Patent Issued for System for providing a data market for health data and for providing rewards to data market participants (USPTO 11942195): Humana Inc.

2024 APR 17 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A patent by the inventors Braun, Emily (Louisville, KY, US), Culver, Kyle (Coxs Creek, KY, US), Hill, Nicholas (Louisville, KY, US), Leach, Norman (Jeffersonville, IN, US), Lee, Chulmin (Prospect, KY, US), Plappert, Matthew A. (Louisville, KY, US), Singer, Benjamin (Louisville, KY, US), Stout, Zachary A. (Louisville, KY, US), Wason, Rohit (Louisville, KY, US), filed on January 30, 2018, was published online on March 26, 2024, according to news reporting originating from Alexandria, Virginia, by NewsRx correspondents.

Patent number 11942195 is assigned to Humana Inc. (Louisville, Kentucky, United States).

The following quote was obtained by the news editors from the background information supplied by the inventors: “BACKGROUND OF THE INVENTIVE FIELD

“The present invention is directed to a system for maintaining accurate health data by connecting buyers and sellers of data and offering the capabilities needed to participate in a distributed data market. Enabling the efficient exchange of data is critical to improving health care. Information equips both physicians and patients to make decisions that impact their well-being. There is a need for a shared foundation or platform for the secure and efficient exchange of health information to decrease costs, improve efficiencies, and facilitate competition. In one embodiment of the invention, a Provider Directory Management (PDM) process is demonstrated to show how the shared foundation can facilitate the efficient and secure exchange of data.

“This shared foundation acts a utility and serves as a data market for the entire industry. By acting as a market, and providing a platform for users, the sources of data represent “sellers” and the consumers of data “buyers”. Structuring the foundation this way allows free market forces to act upon the current interoperability problems that plague the health care industry. Buyers can now utilize the market to incentivize sellers’ behavior to improve data quality. For example, the buyer will pay more for data that is more current, or only pay for data that meets the formatting requirements that they have outlined in the contract. Sellers can now compete for the rewards of providing high quality data.

“In one scenario, a physician is willing to pay a small fee for the medication claim history for a patient with a complicated list of medications. This request for data on the market would create competition across pharmacies, payers and other firms to fulfill this request and realize the reward.

“In one embodiment, Blockchain technologies will power the shared platform and allow applications to compete while removing the high barriers to data access. This platform will benefit from the use of an established technology that provides a transparent and trusted foundation that reduces the friction in data exchange and uses the Blockchain-not only for the shared ledger, but also as the industry’s “card catalog” system.

“One of the first questions a health plan member asks when engaging with their health insurance is if their doctor is in network. Maintaining an accurate directory of providers with demographics is important to customer service. Because the provider details change rapidly, Provider Directory Management (PDM) is a necessary and ongoing set of processes for data maintenance. These processes cost millions of dollars per year and are currently very inefficient. Because customers and patients rely on directories to locate an in-network provider, these directories need to be maintained with accurate data.

“The financial obligations of maintaining a national provider directory are significant. Approximately 162 MAOs maintain directories with similar levels of relative inefficiency and expense. The duplication is expensive and wasteful and is one of the problems solved by the present invention. Currently, each MA organization is spending millions curating a public provider data set and then isolating all that valuable data in their own silos.

“There are several issues that contribute to industry inefficiencies in providing up-to-date provider directories, but the most significant is the frequency of change of provider data. Currently, most proposed updates are validated by manual processes including faxes, phone calls and word of mouth conversations that can take significant time to complete.

“Providers maintain their practice information by updating each directory maintained by each payer and MAO. Physicians making updates must visit each Web portal or fax each update directly, which creates a “door-to-door” process. A provider’s inability to broadcast updates to all the individual PDM data silos creates significant friction and inefficiency. Payers attempt to overcome this friction, and stay compliant with regulation, by reaching out to the providers to request updates. From a provider’s perspective, this outreach creates a flood of faxes, emails and calls from all of the payers which whom they are affiliated, each attempting to obtain updated information. Because information is requested periodically, this onerous process contributes to an ongoing friction with providers. When asked directly about the situation, providers understandably exhibit little awareness about the needs of updating physician directories for a payer.

“The present invention provides a shared mechanism to broadcast physician directory demographics that provides significant benefits. From an MAO perspective, the burden of building and maintaining a national scale directory is shared by the firms interested in collaborating that have a vested interest in accurate data. From a provider’s perspective, the prospect of simplifying their process to a single update for all partners is significantly more efficient and reduces calls, faxes and emails. In one embodiment of the invention, the system is comprised of a crowd sourced Blockchain solution that provides a utility that is trusted, incentivized, and extensible for all players in the ecosystem. The present invention provides a platform that enables firms like MAOs to collaborate and crowd source provider directory data. The present invention enables incentives to reward crowd sourcing activities.”

In addition to the background information obtained for this patent, NewsRx journalists also obtained the inventors’ summary information for this patent: “SUMMARY OF THE GENERAL INVENTIVE CONCEPT

“In one embodiment of the invention, the system is configured for storing and updating up-to-date medical data and for providing reward incentives to systems users, the system comprising:”

The claims supplied by the inventors are:

“1. A system for storing, updating, and validating medical data or information using a distributed ledger of a Blockchain distributed network and for providing reward incentives to users, the system comprising: one or more servers forming part of the Blockchain distributed network and comprising one or more electronic storage devices storing software instructions, which when executed, configure one or more processors of the one or more servers to: issue an open, standing request for updates to medical data at a decentralized distributed data marketplace hosted by the one or more servers from an offering user; receive an offer to fulfil the open, standing request for the updates to the medical data with a first update from a first user; receive the first update to the medical data from the first user; receive indication of payment of a validation escrow fee from the first user; issue an open, standing request for validations of the updates to the medical data; and receive an offer to fulfil the open, standing request for the validations of the updates to the medical data for the first update from a second user; a first executable portion of code stored at the one or more electronic storage devices, wherein the first executable portion of code is a smart contract configured to: store a public key of the first user; store a hash of the medical data in need of updating; provide a first reward and the validation escrow fee to the first user for providing the first update for the medical data following successful validation of the first update by the second user; provide the validation escrow fee to the offering user where the first update is not successfully validated by the second user; provide a reward to the second user for validating the update for the medical data; the distributed ledger adapted to receive a first block or transaction for storage on the distributed ledger representing or providing the first update for the medical data, the first block or transaction configured to: store a first encrypted value encrypted using the public key of the first user; at least one processor for use by the first user comprising software instructions which when executed by the at least one processor configures the computer to: receive the first encrypted value; decrypt the first encrypted value using a private key of the first user; use the decrypted value of the first encrypted value to access a data resource; and receive the first update to the medical data stored at the data resource; wherein the Blockchain distributed network is a decentralized network of nodes operably connected to each other and comprising the one or more servers, wherein the nodes comprise processing devices, computers, and databases.

“2. The system of claim 1, wherein the first block or transaction is configured to store a second encrypted value encrypted using a public key of the second user.

“3. The system of claim 1, wherein the smart contract is configured to store an address or location for escrowing the validation escrow fee, and wherein the first block or transaction is configured to provide an address or location for the first user to send funds.

“4. The system of claim 1, wherein the hash of medical data is a hash of provider directory information.

“5. The system of claim 1, wherein: the first block or transaction is configured to: provide a public key of the first user; provide identification information of the first user; and provide a hash of the first update to the medical data to ensure transparency to all of the users of the system; and the smart contract is configured to: provide validation requirements; and provide one or more public keys for acceptable validators.

“6. The system of claim 5, further comprising additional software instructions stored at the one or more electronic storage devices, which when executed, configures the one or more processors to: receive the second encrypted value; decrypt the second encrypted value using a private key of the validator; use the decrypted value of the second encrypted value to access the data resource; obtain the first update to the medical data stored at the data resource; and provide an indication that the first update to the medical data is validated or is not validated.

“7. The system of claim 1, wherein the smart contract is configured to: increase the first user’s credibility score if the first update to the medical data is validated; and increase the second user’s and the first user’s credibility or user score if the first update to the medical data is validated.

“8. The system of claim 1, wherein the medical data is patient medical history and the hash of medical data is a hash of patient medical data.

“9. The system of claim 1, wherein the decrypted value of the first encrypted value is a URL pointing to a location the first update to the medical data is stored and the data resource is a web page.”

URL and more information on this patent, see: Braun, Emily. System for providing a data market for health data and for providing rewards to data market participants. U.S. Patent Number 11942195, filed January 30, 2018, and published online on March 26, 2024. Patent URL (for desktop use only): https://ppubs.uspto.gov/pubwebapp/external.html?q=(11942195)&db=USPAT&type=ids

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