Patent Application
20150193852
The present disclosure relates generally to computer systems and processes for collecting information from a user that may be used for the purposes of evaluating health plan benefits.
Consumers face challenges in the field of health such as making informed decisions and reducing healthcare costs. Plan sponsors and the Government also face challenges in reducing costs and streamlining the current business process. Because of the expense of medications, it is in the interest of patients to be able to find the most cost effective health plans with the least annual drug costs.
Numerous factors enter into the determination of what is optimum for each individual patient when choosing health plans or obtaining his or her medications. A patient may consider, for instance, how far he or she must travel to different local retail pharmacies, the time difference involved in patronizing a local retail pharmacy as compared to obtaining medications from a mail-order pharmacy, and/or a Preferred Network Pharmacy for a lower cost. For example, a patient may accept the need for longer travel time to a more distant pharmacy if that pharmacy's price for the medication is lower than the price at a pharmacy which is more conveniently located.
Oftentimes a patient cannot readily determine what prices are being charged for a particular medication at different pharmacies. A patient could theoretically shop several different pharmacies, either by traveling to each or telephoning each, to determine which provides the best combination of price and convenience. However, this is not time-feasible for many patients. Thus, a patient usually ends up simply obtaining his or her medications from a pharmacy recommended to the patient, or by referring to some self-interested source such as a pharmacy's newspaper advertisement, without having means to recognize that another pharmacy (or perhaps several other pharmacies) convenient to the patient has the same medication available at a substantially lower cost. The cost of medication plays very crucial role in drug plan benefit specifically for Medicare Part D. The high cost of drug can put a member in GAP or Donut hole of Medicare Part D benefit where member pays the full cost of the drugs.
What is needed is a multi-user web portal providing choices of health plans, pharmacies and locations, choice of doctors and hospitals, choices of brand and generic drugs, choices of co-payment and out of pocket pricing options, choices of fulfillment options, and relevant safety, health and wellness information.
The present disclosure is a system and method for displaying health plans to consumers. The system and method can be accessed directly by consumers or other entities can help consumers by providing information needed to make a decision. For example a pharmacy can implement the system within their environment where patient drug profile is easily accessible to find the best plan for the member as a service. A user can search for a health plan based on input criteria such as their ZIP Code and their choice of drugs. Based on the input criteria, the method displays the most cost effective health plans with the least annual drug costs for available pharmacies. The method displays the cost of the drugs at other pharmacies for a plan. The method also allows users to select a pharmacy of their choice within a plan and find the most cost effective plan where the selected pharmacy is preferred. The method allows users to see the detailed formulary information of the drugs selected including formulary tier status, quantity limit including the amount allowed per day, prior authorization requirements including the detailed information, step therapy requirements and the limited access requirement.
The present disclosure allows users to see the most cost effective health plans offered in the area of their residence by calculating selected drug costs. The present disclosure shows the health plans with the most cost-effective pharmacy per plan and allows users to see the cost differences between pharmacies available nearby.
One embodiment of the present disclosure includes an intuitive user interface (UI) that allows users to follow simple steps to get find the most cost effective health plans with the least annual drug costs. The smart menu allows user to add, delete or modify drugs or change zip-code on the fly without going all the back to the drug selection page.
One embodiment of the present disclosure is implemented using service oriented architecture (SOA). The SOA software design is based on discrete pieces of software providing application functionality as services to other applications. The SOA allows each service to integrate with existing applications in a seamless manner, for example the drug search component of the tool could be a service itself and could be easily implemented into any web based application.
Appendix A illustrates exemplary services that could be utilized in the performance of present disclosure.
Appendix B is pseudo code for various functions used within the present disclosure.
The following detailed description discloses various embodiments and features of the present disclosure. These embodiments and features are meant to be exemplary and not limiting. Accordingly, those of ordinary skill in the art will recognize that various changes and modifications of the embodiments described herein can be made without departing from the scope and spirit of the invention.
The present disclosure is a system and method for displaying health plans to a consumer. A user can search for a health plan based on input criteria such as their ZIP Code or other geographical information and drugs (brand name or generic). Based on the input criteria, the method displays the most cost effective health plans with the least annual drug costs for available pharmacies.
The present disclosure allows users to see the most cost effective health plans offered in the area of their residence by calculating selected drug costs. The present disclosure shows the health plans with the most cost-effective pharmacy and allows users to see the cost differences between pharmacies available nearby and within a specific zip code. It can be appreciated that embodiments of the present disclosure maximize use of publically available data, for example National Plan and Provider Enumeration System (NPPES) data for National Provider Identification (NPI) information for pharmacy demographics. Embodiments of the present disclosure update formulary, pricing and plan information as frequently as needed, near real-time information available to users.
In one embodiment, a pharmacy can also implement this tool to help customers identify the most cost effective plan. A drugstore chain may integrate with their pharmacy software that will allow the drugstore chain to pull the list of the drugs taken from the patient profile and then look for most cost effective plan for them.
One embodiment of the present disclosure includes a calculation algorithm which uses LINQ queries to sort through plans available in the user's geographical area and for each plan perform a unique pharmacy selection method to find the best pharmacy for each. The cost of the drug per pharmacy represents the net negotiated drug cost plus the cost of dispensing the drug based on brand or generic and days supply.
In one embodiment, the unique pharmacy selection method uses LINQ queries to allow the application to quickly sort through all pharmacies in a given area and chose the cheapest one based on the combination of a users' given location and their drug selection. The unique pharmacy selection method can return not only the lowest cost pharmacy but also a list of all other pharmacies and their cost for the selected drugs for a particular plan. So the user can see a full list and make a full informed decision when choosing what plan fits their needs best.
One embodiment of the present disclosure includes a provider network search which allows the user to determine if their provider is present in any one of the plans returned by the JSON services. The user can search provider within a particular plan or the user can search globally among all returned plans to see the provider network status.
One embodiment of the present disclosure includes a quick menu that allows the user to easily add a drug change a zip or look at previously entered information with ease. This quick menu can be implemented using CSS3, HTML and jQuery.
One embodiment of the present disclosure includes a voice command tool which gives the user the option to interface with the system using their voice. Users can navigate through the web application add drugs and edit their information. The voice command tool utilizes the latest in speech recognition technology to understand the users' commands.
One embodiment of the present disclosure includes a map view which may use the Google Maps API and the jQuery library to allow the user to see all of the providers in their geographic area, allowing them to see addresses as well as plans associated with a selected provider. The map view can include a map filter which allows the user to quickly sort through providers on a geographical scale. The user can filter on the basis of provider name and chosen plan. The map filters may use a combination of the Google Maps JavaScript Application Program interface and the latest JQuery library.
The exemplary systems and methods illustrated herein may be described in terms of functional block components, screen shots, optional selections and various processing steps. It should be appreciated that such functional blocks may be realized by any number of hardware and/or software components configured to perform the specified functions. For example, the system may employ various integrated circuit components, e.g., memory elements, processing elements, logic elements, look-up tables, and the like, which may carry out a variety of functions under the control of one or more microprocessors or other control devices. Similarly, the software elements of the system may be implemented with any programming or scripting language such as C, C++, C#, Java, JavaScript, VBScript, Macromedia Cold Fusion, COBOL, Microsoft Active Server Pages, assembly, PERL, PHP, AWK, Python, Visual Basic, SQL Stored Procedures, PL/SQL, any UNIX shell script, and extensible markup language (XML) with the various algorithms being implemented with any combination of data structures, objects, processes, routines or other programming elements. Further, it should be noted that the system may employ any number of conventional techniques for data transmission, signaling, data processing, network control, and the like. Still further, the system could be used to detect or prevent security issues with a client-side scripting language, such as JavaScript, VBScript or the like.
The systems and methods of the present disclosure may be embodied as a customization of an existing system, an add-on product, a processing apparatus executing upgraded software, a stand alone system, a distributed system, a method, a data processing system, a device for data processing, and/or a computer program product. Accordingly, any portion of the system or a module may take the form of a processing apparatus executing code, an internet based embodiment, an entirely hardware embodiment, or an embodiment combining aspects of the internet, software and hardware. Furthermore, the system may take the form of a computer program product on a computer-readable storage medium having computer-readable program code means embodied in the storage medium. Any suitable computer-readable storage medium may be utilized, including hard disks, CD-ROM, optical storage devices, magnetic storage devices, and/or the like.
Although some of the screens illustrate a number of operations in a particular order, operations which are not order dependent may be reordered and other operations may be combined or broken out. While some reordering or other groupings are specifically mentioned, others will be apparent to those of ordinary skill in the art and so do not present an exhaustive list of alternatives. Moreover, it should be recognized that the stages could be implemented in hardware, firmware, software or any combination thereof
The system and method is described herein with reference to screen shots, block diagrams and flowchart illustrations of methods, apparatus (e.g., systems), and computer program products according to various embodiments. It will be understood that each functional block of the block diagrams and the flowchart illustrations, and combinations of functional blocks in the block diagrams and flowchart illustrations, respectively, can be implemented by computer program instructions.
These computer program instructions may be loaded onto a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions that execute on the computer or other programmable data processing apparatus create means for implementing the functions specified in the flowchart block or blocks. These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart block or blocks.
Accordingly, functional blocks of the block diagrams and flowchart illustrations support combinations of means for performing the specified functions, combinations of steps for performing the specified functions, and program instruction means for performing the specified functions. It will also be understood that each functional block of the block diagrams and flowchart illustrations, and combinations of functional blocks in the block diagrams and flowchart illustrations, can be implemented by either special purpose hardware-based computer systems which perform the specified functions or steps, or suitable combinations of special purpose hardware and computer instructions.
Although the disclosure includes a method, it is contemplated that it may be embodied as computer program instructions on a tangible computer-readable carrier, such as a magnetic or optical memory or a magnetic or optical disk. All structural, chemical, and functional equivalents to the elements of the above-described exemplary embodiments that are known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the present claims. Moreover, it is not necessary for a device or method to address each and every problem sought to be solved by the present disclosure, for it to be encompassed by the present claims. Furthermore, no element, component, or method step in the present disclosure is intended to be dedicated to the public regardless of whether the element, component, or method step is explicitly recited in the claims. No claim element herein is to be construed under the provisions of 35 U.S.C. 112, sixth paragraph, unless the element is expressly recited using the phrase “means for.” As used herein, the terms “comprises”, “comprising”, or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus.
Changes and modifications may be made to the disclosed embodiments without departing from the scope of the present disclosure. These and other changes or modifications are intended to be included within the scope of the present disclosure, as expressed in the following claims.
Appendix A illustrates exemplary services that could be utilized in the performance of present disclosure.
The services utilized in Appendix A are implemented using Windows Communication Foundation (WCF). The protocol used by the services is JSON. The advantage of using JSON as the protocol over using an XML protocol is that JSON is more compact and can be easily loaded in JavaScript. These services are set up to access the database real-time to retrieve up to the minute data and can be integrated into an application in any manner that is specific for that application. The services are discussed in Appendix A are:
Appendix B is pseudo code for various functions used within the present disclosure. The following Abbreviations are used in the Pseudo Code in Appendix B:
| Number | Date | Country | |
|---|---|---|---|
| 61925506 | Jan 2014 | US |
