The invention relates to systems and methods of modeling expenses and, more particularly, to systems and methods of modeling expenses based on demographic information.
The cost of health care services and the many variables affecting the cost of health care services are important factors in selecting certain medical insurance plans. That is, costs can have a major impact on the decision to purchase certain types of medical insurance plans, from basic medical insurance coverage to coverage with a host of more advanced options. In fact, in many instances consumer costs are a driving factor in selecting certain medical insurance plans.
Typically, an employer offers several medical insurance plans to their employees. These medical insurance plans come with different costs and different coverage. For example, one medical insurance plan can have a high deductible with a low premium; whereas, another medical insurance plan may have a low deductible with a high premium. These different plans can also include different co-payments and costs for different prescription drug plans. To complicate the selection process even more, the employer can offer certain benefits to their employees, ranging from health savings accounts (HSA) to premium support. With these many factors to consider, it becomes ever more difficult for a consumer to select an appropriate medical insurance plan.
In a first aspect of the invention, a method of modeling medical insurance expenses implemented by a computer system comprises determining an initial estimate of a contribution cost to a consumer for a plurality of offered medical insurance plans based on demographic information associated with the consumer. The method further comprises launching the consumer to an estimator tool which displays values associated with different scenarios initially based on the demographic information. The method further comprises recalculating the initial estimate of the contribution cost of the plurality of offered medical insurance plans based on adjusted values of one or more of the different scenarios, as adjusted by the consumer. The method further comprises displaying, as an updated estimate contribution cost, the recalculated initial estimate of the contribution cost to the consumer for each of the offered medical insurance plans.
In a further aspect of the invention, a computer system for generating estimate contribution costs for medical insurance comprises: a hardware memory device that stores program instructions and demographic and associated cost information associated with a plurality of medical insurance plans; and a processor that executes the program instructions and causes the computer system to: estimate a minimum contribution cost, typical contribution cost and maximum contribution cost for a plurality of offered medical insurance plans based on the demographic information associated with the consumer; recalculate the typical contribution cost of the plurality of offered medical insurance plans based on adjusted values of one or more of different plan options for each of the plurality of offered medical insurance plans; and automatically display, as an updated estimate contribution cost, the typical contribution cost to the consumer for each of the offered medical insurance plans.
In a further aspect of the invention, a computer program product comprises computer readable program instructions stored on non-transitory computer readable storage medium. The computer readable program instructions causing a computing device to: estimate a minimum contribution cost, typical contribution cost and maximum contribution cost for a plurality of offered medical insurance plans based on the demographic information associated with the consumer; display the minimum contribution cost, typical contribution cost and maximum contribution cost for the plurality of offered medical insurance plans; calculate and display a per pay check cost for the minimum contribution cost for the plurality of offered medical insurance plans; recalculate the typical contribution cost of the plurality of offered medical insurance plans based on adjusted values of one or more of different plan options for each of the plurality of offered medical insurance plans; and automatically updated the typical contribution cost, while keeping the minimum contribution cost and the maximum contribution cost static.
The present invention is described in the detailed description which follows, in reference to the noted plurality of drawings by way of non-limiting examples of exemplary embodiments of the present invention.
The invention relates to systems and methods of modeling expenses and, more particularly, to systems and methods of modeling expenses based on demographic information. More specifically, the present invention relates to systems and methods of modeling medical expenses and more particularly estimating consumer costs based on demographic information. In embodiments, the consumer can fine tune or adjust the cost estimate by adjusting values of different scenarios associated with the medical insurance plans (and/or demographic information). In this way, the systems and methods of the present invention allow a consumer to compare out-of-pocket contribution costs of medical insurance for different medical insurance plans using different scenarios, based on the demographic information and as adjusted by the user (consumer) according to different unique situations or scenarios.
In accordance with embodiments of the present invention, the systems and methods (e.g., cost comparison tool) allow a user to select possible future events in order to calculate more accurately estimate medical expenses associated with unique situations under various aspects of multiple medical plans. For example, by implementing the cost comparison tool the user can edit medical usage levels based on an individual situation and, based on such adjusted information, obtain cost estimates for particular medical insurance plans. In this way, the consumer is provided an opportunity to make an educated decision with regard to comparison costs of different medical insurance plans based on unique situations relevant to the requesting consumer and, hence select appropriate medical insurance coverage.
In embodiments, the cost comparison tool provides a model of consumer contribution costs based on demographic information obtained from, for example, a third party service provider. This demographic information can then be used to model individual costs for different medical insurance plans based on individual scenarios, and using these estimate costs (amongst other features) make a comparison for selection of the most appropriate medical insurance plan. The modeled medical costs include costs directly attributable to an employee and, depending on benefits received from an employer, can include all out-of-pocket expenses, taking into consideration factors such as health savings accounts (HSA), particular usage of certain services, etc.
By way of an illustrative example, the demographic information used to provide cost estimates of different medical plans can include economic status, age, health (past medical history), family and/or marital status, location, medical service usage (e.g., use of medical services (e.g., doctor visits, hospital stays, x-rays and other diagnostics), prescription usage, etc. In embodiments, the demographic information can be obtained from statistical information collated, developed, and/or created, etc. by a third party service provider, as further described herein.
As shown in
The bus 110 permits communication among the components of computing device 105. For example, bus 110 may be any of several types of bus structures including a memory bus or memory controller, a peripheral bus, and a local bus using any of a variety of bus architectures to provide one or more wired or wireless communication links or paths for transferring data and/or power to, from, or between various other components of computing device 105.
The processor 115 may be one or more conventional processors, microprocessors, or specialized dedicated processors that include processing circuitry operative to interpret and execute computer readable program instructions, such as program instructions for controlling the operation and performance of one or more of the various other components of computing device 105 for implementing the functionality, steps, and/or performance of the present invention.
In embodiments, processor 115 interprets and executes the processes, steps, functions, and/or operations of the present invention, which may be operatively implemented by the computer readable program instructions. For example, processor 115 can calculate contribution cost estimates for medical insurance plans based on, for example, demographic information. In embodiments, the demographic information can be stored in the storage device 120, and can include a host of disparate information that is not typically collated in any single database. This disparate information can be, e.g.,
This demographic information is used to calculate initial cost estimates for different medical insurance plans offered, e.g., by an employer. In embodiments, the storage system contains medical expenses for different events based on average expenses for a particular group, e.g., cost per service, number of uses for a given event, etc. These costs can be applied to different medical plans for comparison, with the events being customized based on likelihood of certain events for the user's demographics or personal situation, or past medical history. In aspects of the present invention, the demographic information can be obtained from disparate databases which include the different types of information needed to provide cost estimate information for different medical plans. This information can then be used to estimate contribution costs for different insurance plans using, e.g., statistical information known to those in the insurance industry. For example, the estimate contribution costs can be based on different models using the demographic information. These models include, e.g., risk-adjustment models, deterministic models, payer-centric data, etc. By way of more specific example, the risk-adjustment model can use the demographic infor nation to estimate an expected annual cost for each consumer to be enrolled in a medical insurance plan. In this way, the present invention contemplates that a service provider has access to different information in order to obtain, collate, develop, and/or create the necessary statistical information to be used by the cost estimator tool of the present invention. This demographic information can then be used to provide an added service to employees.
Also, additional information can be provided by the consumer to recalculate out-of pocket expenses for the consumer, in order to determine a more accurate cost estimate, and hence allow the consumer to make an educated selection decision for different medical plans and different individual situations. For example, the cost estimator tool of the present invention provides the consumer the ability to adjust services associated which, in turn, will adjust contribution costs for the consumer. This will allow the consumer to compare medical costs for different scenarios. This adjusted information can include, for example, amongst other things:
In aspects of the present invention, the cost estimator tool has access to costs associated with different medical plans in order to make adjustments for out-of-pocket expenses based on the different scenarios provided by the consumer. The different types of expenses can include, for example, any deductibles as well as copayments for doctor's visits, prescription drugs, diagnostic testing, etc. In embodiments, these different types of expenses are provided in the storage device 120, associated with the appropriate medical insurance plan. This information can then be used to fine tune the contribution costs for different insurance plans using different scenarios that are unique to the consumer. In this way, the present invention contemplates that a service provider has access to different information of each medical insurance plan offered, e.g., by an employer.
In embodiments, processor 115 may receive input signals from one or more input devices 130 and/or drive output signals through one or more output devices 135. The input devices 130 may be, for example, a keyboard or touch sensitive user interface (UI) as further described below. The output devices 135 can be, for example, any display device, printer, etc., as further described below.
The storage device 120 may include removable/non-removable, volatile/non-volatile computer readable media, such as, but not limited to, non-transitory media such as magnetic and/or optical recording media and their corresponding drives. The drives and their associated computer readable media provide for storage of computer readable program instructions, data structures, program modules and other data for operation of computing device 105 in accordance with the different aspects of the present invention. In embodiments, storage device 120 may store operating system 145, application programs 150, and program data 155 in accordance with aspects of the present invention.
The system memory 125 may include one or more storage mediums, including for example, non-transitory media such as flash memory, permanent memory such as read-only memory (“ROM”), semi-permanent memory such as random access memory (“RAM”), any other suitable type of storage component, or any combination thereof. In some embodiments, an input/output system 160 (BIOS) including the basic routines that help to transfer information between the various other components of computing device 105, such as during start-up, may be stored in the ROM. Additionally, data and/or program modules 165, such as at least a portion of operating system 145, program modules application programs 150, and/or program data 155, that are accessible to and/or presently being operated on by processor 115, may be contained in the RAM. In embodiments, the program modules 165 and/or application programs 150 can comprise the cost estimation tool of the present invention, which provides the instructions for execution of processor 115.
The one or more input devices 130 may include one or more mechanisms that permit an operator to input information to computing device 105, such as, but not limited to, a touch pad, dial, click wheel, scroll wheel, touch screen, one or more buttons (e.g., a keyboard), mouse, game controller, track ball, microphone, camera, proximity sensor, light detector, motion sensors, biometric sensor, and combinations thereof. The one or more output devices 135 may include one or more mechanisms that output information to an operator, such as, but not limited to, audio speakers, headphones, audio line-outs, visual displays, antennas, infrared ports, tactile feedback, printers, or combinations thereof.
The communication interface 140 may include any transceiver-like mechanism (e.g., a network interface, a network adapter, a modem, or combinations thereof) that enables computing device 105 to communicate with remote devices or systems, such as a mobile device or other computing devices such as, for example, a server in a networked environment, e.g., cloud environment. For example, computing device 105 may be connected to remote devices or systems via one or more local area networks (LAN) and/or one or more wide area networks (WAN) using communication interface 140.
As discussed herein, computing system 100 may be configured to provide cost estimates and comparisons of different medical insurance based on demographic information and unique information provided by the consumer. In particular, computing device 105 may perform tasks (e.g., process, steps, methods and/or functionality) in response to processor 115 executing program instructions contained in computer readable medium, such as system memory 125. The program instructions may be read into system memory 125 from another computer readable medium, such as data storage device 120, or from another device via the communication interface 140 or server within or outside of a cloud environment. In embodiments, an operator may interact with computing device 105 via the one or more input devices 130 and/or the one or more output devices 135 to facilitate performance of the tasks and/or realize the end results of such tasks in accordance with aspects of the present invention. In additional or alternative embodiments, hardwired circuitry may be used in place of or in combination with the program instructions to implement the tasks, e.g., steps, methods and/or functionality, consistent with the different aspects of the present invention. Thus, the steps, methods and/or functionality disclosed herein can be implemented in any combination of hardware circuitry and software.
As depicted in
Cloud computing environment 200 may be configured such that cloud resources 205 provide computing resources to client devices 210 through a variety of service models, such as Software as a Service (SaaS), Platforms as a service (PaaS), Infrastructure as a Service (IaaS), and/or any other cloud service models. Cloud resources 205 may be configured, in some cases, to provide multiple service models to a client device 210. For example, cloud resources 205 can provide both SaaS and IaaS to a client device 210. Cloud resources 205 may be configured, in some cases, to provide different service models to different client devices 210. For example, cloud resources 205 can provide SaaS to a first client device 210 and PaaS to a second client device 210.
Cloud computing environment 200 may be configured such that cloud resources 205 provide computing resources to client devices 210 through a variety of deployment models, such as public, private, community, hybrid, and/or any other cloud deployment model. Cloud resources 205 may be configured, in some cases, to support multiple deployment models. For example, cloud resources 205 can provide one set of computing resources through a public deployment model and another set of computing resources through a private deployment model.
One or more cloud resources 205 may be conceptually structured in multiple layers. In one example, the layers include a firmware and hardware layer, a kernel layer, an infrastructure service layer, a platform service layer, and an application service layer. The firmware and hardware layer may be the lowest layer upon which the other layers are built, and may include generic contributing nodes (e.g., data centers, computers, and storage devices) geographically distributed across the Internet and provide the physical resources for implementing the upper layers of the cloud service provider. The kernel layer is above the firmware and hardware layer and may include an operating system and/or virtual machine manager that host the cloud infrastructure services. The kernel layer controls and communicates with the underlying firmware and hardware layer through one or more hardware/firmware-level application programming interfaces (APIs). The infrastructure service layer is above the kernel layer and may include virtualized resources, such as virtual machines, virtual storage (e.g., virtual disks), virtual network appliances (e.g., firewalls), and so on. The infrastructure service layer may also include virtualized services, such as database services, networking services, file system services, web hosting services, load balancing services, message queue services, map services, e-mail services, and so on. The platform service layer is above the infrastructure service layer and may include platforms and application frameworks that provide platform services, such as an environment for running virtual machines or a framework for developing and launching a particular type of software application. The application service layer is above the platform service layer and may include a software application installed on one or more virtual machines or deployed in an application framework in the platform service layer. The software application can also communicate with one or more infrastructure service components (e.g., firewalls, databases, web servers, etc.) in the infrastructure service layer.
In another example, one or more cloud resources 205 may be conceptually structured in functional abstraction layers including hardware and software layers, a virtualization layer, a management layer, and a workloads layer. The hardware and software layer may include hardware and software components such as mainframes, RISC (reduced instruction set computer) architecture based servers, storage devices, networks and networking components, application server software, and database software. The virtualization layer may include virtual entities such as virtual servers, virtual storage, virtual networks, virtual applications, and virtual clients. The management layer may provide functions such as resource provisioning, metering and pricing, security, user portals, service level management, and service level agreement planning and fulfillment. The workloads layer may provide functions for which the cloud computing environment is utilized, such as mapping and navigation, software development and lifecycle management, data analytics and processing, and transaction processing.
In embodiments, software and/or hardware that performs one or more of the aspects, functions and/or processes described herein may be accessed and/or utilized by a client (e.g., an enterprise or an end user) as one or more of an SaaS, PaaS and IaaS model in one or more of a private, community, public, and hybrid cloud. Moreover, although this disclosure includes a description of cloud computing, the systems and methods described herein are not limited to cloud computing and instead can be implemented on any suitable computing environment.
Cloud resources 205 may be configured to provide a variety of functionality that involves user interaction. Accordingly, a user interface (UI) can be provided for communicating with cloud resources 205 and/or performing tasks associated with cloud resources 205. The UI can be accessed via the client device 210 in communication with cloud resources 205. The UI can be configured to operate in a variety of client modes, including a fat client mode, a thin client mode, or a hybrid client mode, depending on the storage and processing capabilities of cloud resources 205 and/or client device 210. Therefore, a UI can be implemented as a standalone application operating at the client device 210 in some embodiments. In other embodiments, a web browser-based portal can be used to provide the UI. Any other configuration to access cloud resources 205 can also be used in various implementations.
Specifically,
As shown further in
Still referring to
To assist in the enrollment process, the cost comparison interface 300 also provides the user with the ability to enroll in any desired medical plan, e.g., medical plan #1, medical plan #2 or medical plan #3, by simply selecting the enrollment “button” 325. On the other hand, the user can deny coverage by simply selecting the “I do not want benefit” button 330. It should be understood by those of skill in the art that the nomenclature used for any of the buttons, icons or descriptive terms herein is provided as an illustrative example, and that other descriptive terms, icons, and/or scroll down windows are contemplated by the present invention.
The cost comparison interface 300 also provides additional information about the particular medical plans including, for example, the days left for enrollment icon 335, as well as additional information “at a glance” shown at reference numeral 340. The days left for enrollment can be based on the open enrollment period and, more specifically, the number of days left in the open enrollment period. By selecting the days left for enrollment icon 335, a calendar with the last day of open enrollment for a particular medical plan can be displayed to the consumer, as an example. The “information at a glance” field 340 can include different medical plans based on such factors as, e.g., lowest premiums, employee funded health savings accounts (HSA), no cost preventative care, high annual deductibles, etc.
The cost comparison interface 300 can also be used as a launching site for the consumer to select different options and scenarios, which may be used in a cost calculation of particular medical plans, e.g., medical plan #1, medical plan #2 or medical plan #3. The launching can be effectuated by, for example, selecting any column, header or number, to open an editing screen. By way of example, by selecting medical plan #1, the user interface 400 of
In the user interface 400 of
In embodiments, the different scenarios shown in
Based on the typical usage scenario, several cost estimates can be provided to the consumer as shown at reference numerals 410 and 415. These cost estimates can be shown in a graphical format (e.g., bar graph 410) based on contributions and out-of-pocket expenses for the typical usage plan, as well as a total dollar amount shown at reference numeral 415. In embodiments, the graphical format 410 includes the maximum dollar amount that can be expended by the consumer, based on different scenarios and values. In addition, the graphical format 410 can include other information such as, for example, employer contributions (e.g., least amount paid as shown in
In embodiments, the contributions and out-of-pocket expenses shown in
In any scenario, the interface 400 of
More specifically, in
Accordingly, by using the slide bar 605, the consumer can adjust the number (value) of doctor's visit for any of the covered participants. It should be understood by those of ordinary skill in the art that this same process can be used for any other scenario shown in the table 405, and that alternative methods of adjusting the number of doctor's visit for each of the covered participants is contemplated by the present invention. For example, a fillable field may be provided by the interface, which allows the consumer to enter a number (value) within the fillable field.
In any of these alternative methods, the adjustment of the number of doctor's visits (or any other scenario in table 405) will automatically result in a recalculation of the out-of pocket expenses for each medical plan, as shown at reference numerals 410a and 415a. That is, the bar graph shown at reference numeral 410a will update (compared to the graph shown at reference numeral 410 of
In embodiments, the recalculation can be based on the particular costs associated with the medical plan. By way of example, if the consumer selected two additional doctor's visits per year, and the medical plan includes an out-of-pocket expense (e.g., copayment) of $50 for each additional doctor's visit, the total contribution per year amount as shown at reference numeral 415a will be updated by $100 (e.g., 2×$50/visit=$100). Similar calculations can be performed for different scenarios. For example, a minor surgery may result in an additional cost of $100 per surgery, resulting in the total contribution per year amount increasing by $100. In embodiments, this calculation is based on each particular medical plan costs, deductibles, and other cost factors associated with the particular medical plan.
In the example shown in
Advantageously, the “what if” scenario 705 allows the consumer to have a clear, tactile way to edit the information and minimize the amount of clicks needed to set the value. This interface will also encourage the consumer to select different scenarios, and automatically see a change in the values for different categories. Additionally, in real time, the consumer can see the change in relation to their actions, as already described herein.
Referring to
In embodiments, this calculation can include a maximum contribution cost and a minimum contribution cost for the consumer, based on the parameters of an individual medical plan. For example, the processes of the present invention can obtain associated costs for each medical plan, including out-of-pocket expenses from the medical insurer, employer, etc., based on many different factors including premium contributions from the employer, HSA accounts of the participant, etc. Once all of this information is obtained and collated, the processes of the present invention can provide a calculated contribution cost, including a maximum cost and a minimum cost for out-of-pocket expenses, e.g., total contribution costs for a plan participant.
At step 905, the processes of the present invention can display this information to the consumer. In embodiments, this information can be displayed in a user interface, as described herein. For example, the present invention contemplates displaying maximum and minimum contribution costs, as well as typical contribution costs. In embodiments, the minimum contribution cost can be further provided as a per paycheck cost to the consumer at step 910.
At step 915, the processes of the present invention can launch the consumer to a cost estimator interface, which allows the consumer to adjust certain values based on certain scenarios. In embodiments, the consumer can select a particular medical plan or icon on an initial user interface to launch to the cost estimator interface.
At step 920, the processes of the present invention and more particularly the cost estimator interface provides the consumer with the ability to adjust values associated with different scenarios, as already described herein. For example, the consumer can adjust a number of visits to a doctor's office, different combinations of prescriptions, etc. (plan options). In embodiments, the values can be adjusted by a slide bar, a manual entry in a fillable field, or by group settings.
Based on the new values, and the information obtained and/or known from step 900, the processes of the present invention will recalculate the total contribution costs for the consumer at step 925. This updated contribution cost can then be automatically updated for each medical plan, which can be automatically updated in any combination of user interfaces shown in
The service provider or other third party vendor can provide the services of the present invention based on, for example, a subscription business model. To this end, the service provider and/or third party vendor can create, maintain, support, etc., a computer infrastructure, such as computing system 100 (
The foregoing examples have been provided merely for the purpose of explanation and are in no way to be construed as limiting of the present invention. While aspects of the present invention have been described with reference to an exemplary embodiment, it is understood that the words which have been used herein are words of description and illustration, rather than words of limitation. Changes may be made, within the purview of the appended claims, as presently stated and as amended, without departing from the scope and spirit of the present invention in its aspects. Although aspects of the present invention have been described herein with reference to particular means, materials and embodiments, the present invention is not intended to be limited to the particulars disclosed herein; rather, the present invention extends to all functionally equivalent structures, methods and uses, such as are within the scope of the appended claims.