health care providers or pharmacies and pharmaceutical or medical device manufacturers for health care services or medications/devices respectively.”

The claims supplied by the inventors are:

“1. A web and computer-supported method for establishing prices for health care devices, services and medications through a process of negotiation between two parties, using two feeds of information between the first party and a second party transferred between the two parties through a computer and web system: where the first feed of information from a first party is generated on a web and computer platform as a comprehensive list of all health services, medications, and devices offered by the first party each at an initial price rate, wherein the health services, medications, and devices are divided into categories based on specialty and type of service; and a second feed of information from the second party is generated on said internet-based platform and includes an indication of all health care services, medications, and devices on a comprehensive list for which the second party would like to negotiate the initial price rates; followed by a third feed of information from the first party indicating how the initial price rates of the health services, medications, and devices identified by the second party is changed to negotiated price rates based on the first and second feed of information and a set of second party characteristics; said computer and web-based method using as negotiation criteria a said set of characteristics of a second party, said characteristics inducting: age; gender; income; number of individuals represented by the second party; productivity of the health services, medications, and devices identified by the second party; whether the second party has negotiated with other providers of health services, medications, and devices in a given geographical area, and if so, how many; number of specialties identified by second party; number of types of services identified by the second party; specialties and types of services the second party does not negotiate with the other party; number and productivity of health services, medications, and devices needed by the second party; geographical location of the second party; and whether the second party locks in the negotiated price rates, and if so, the length of time the second party desires to lock in the negotiated price rates; and said computer and web-based method generating a contract for a comprehensive list of health services, medications, and devices to be entered into by the first party and the second party, such contract being based on criteria included in the first feed of information offered by the first party and the second feed of information offered by the second party, contract under which the first party makes available over a period of time to the second party at the negotiated price rates the health services, medications, and devices identified by the second party.

“2. The computer and web-based method of claim 1, wherein the first party comprises one or more healthcare providers or medical sources.

“3. The computer and web-based method of claim 1, wherein the second party comprises one or more potential patients seeking to receive one or more health services, medications, or devices offered by the first party, or one or more healthcare insurance members, or companies representing such potential patients or insurance members.

“4. The computer and web-based method of claim 1 further comprising: collecting a commission proportional to the difference between the initial price rates and the negotiated price rates and transmitting the negotiated price rates to the first party and the second party.

“5. The computer and web-based method of claim 1 further comprising offering the negotiated price rates for the health services, medications, and devices identified by the second party to an entity other than the second party.

“6. The computer and web-based method of claim 1, wherein the difference between the negotiated price rates and the initial price rates increases as: age of individuals in second party increases; number of individuals represented by the second party increases; when the first party comprises one or more healthcare providers or medical sources, the number of healthcare providers and medical sources represented by the first party decreases; number of specialties and types of services identified by the second party increases; or the number and productivity of health services, medications, and devices needed by the second party increases.

“7. The computer and web-based method of claim 1, wherein the difference between the negotiated price rates and the initial price rates decreases if: the second party locks in the negotiated price rates; or as the length of time for which the second party desires to lock in the negotiated price rates increases.

“8. The computer and web-based method of claim 1, further comprising: the first and second party receiving from a third party a third feed of information including an identification of all health services, medications, and devices on the list for which the third party would like to negotiate initial price rates, said feed also including third party characteristics; age; gender; income; number of individuals represented by the third party; productivity of the health services, medications, and devices identified by the third party; whether the party has negotiated with other providers of health services, medications, and devices in a given geographical area, and if so, how many; number of specialties identified by third party; number of types of services identified by the third party; specialties and types of service the third party does not negotiate with the other party; number and productivity of health services, medications, and devices needed by the third party; geographical location of the third party; and whether the third party locks in the negotiated price rates, and if so, the length of time the third party desires to lock in the negotiated price rates; receiving from the third party a third feed of information; and changing the negotiated price rates based on the third feed of information.

“9. The computer and web-based method of claim 8, wherein the third party comprises one or more potential patients seeking to receive one or more health services, medications, or devices offered by the first party, or one or more healthcare insurance members, or companies representing such potential patients or health insurance members, wherein the one or more potential patients or health insurance members are not represented by the second party.

“10. The computer and web-based method of claim 8, further comprising generating a contract to be entered into by the first party, the second party, and the third party, under which the first party makes available over a period of time to the second party and the third party at the negotiated price rates the health services, medications, and devices identified by the second party and the third party.

“11. The computer and web-based method of claim 1, further comprising adjusting the negotiated price rates over time.

“12. The computer and web-based method of claim 1, further comprising adjusting the negotiated price rates based on the ratio of the number of potential patients represented by the second party in a geographical area and the number of potential patients in said given geographical area not represented by the second party.”

For the URL and additional information on this patent, see: Angheloiu, George O. Interactive algorithm for determining negotiated healthcare price rates. U.S. Patent Number 11288749, filed February 27, 2015, and published online on March 29, 2022. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=11288749.PN.&OS=PN/11288749RS=PN/11288749

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