System and method for using financial incentives with member engagement metrics to reduce health care claim costs

Abstract

A health care plan system and method designed to reduce future claims costs through financial incentives with member engagement metrics. Targets are pre-set for member engagement metrics. Claims cost targets for the sponsor are set based on the sponsor meeting member engagement targets. A percentage of health care plan base administrative fees are at risk based on the sponsor's claims cost performance in relation to the claims cost target. If the claims cost target is missed, the health plan administrator repays or reduces administrative fees charged to the sponsor. If the claims cost target is met, the sponsor pays additional fees to the health plan administrator. Base administrative fees are also repaid or reduced if the health care plan administrator fails to meet service performance targets. The sponsor is appraised on progress of member engagement and service performance metrics through scorecards that are sent during the plan year.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS[0001]This application is a continuation of U.S. patent application Ser. No. 12 / 101,344, filed Apr. 11, 2008, titled SYSTEM AND METHOD FOR USING FINANCIAL INCENTIVES WITH MEMBER ENGAGEMENT METRICS TO REDUCE HEALTH CARE CLAIM COSTS, now U.S. Pat. No. 8,744,878, issued Jun. 3, 2014, which is herein incorporated by reference in its entirety.FIELD OF THE INVENTION[0002]The embodiments of the present invention relate generally to health care plans and more specifically to a health care plan program designed to reduce future health care claims costs using financial incentives with member engagement metrics.BACKGROUND OF THE INVENTION[0003]Health care spending in the US has risen every year for decades. The factors that influence health care spending are numerous and include advances in medical technologies as well as population changes and changes in disease prevalence. Many heath care costs are covered through third party health care plans that plan...

AI Technical Summary

Benefits of technology

This approach leads to improved health outcomes and reduced claims costs by increasing member participation in health programs, aligning incentives for all parties involved and providing a structured mechanism for tracking and rewarding engagement metrics.

Problems solved by technology

Twenty percent of the base administrative fees may be placed at risk for the claims cost target.

Twenty percent of the base administrative fees are placed at risk for service performance as well.

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