Intelligent health management and insurance service integration system and method

Abstract

The invention discloses an intelligent health management and insurance service integration system and method, and belongs to the technical field of information integration systems. An intelligent health management and insurance service integrated system comprises a user side, an insurance company side, a hospital side and a third-party server side which are in communication connection with a server. The user side is provided with an information acquisition module, a health monitoring module, a health service module and an insurance module. According to the invention, the health management and the insurance service are creatively and deeply fused, a one-stop integrated service mode is created, and the situation that the health management and the insurance service are mutually independent and the user needs to respectively search and connect is changed; according to the invention, the user can obtain accurate insurance recommendation and convenient claim settlement service while enjoying the health management service, and the insurance company can better develop business by means of the health management data, so that win-win of the user, the insurance company, the medical institution and the like is realized, and a brand new service concept and mode change are brought to the field of health insurance service.

Description

Technical Field

[0001] The invention relates to the technical field of information integration systems, and particularly to an intelligent health management and insurance service integration system and method. Background Art

[0002] With the continuous improvement of people's health awareness and the increasing demand for insurance services, the traditional health management and insurance service models have been difficult to meet the market needs. The company has specifically combined the needs of users and the company to construct an intelligent health management and insurance service integration system. By integrating information technology, medical resources, and insurance services, it provides users with a comprehensive and personalized health management solution; at the same time, it provides an efficient and convenient service platform for insurance companies and hospitals, realizing functions such as user health monitoring, insurance plan recommendation, risk reminder, and hospital-end access, and improving the efficiency and quality of the entire health insurance service ecosystem. Summary of the Invention

[0003] The purpose of the invention is to propose an intelligent health management and insurance service integration system and method to better serve users.

[0004] To achieve the above purpose, the invention adopts the following technical solutions: An intelligent health management and insurance service integration system includes a user terminal, an insurance company terminal, a hospital terminal, and a third-party service terminal that are communicatively connected to a server; The carrier of the user terminal is a smart phone and a wearable device; the user terminal is provided with an information collection module, a health monitoring module, a health service module, and an insurance module; The carrier of the insurance company terminal is a smart phone and a computer; The carrier of the hospital terminal is a smart phone and a computer, and it is connected to the hospital system.

[0005] Preferably, the information collection module of the wearable device acquires the user's physiological data such as physical activity, calorie consumption, sleep quality, heart rate, and blood pressure, and sends it to the health monitoring module for analysis and feedback; The information collection module of the smart phone uploads the injury photos and case information provided by the user, automatically identifies them and displays the recommended information, or triggers the access to the insurance company's customer service; The health monitoring module monitors and displays the user's physiological data in real time; when the physiological data is abnormal or the health risk reaches the warning threshold, it sends a risk reminder to the user.

[0006] Preferably, it further includes: a health risk assessment model; The health risk assessment model outputs the probability risk values of the user suffering from various major diseases in a future period based on the user's basic information, lifestyle data, long-term health monitoring data, and family medical history characteristics; uses a large amount of real user health data and follow-up results as training samples to continuously optimize the model parameters and improve the accuracy of risk prediction; In addition, regularly retrospectively verify the model effect, and update and iterate the model according to newly emerging disease characteristics, medical research results, etc.

[0007] Preferably, the health service module is provided with: a doctor consultation module, a health record module, a health plan module, and a third-party service module; Communicate and interact with doctors through the doctor consultation module, and can make online appointments and registrations; View one's own health record information through the health record module; View the personalized health management plan formulated by the system according to the user's health status through the health plan module; Connect to a third-party service provider that cooperates with an insurance company through the third-party service module; The health plan module formulates a personalized health management plan for the user based on the user's health assessment results, combined with medical knowledge and expert experience, including diet advice, exercise plans, sleep guidance, and psychological adjustment; in addition, the health plan module automatically records or the user manually enters the implementation status of the health plan, and the system automatically adjusts the health management plan according to the user's implementation status to provide more accurate guidance.

[0008] Preferably, the insurance module is provided with: an insurance recommendation module, an insurance purchase query module, and a claims module; The user views the insurance products recommended by the insurance company to him through the insurance recommendation module, consults the purchased insurance information through the insurance purchase query module, and sends claims information to the insurance company through the claims module; The insurance recommendation module recommends suitable insurance products and protection plans for the user based on the user's basic information, health status, risk assessment results, and insurance needs, using intelligent algorithms; for the insurance products of interest, the insurance purchase process can be directly completed on the user side to achieve one-key insurance purchase.

[0009] Preferably, the intelligent algorithm of the insurance recommendation module is based on the combination of collaborative filtering algorithm and content recommendation algorithm; the collaborative filtering algorithm recommends insurance products that the target user may be interested in according to the insurance purchase preferences of similar user groups; the content recommendation algorithm matches and recommends according to the attributes of insurance products, the user's health risk needs, and economic affordability; Meanwhile, it has a dynamic adjustment function; as the user's health data is updated in real time and the products in the insurance market change, the recommendation algorithm optimizes the recommendation results in real time to ensure that the insurance plan recommended to the user always meets their current needs and improves the user's willingness to purchase insurance.

[0010] Preferably, the claim settlement module provides a claim application entry; The user submits a claim application and uploads relevant medical certification materials; The system automatically reviews and processes the claim application, and fast claim settlement is achieved for claim applications that meet the requirements; For claim applications with incomplete or non-compliant materials, the system will promptly feedback the review result to the user and prompt the user to supplement or modify the materials.

[0011] Preferably, the insurance company side is provided with a user information module, a monitoring and reminder module, a risk assessment module, an insurance business management module, an insurance processing module, and a cooperation management module; The user information module establishes a detailed customer file; The monitoring and reminder module forms key-marked users based on the abnormal information uploaded by the user side; The risk assessment module evaluates the user's health risks based on the data analysis and mining results of the system, and conducts insurance pricing and risk control accordingly; for high-risk customers, the insurance premium is appropriately increased or the protection plan is adjusted; for low-risk customers, more preferential insurance premiums are provided to achieve differential pricing and precision marketing.

[0012] Preferably, the hospital side is provided with: a patient identity reminder module, an insurance settlement module; When receiving patients, the patient identity reminder module prompts the insured patients; and pulls the patient's health data, medical records, insurance information, etc. stored in the insurance company's server; at the same time, uploads the patient's current medical data; The insurance settlement module is docked with the insurance company's claim settlement system; for medical expenses within the insurance coverage, automatic insurance payment is made.

[0013] An integrated method for intelligent health management and insurance services includes the following steps: S1. Monitor, manage, and evaluate the user's health information; S2. Recommend suitable insurance services corresponding to the user's health information; S3. The insured user pays through the insurance company at the hospital or a third party.

[0014] Compared with the prior art, the invention provides an integrated system and method for intelligent health management and insurance services, which has the following beneficial effects.

[0015] 1. The present invention integrates the user side, the insurance company side, the hospital side, and the third-party service side to achieve one-stop services such as health monitoring, management, insurance recommendation, and claim settlement. The user side covers information collection, health monitoring, health services, and insurance modules, which can monitor the health status in real time, obtain professional advice, formulate personalized health management plans, and recommend suitable insurance products. The insurance company side is responsible for user information management, risk assessment, insurance business management, etc., to provide accurate services and risk control. The hospital side realizes patient identity reminder, insurance settlement, and health cooperation to improve the quality of medical services and the patient experience. The third-party service side cooperates with the physical examination reservation, online drug purchase, and health knowledge modules of the user side to provide comprehensive health management support for users.

[0016] 2. The present invention innovatively integrates health management and insurance services deeply to create a one-stop integrated service model, changing the previous situation where health management and insurance services were independent of each other and users needed to search and connect separately. While enjoying health management services, users can obtain accurate insurance recommendations and convenient claim settlement services. Insurance companies can also better carry out their business with the help of health management data, achieving a win-win situation for multiple parties such as users, insurance companies, and medical institutions, and bringing new service concepts and model reforms to the field of health insurance services.

[0017] Other advantages, objectives, and features of the invention will be described to some extent in the subsequent specification; and to some extent, based on the study of the following text, they will be obvious to those skilled in the art; or, they can be learned from the practice of the invention. BRIEF DESCRIPTION OF THE DRAWINGS

[0018] Figure 1 It is a schematic diagram of the invention.

[0019] Figure 2 It is a schematic diagram of the user side.

[0020] Figure 3 It is a schematic diagram of the insurance company side.

[0021] Figure 4 It is a schematic diagram of the hospital side.

[0022] Figure 5 It is a schematic diagram of the third-party service side. DETAILED DESCRIPTION OF THE INVENTION

[0023] Next, the technical solutions in the embodiments of the invention will be described clearly and completely in conjunction with the drawings in the embodiments of the invention. Obviously, the described embodiments are only a part of the embodiments of the invention, rather than all the embodiments.

[0024] Refer to Figures 1 to 5, An integrated system for intelligent health management and insurance services, including a user terminal, an insurance company terminal, a hospital terminal, and a third-party service terminal that communicate with a server; among them, the server is deployed and managed by the insurance company, the user terminal can register by itself or the insurance company can batch-register customers, and the hospital terminal and the third-party service terminal are authorized and opened for use by institutions cooperating with the insurance company.

[0025] The carrier of the user terminal is a smart phone and wearable devices; the carrier of the insurance company terminal is a smart phone and a computer; the carrier of the hospital terminal is a smart phone and a computer, and it is connected to the hospital system and interacts with the hospital's case system, etc.

[0026] Among them, the user terminal is provided with an information collection module, a health monitoring module, a health service module, and an insurance module to respectively implement related functions.

[0027] Specifically: The information collection module of wearable devices (such as smart bracelets, smart watches, etc.) obtains physiological data of the user, such as physical activities, calorie consumption, sleep quality, heart rate, blood pressure, etc., and sends it to the health monitoring module for analysis and feedback; the information collection module of the smart phone uploads photos of injuries, case information, etc. provided by the user, automatically identifies them and displays recommended information, or triggers the access of the insurance company's customer service.

[0028] In daily use, this system monitors the health of users in real time; in addition, users can also take photos of injured parts, diagnosis certificates, prescriptions, etc., which are recognized by the system and relevant suggestions are provided; for example, the system reminds whether online consultation is needed after recognizing an injury, and initially judges whether it meets the claim scope of the insured after recognizing case information, etc.

[0029] In addition, the information collection module is also provided with: a manual input health data module.

[0030] It can be understood that some information cannot be automatically obtained; this function is additionally set for users to manually input medical history, long-term medication history, recent health and medication conditions, mental state, and living habits (such as diet, exercise, smoking and drinking conditions, etc.); in order to obtain more comprehensive user health information.

[0031] The health monitoring module monitors and displays the user's physiological data in real time, including real-time curves, historical data comparison, etc., presenting the user's health trend and allowing the user to intuitively understand their own health status; at the same time, the user is analyzed according to the health risk assessment model, and when the physiological data is abnormal or the health risk reaches the warning threshold, a risk reminder is sent to the user; at the same time, for high-risk situations, information is sent to the emergency contact (which needs to be set in advance by the user), and a warning is sent to the insurance company terminal.

[0032] Correspondingly, it also includes: a health risk assessment model.

[0033] The health risk assessment model integrates machine learning algorithms and medical expert knowledge. Based on features such as the user's basic information, lifestyle data, long-term health monitoring data, and family medical history, it outputs the probability risk values of the user suffering from various major diseases (such as cardiovascular diseases, diabetes, cancer, etc.) in a future period (such as 1 year, 3 years, 5 years); uses a large amount of real user health data and follow-up results as training samples to continuously optimize the model parameters and improve the accuracy of risk prediction; at the same time, regularly backtracks and validates the model effect, and updates and iterates the model according to newly emerging disease characteristics, medical research results, etc. to ensure the effectiveness of the model.

[0034] The health service module is set with: a doctor consultation module, a health record module, a health plan module, and a third-party service module.

[0035] Correspondingly: communicate and interact with doctors through the doctor consultation module, and can make online appointments and registrations; view one's own health record information through the health record module; view the personalized health management plan formulated by the system according to the user's health condition through the health plan module; connect to a third-party service provider that cooperates with an insurance company through the third-party service module.

[0036] Specifically, the doctor consultation module consults health problems with doctors in various ways such as text, voice, and video. The doctor makes a remote diagnosis based on the information provided by the user and provides professional medical advice.

[0037] Furthermore, the doctor consultation module is also set with a medical knowledge base query function; users can consult relevant medical knowledge and health information at any time, learn relevant health knowledge, and improve their own health literacy.

[0038] The health plan module formulates a personalized health management plan for the user according to the user's health assessment results, combining medical knowledge and expert experience, including diet suggestions, exercise plans, sleep guidance, psychological adjustment, etc.; and pushes reminders through the user terminal to urge the user to execute the health management plan.

[0039] In addition, the health plan module automatically records or the user manually enters the implementation situation of the health plan (such as exercise records, diet diaries, etc.). The system automatically adjusts the health management plan according to the user's implementation situation to provide more accurate guidance.

[0040] It can be understood that some records cannot be automatically recorded and must be manually entered by the user.

[0041] The insurance module is set with: an insurance recommendation module, an insurance participation query module, and a claims module.

[0042] Users can view the insurance products recommended by insurance companies to them through the insurance recommendation module, consult the purchased insurance information through the insurance participation query module, and send claim information to the insurance company through the claims module.

[0043] Specifically, the insurance recommendation module recommends suitable insurance products and protection plans (such as critical illness insurance, medical insurance, accident insurance, life insurance, etc.) for users by using intelligent algorithms based on the user's basic information (age, occupation, family medical history, etc.), health status, risk assessment results, and insurance needs.

[0044] In addition, the insurance recommendation module provides functions such as detailed introductions of insurance products, interpretation of terms (coverage, claim conditions, exemption clauses, etc.), and premium calculation to help users better understand insurance products and make clear insurance purchase decisions; for insurance products of interest, the insurance purchase process can be directly completed on the user side, including operations such as filling in insurance purchase information, selecting protection plans, and paying premiums, realizing one-click insurance purchase.

[0045] Furthermore, the recommended insurance intelligent algorithm is based on the combination of collaborative filtering algorithm and content recommendation algorithm; the collaborative filtering algorithm recommends insurance products that the target user may be interested in according to the insurance purchase preferences of similar user groups (with similar characteristics such as age, health status, occupation, etc.); the content recommendation algorithm matches and recommends according to the attributes of insurance products (coverage, premium price range, insurance term, etc.) and the user's health risk needs and economic affordability. At the same time, the algorithm has a dynamic adjustment function. With the real-time update of user health data and the changes in insurance market products, the recommended results are optimized in real time to ensure that the insurance plan recommended to users always meets their current needs and improves the user's insurance purchase willingness.

[0046] The claims module is a processing function module for claim events; when a user has an insurance accident, it provides a convenient claim application entry.

[0047] The user submits a claim application, including relevant claim information such as accident time, accident cause, loss situation, etc., and uploads relevant medical certification materials such as diagnosis reports, inspection and test reports, medical expense invoices, etc.

[0048] The system automatically reviews and processes the claim application, checking the integrity and accuracy of the materials. For claim applications with complete and compliant materials, the system will automatically enter the claim processing process to achieve fast claims settlement, improve the claims settlement efficiency, and reduce the user's waiting time. For claim applications with incomplete or non-compliant materials, the system will promptly feedback the review results to the user and prompt the user to supplement or modify the materials.

[0049] Among them, natural language processing (NLP) technology and computer vision (CV) technology are used to identify and parse the claim settlement documents such as uploaded certificates, reports, invoices, etc., and extract key information (such as disease names, treatment times, expense item details, etc.); combined with the claim settlement terms in the insurance contract, a rule engine is used for automated review and judgment.

[0050] Correspondingly, it also includes exception handling; for claim settlement applications that are unclear or suspected of fraud, the system automatically marks and pushes them to the manual review queue, and at the same time provides relevant suspicious information to assist the manual review personnel to further verify, ensuring the fairness and accuracy of claim settlement review and preventing insurance fraud risks.

[0051] In addition, the claim settlement module is also equipped with a claim settlement progress query module: users can query the progress of their claim settlement applications in real time in the application; including information on claim settlement review status, claim settlement amount calculation, claim settlement payment and other links. At the same time, through methods such as client push and SMS reminder, the user is timely informed of the changes in the claim settlement progress, enabling the user to understand their claim settlement situation at any time and ensuring the transparency of the claim settlement process.

[0052] In addition, when the claim settlement process is completed, the system will feedback the claim settlement result to the user, including information such as claim settlement amount, payment method, payment time, etc.; if the user has questions or is not satisfied with the claim settlement result, they can file a complaint or consultation with the insurance company through the feedback channel of the claim settlement module, and the insurance company will handle and reply in a timely manner.

[0053] The insurance company side is provided with a user information module, a monitoring and reminder module, a risk assessment module, an insurance business management module, an insurance processing module, and a cooperation management module.

[0054] The user information module collects and stores the user's basic information, insurance information, health data, claim settlement records, etc., and establishes a detailed customer file; the insurance company conducts classified management, precise marketing and risk assessment of customers to improve customer service levels and business efficiency.

[0055] Furthermore, the user information module formulates personalized marketing plans according to the system's analysis of the user's health status, consumption behavior, etc., and pushes exclusive preferential activities, insurance value-added services, etc., to improve the marketing conversion rate (pushed to the insurance recommendation module on the user side, or marketing SMS, etc.).

[0056] The monitoring and reminder module sends an exception reminder to the insurance company according to the abnormal information uploaded by the user side and forms a key-marked user.

[0057] The risk assessment module conducts a more accurate assessment of the user's health risks based on the data analysis and mining results of the system, and accordingly conducts insurance pricing and risk control; for high-risk customers, appropriately increase the premium or adjust the protection plan; for low-risk customers, offer more preferential premiums to achieve differential pricing and precision marketing.

[0058] The insurance business management module is used to add, modify, and delete insurance product information in the background, including product names, protection scopes, clause contents, rate tables, etc.; at the same time, it can also flexibly adjust the design and pricing of insurance products according to market demands and company strategies to ensure that the insurance plans displayed on the user side are up-to-date and effective.

[0059] Furthermore, the insurance business management module, based on big data analysis technology, mines the health risk characteristics of different user groups to provide accurate data support for the development, pricing, and underwriting of insurance products; and combines real-time updated health data to dynamically adjust the risk parameters in the insurance actuarial model, making the insurance rate more scientific and reasonable, enhancing the company's competitiveness in the market, and reducing the claim risk.

[0060] The insurance processing module cooperates with the claim module on the user side. After the user submits a claim application, it automatically receives and reviews the claim materials, and for eligible claim cases, it realizes fast claims settlement; for those that require manual review, it pushes them to the manual review queue.

[0061] In addition, it conducts statistical analysis on claim cases to provide claim risk warnings and business decision-making support for the insurance company.

[0062] In addition, the insurance processing module also cooperates in the insurance application process; when the user applies for insurance, it automatically retrieves the user's health data and risk assessment report to assist underwriters in quickly judging risks. For low-risk users, it realizes instant automatic underwriting approval, and for high-risk users, it prompts manual key underwriting to improve the underwriting efficiency.

[0063] The cooperation management module cooperates and interfaces with health service providers (hospitals, third-party service providers) to jointly provide health management services for users; including formulating health management service plans, allocating service resources, tracking service effects, etc., to enhance the added value and competitiveness of insurance services.

[0064] The hospital side is equipped with: a patient identity reminder module, an insurance settlement module, a case file module, and a health cooperation module.

[0065] The patient identity reminder module, when the doctor receives a patient, reminds the insured patients; and retrieves the patient's health data, medical records, insurance information, etc. stored on the insurance company's server to provide more comprehensive patient information for the doctor to assist in diagnosis and treatment; at the same time, uploads the patient's current medical data.

[0066] The insurance settlement module is connected to the claims settlement system of the insurance company to achieve instant settlement of medical expenses; for medical expenses within the scope of insurance coverage, insurance payments are automatically made, and patients only need to pay the out-of-pocket part; the medical expense reimbursement process is simplified, improving the patient's medical experience.

[0067] Furthermore, a health cooperation module is also set up on the hospital side.

[0068] The health cooperation module interacts with the health management providers provided by the insurance company to jointly provide health management services for patients. For example, the hospital can refer patients to health management institutions for rehabilitation treatment, health check-ups, etc., or jointly carry out health lectures, free medical consultations, etc. with health management institutions to improve the quality of medical services and patient satisfaction in the hospital.

[0069] The third-party service end is used by third-party service providers; third-party service providers include health service providers, physical examination centers, pharmacies, etc. that cooperate with insurance companies, and they jointly cooperate to provide one-stop health management services for users.

[0070] Correspondingly, the third-party service end is provided with: a user verification module, an insurance settlement module, and a user push module.

[0071] The user verification module verifies the user's identity information; the insurance settlement module is connected to the claims settlement system of the insurance company to make insurance payments for expenses within the scope of insurance coverage; the user push module pushes the user information that is not suitable for this third-party service provider to other third-party service providers.

[0072] Correspondingly, the third-party service module on the user side is provided with: a physical examination reservation module, an online pharmacy module, and a health knowledge module.

[0073] Users can choose to make physical examination reservations with hospitals, health service providers, and physical examination centers that cooperate with insurance companies; at the same time, the physical examination reservation module recommends appropriate physical examination service packages according to the user information and health conditions.

[0074] Users can choose to use the online pharmacy module and make self-pay or insurance payments at pharmacies that cooperate with insurance companies. The pharmacy receives the order and delivers it, providing comprehensive health management service support for users.

[0075] The health knowledge module provides rich health knowledge courses (such as fitness courses, nutrition lectures, disease prevention and control popular science), health information articles, etc.; users can learn according to their needs to improve their health literacy.

[0076] An intelligent health management and insurance service integration method, based on an intelligent health management and insurance service integration system; includes the following steps: S1. Monitor, manage, and evaluate the user's health information; S2. Recommend suitable insurance services according to the user's health information; S3. The insured user pays through the insurance company at the hospital or a third party.

[0077] In the present invention, by integrating the user terminal, the insurance company terminal, the hospital terminal and the third-party service terminal, one-stop services such as health monitoring, management, insurance recommendation and claim settlement are realized; the user terminal covers information collection, health monitoring, health services and insurance modules, and can monitor the health status in real time, obtain professional advice, formulate personalized health management plans, and recommend suitable insurance products; the insurance company terminal is responsible for user information management, risk assessment, insurance business management, etc., so as to provide accurate services and risk control; the hospital terminal realizes patient identity reminder, insurance settlement and health cooperation, improving the quality of medical services and the patient experience. The third-party service terminal cooperates with the physical examination appointment, online drug purchase and health knowledge modules of the user terminal to provide comprehensive health management support for users.

[0078] In the present invention, with the help of the information collection modules of wearable devices and smartphones, the user's physiological data and manually input health-related information can be obtained in real time, realizing all-round and multi-dimensional health monitoring, enabling users to always master their own health status and timely discover potential health problems; according to the user's health assessment results, combined with medical knowledge and expert experience, a personalized health management plan covering many aspects such as diet, exercise, sleep, and psychological adjustment is customized for the user, and through the recording and feedback of the implementation situation, the plan is dynamically adjusted to provide accurate guidance, effectively improving the scientificity and pertinence of the user's health management; based on the user's multi-dimensional information and intelligent algorithms, insurance products and guarantee plans that meet the user's needs are accurately recommended, improving the insurance purchase efficiency and satisfaction; the claim settlement module quickly processes cases, reducing the user's waiting time and improving the claim settlement efficiency; cooperating with the claim settlement progress query and result feedback functions, ensuring the transparency of the claim settlement process and enhancing the user's trust; all parties such as insurance companies, hospitals, and third-party service providers closely cooperate to achieve resource sharing and complementary advantages; the insurance settlement module at the hospital terminal simplifies the medical treatment process and improves the patient's medical treatment experience; the diversified services of the third-party service terminal cooperate with the relevant modules of the user terminal to provide one-stop health management services such as physical examination appointment, online drug purchase, and health knowledge learning for users, forming an all-round health guarantee ecosystem; the health risk assessment model integrates machine learning algorithms and medical expert knowledge, and is continuously optimized based on a large amount of user data and follow-up results, accurately predicting the user's disease risk, providing a strong basis for the insurance company's accurate pricing and risk control, helping to reduce the claim settlement risk, realizing differential pricing and accurate marketing, and enhancing the company's market competitiveness.

[0079] In the present invention, cutting-edge technologies such as big data analysis, machine learning, natural language processing, and computer vision are comprehensively applied, deeply integrating technological advantages into all aspects of health management and insurance services, such as the construction and optimization of health risk assessment models, the precise matching of insurance recommendation algorithms, the automated review of claim applications, etc., promoting the transformation and upgrading of traditional health management and insurance service models towards intelligence and digitization, and setting a new benchmark for industry technology applications.

[0080] In the present invention, the health management and insurance services are innovatively and deeply integrated to create a one-stop integrated service model, changing the previous situation where health management and insurance services were independent of each other and users needed to search for and connect with them separately; while enjoying health management services, users can obtain precise insurance recommendations and convenient claim services, and insurance companies can also better carry out their business with the help of health management data, achieving a win-win situation for multiple parties such as users, insurance companies, and medical institutions, and bringing new service concepts and model reforms to the field of health insurance services.

[0081] In the present invention, starting from the actual needs of users, attention is paid to improving all aspects of user experience; by simplifying the operation process, providing real-time feedback, ensuring service transparency, etc., users can feel convenient, efficient, and considerate during the processes of health management, insurance purchase, and claim settlement, greatly enhancing users' acceptance and satisfaction of health management and insurance services, helping to improve user stickiness and market reputation, and promoting the healthy development of the entire industry.

[0082] In the present invention, it promotes the deep cooperation and coordinated development among different industry players such as insurance companies, medical institutions, and third-party service providers, breaks down industry barriers, and forms a close health service industrial chain; all parties achieve resource sharing and complementary advantages in cooperation, jointly providing users with higher-quality and more comprehensive services, not only improving their respective service levels and business benefits, but also providing new ideas and models for the resource integration and coordinated development of the entire health insurance service industry, and promoting the industry to develop towards a more efficient, coordinated, and innovative direction.

[0083] Although the embodiments of the invention have been shown and described above, it can be understood that the above embodiments are exemplary and should not be construed as limiting the invention. Those of ordinary skill in the art can make changes, modifications, substitutions, and variations to the above embodiments within the scope of the invention.

Claims

1. An intelligent health management and insurance service integrated system, characterized in that: Including the user side, insurance company side, hospital side and third-party service side that are connected to the server for communication; The carrier of the user terminal is a smart phone and a wearable device; the user terminal is provided with an information collection module, a health monitoring module, a health service module, and an insurance module; The carriers of the insurance company are smart phones and computers; The carriers on the hospital side are smart phones and computers, which are connected to the hospital system.

2. The intelligent health management and insurance service integrated system according to claim 1, characterized in that: The information collection module of the wearable device obtains the user's physical activity, calorie consumption, sleep quality, heart rate, blood pressure and other physiological data, and sends it to the health monitoring module for analysis and feedback; The information collection module of the smartphone uploads the patient's injury photos and case information provided by the user, and automatically identifies and displays recommended information, or triggers the insurance company's customer service to access the information; The health monitoring module monitors and displays the user's physiological data in real time; When physiological data is abnormal or health risks reach the warning threshold, risk reminders are sent to users.

3. The intelligent health management and insurance service integrated system according to claim 1, characterized in that: Also included: health risk assessment models; The health risk assessment model outputs the probability risk value of the user suffering from various major diseases in the future based on the user's basic information, living habit data, long-term health monitoring data and family medical history characteristics; using massive real user health data and follow-up results as training samples, the model parameters are continuously optimized to improve the accuracy of risk prediction; In addition, the model’s effectiveness is verified periodically, and the model is updated and iterated based on emerging disease characteristics, medical research results, etc.

4. The intelligent health management and insurance service integrated system according to claim 1, characterized in that: The health service module is provided with: doctor consultation module, health record module, health plan module, and third-party service module; Communicate and interact with doctors through the doctor consultation module, and make appointments and register online; View your own health record information through the health record module; View the personalized health management plan formulated by the system based on the user's health status through the health plan module; Connect to third-party service providers that cooperate with insurance companies through the third-party service module; The health plan module formulates a personalized health management plan for the user based on the user's health assessment results combined with medical knowledge and expert experience, including diet suggestions, exercise plans, sleep guidance, and psychological adjustment; In addition, the health plan module automatically records or the user manually inputs the health plan execution status, and the system automatically adjusts the health management plan according to the user's execution status to provide more accurate guidance.

5. The intelligent health management and insurance service integrated system according to claim 1, characterized in that: The insurance module is provided with: an insurance recommendation module, an insurance query module, and a claim settlement module; Users can view the insurance products recommended by the insurance company through the insurance recommendation module, check the purchased insurance information through the insurance query module, and send claim information to the insurance company through the claim module; The insurance recommendation module uses intelligent algorithms to recommend suitable insurance products and protection plans to users based on their basic information, health status, risk assessment results and insurance needs; it is used to complete the insurance process for insurance products of interest directly on the user side, realizing one-click insurance.

6. The intelligent health management and insurance service integrated system according to claim 5, characterized in that: The intelligent algorithm of the insurance recommendation module is based on a combination of a collaborative filtering algorithm and a content recommendation algorithm; the collaborative filtering algorithm recommends insurance products that may be of interest to target users based on the insurance purchase preferences of similar user groups; the content recommendation algorithm matches and recommends insurance products based on the attributes of insurance products and the health risk needs and economic affordability of users; At the same time, it has a dynamic adjustment function; with the real-time update of user health data and changes in insurance market products, the recommendation algorithm optimizes the recommendation results in real time to ensure that the insurance plans recommended to users always meet their current needs and increase users' willingness to take out insurance.

7. The intelligent health management and insurance service integrated system according to claim 5, characterized in that: The claims module provides an entry for claims application; The user submits a claim application and uploads relevant medical certification materials; The system automatically reviews and processes claims applications, and claims that meet the requirements are quickly settled; For claims applications with incomplete materials or those that do not meet the requirements, the system will promptly provide users with feedback on the review results and prompt users to supplement or modify the materials.

8. The intelligent health management and insurance service integrated system according to claim 1, characterized in that: The insurance company side is provided with a user information module, a monitoring reminder module, a risk assessment module, an insurance business management module, an insurance processing module, and a cooperation management module; The user information module establishes detailed customer files; The monitoring and reminder module forms a key marked user based on the abnormal information uploaded by the user terminal; The risk assessment module assesses the user's health risks based on the system's data analysis and mining results, and conducts insurance pricing and risk control accordingly; for high-risk customers, the module appropriately increases premiums or adjusts protection plans; for low-risk customers, the module provides more favorable premiums to achieve differentiated pricing and precision marketing.

9. The intelligent health management and insurance service integrated system according to claim 1, characterized in that: The hospital end is provided with: a patient identity reminder module and an insurance settlement module; The patient identity reminder module reminds the insured patient when receiving the patient; and pulls the patient's health data, medical records, insurance information, etc. stored in the insurance company's server; at the same time, uploads the patient's current medical data; The insurance settlement module is connected to the insurance company's claims system; for medical expenses that meet the insurance coverage, insurance payments are automatically made.

10. A method for integrating intelligent health management and insurance services, characterized in that: An intelligent health management and insurance service integration system based on any one of claims 1 to 9; The following steps are involved: S1. Monitor, manage and evaluate user health information; S2. Recommend appropriate insurance services based on the user's health information; S3. The insured user pays the hospital or a third party through the insurance company.

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