Data processing method, system, device and storage medium for health insurance business

Abstract

The present specification relates to the field of data processing technology, and provides a data processing method, system, device and storage medium for health insurance business, the method comprising: extracting the target insured from the health insurance database; obtaining the health data of the target insured from the client corresponding to the target insured; using the health data as input, calling the health risk prediction model to predict the health risk value of the target insured; when the health risk value reaches the health risk threshold, pushing a physical examination notice for the target insured to the client; the physical examination notice carries the information of the physical examination institution; receiving the physical examination results of the target insured sent by the physical examination institution; determining the health support strategy for the target insured according to the physical examination results; sending a notification to the client to execute the health support strategy for the target insured. The embodiments of the present specification can actively control the health insurance expenditure cost of the insurer and improve the health insurance user experience.

Description

Technical Field

[0001] The present specification relates to the field of data processing technology, and in particular to a data processing method, system, device and storage medium for health insurance business. Background Art

[0002] At present, the health insurance claims are generally settled by the policyholder after the accident. After the insurer reviews and approves the claim, it will settle the claim according to the relevant provisions of the insurance contract. However, under this claim settlement method, for the policyholder, since the insurance claim can only be filed when the accident occurs, the policyholder is prone to delaying the timely treatment due to failure to discover the disease in time, and the user experience of the policyholder is poor; for the insurer, the claim settlement costs caused by treatment, etc. have increased significantly. Summary of the invention

[0003] The purpose of the embodiments of this specification is to provide a data processing method, system, device and storage medium for health insurance business to reduce claims costs and improve the health insurance user experience.

[0004] To achieve the above objectives, on the one hand, the embodiments of this specification provide a data processing method for health insurance business, including:

[0005] Extract target policyholders from health insurance database;

[0006] Acquire the health data of the target insured person from the client corresponding to the target insured person;

[0007] Taking the health data as input, calling a health risk prediction model to predict the health risk value of the target insured person;

[0008] When the health risk value reaches the health risk threshold, a physical examination notice for the target insured person is pushed to the client; the physical examination notice carries information about the physical examination institution;

[0009] Receiving the physical examination result of the target insured person sent by the physical examination institution;

[0010] Determining a health support strategy for the target insured person according to the physical examination results;

[0011] A notification of executing the health support policy for the target policyholder is sent to the client.

[0012] In the embodiments of this specification, the target insured is an insured who meets a preset condition; the preset condition includes any one of the following:

[0013] During the validity period of the health insurance, the time from the insured's health insurance effective date reaches the set time;

[0014] During the validity period of the health insurance, the time interval from the last time the insured's health data was obtained reaches the set time.

[0015] In an embodiment of this specification, the step of obtaining the health data of the target policyholder from the client corresponding to the target policyholder includes:

[0016] Sending a health questionnaire to the client corresponding to the target policyholder;

[0017] The health survey result returned by the client is received; the health survey result carries the health data of the target policyholder.

[0018] In an embodiment of this specification, the pushing of a physical examination notification for the target policyholder to the client includes:

[0019] When the health risk value reaches the health risk threshold, a first follow-up task is generated and sent to a first client terminal, so that the first client terminal initiates a first remote follow-up to the target policyholder according to the first follow-up task;

[0020] When receiving the physical examination suggestion notification for the target insured person sent by the first client, pushing the physical examination notification for the target insured person to the client;

[0021] The physical examination recommendation notification is generated by the first client terminal according to the follow-up result of the first remote follow-up.

[0022] In the embodiment of this specification, the determining of the health support strategy for the target insured person according to the physical examination result includes:

[0023] Performing optical character recognition on the physical examination results to obtain a physical examination conclusion and / or physical examination recommendation for the target policyholder;

[0024] According to the physical examination conclusion and / or physical examination suggestion, querying a matching second client terminal from a set of second client terminals for health classification management;

[0025] Generate a second follow-up task and send it to the second client terminal, so that the second client terminal can initiate a second remote follow-up to the target policyholder accordingly;

[0026] When receiving the first health support suggestion for the target insured person sent by the second client, generating a health support strategy for the target insured person according to the first health support suggestion;

[0027] The first health support suggestion is generated by the second client according to the follow-up result of the second remote follow-up.

[0028] In the embodiments of this specification, the health support strategy includes:

[0029] Regularly collecting designated vital sign data of the target policyholder;

[0030] Generating a health status change trend of the target insured person according to the designated vital sign data;

[0031] When the health status shows a downward trend and reaches a set threshold, a third follow-up task is generated and sent to the second client end, so that the second client end initiates a third remote follow-up to the target policyholder according to the third follow-up task;

[0032] receiving a second health support suggestion for the target policyholder sent by the second client end; the second health support suggestion is generated by the second client end according to the follow-up result of the third remote follow-up;

[0033] Determine whether to send a medical consultation notification to the client according to the second health support suggestion.

[0034] In an embodiment of this specification, the health support strategy also includes:

[0035] When the health status shows an upward or stable trend and the duration reaches a duration threshold, a notification of terminating the execution of the health support strategy is sent to the client.

[0036] On the other hand, the embodiment of this specification also provides a data processing system for health insurance business, including a client, a health insurance database, a physical examination institution end and a server, wherein the server is configured as follows:

[0037] Extract target policyholders from health insurance database;

[0038] Acquire the health data of the target insured person from the client corresponding to the target insured person;

[0039] Taking the health data as input, calling a health risk prediction model to predict the health risk value of the target insured person;

[0040] When the health risk value reaches the health risk threshold, a physical examination notice for the target insured person is pushed to the client; the physical examination notice carries information about the physical examination institution;

[0041] Receiving the physical examination result of the target insured person sent by the physical examination institution;

[0042] Determining a health support strategy for the target insured person according to the physical examination results;

[0043] A notification of executing the health support policy for the target policyholder is sent to the client.

[0044] On the other hand, an embodiment of the present specification further provides a server, including:

[0045] A retrieval module is used to retrieve target policyholders from the health insurance database;

[0046] An acquisition module, used for acquiring the health data of the target insured person from a client corresponding to the target insured person;

[0047] A prediction module, used to use the health data as input and call a health risk prediction model to predict the health risk value of the target insured person;

[0048] A push module, used for pushing a physical examination notice for the target insured person to the client when the health risk value reaches the health risk threshold; the physical examination notice carries information of the physical examination institution;

[0049] A receiving module, used for receiving the physical examination result of the target insured person sent by the physical examination institution;

[0050] A determination module, used to determine a health support strategy for the target insured person according to the physical examination result;

[0051] The sending module is used to send a notification of executing the health support strategy for the target policyholder to the client.

[0052] On the other hand, an embodiment of the present specification also provides another server, including a memory, a processor, and a computer program stored in the memory, and when the computer program is run by the processor, the instructions of the above method are executed.

[0053] On the other hand, an embodiment of the present specification further provides a computer storage medium on which a computer program is stored. When the computer program is executed by a processor of a server, the instructions of the above method are executed.

[0054] It can be seen from the technical solutions provided in the above embodiments of this specification that, through the embodiments of this specification, for the policyholder, since the insurer can obtain the policyholder's health data and actively determine whether it is necessary to provide the policyholder with physical examinations, health support and other services, this is conducive to the timely discovery and treatment of the policyholder's condition, and is conducive to avoiding the deterioration of the policyholder's condition, and does not require the policyholder to initiate the process, thereby greatly improving the policyholder's user experience; for the insurer, by actively providing the policyholder with physical examinations, health support and other services, since the policyholder's condition can be discovered and treated in time, it is highly likely that the policyholder's condition will deteriorate due to failure to discover and treat it in time, thereby avoiding the high treatment costs caused by the deterioration of the policyholder's condition, thereby substantially reducing the insurer's claims costs. BRIEF DESCRIPTION OF THE DRAWINGS

[0055] In order to more clearly illustrate the technical solutions in the embodiments of this specification or the prior art, the following briefly introduces the drawings required for use in the embodiments or the prior art description. Obviously, the drawings described below are only some embodiments recorded in this specification. For ordinary technicians in this field, other drawings can be obtained based on these drawings without creative labor. In the drawings:

[0056] Figure 1 A structural block diagram of a data processing system for health insurance business in some embodiments of this specification is shown;

[0057] Figure 2 It shows a structural block diagram of a data processing system for health insurance business in other embodiments of this specification;

[0058] Figure 3 A flowchart showing a data processing method for health insurance business in some embodiments of this specification;

[0059] Figure 4 A flowchart showing some embodiments of this specification for obtaining health data of a target policyholder from a client corresponding to the target policyholder;

[0060] Figure 5 A flowchart showing some embodiments of this specification for pushing a medical examination notification for a target policyholder to a client;

[0061] Figure 6 A flowchart showing some embodiments of this specification for determining a health support strategy for a target insured person according to a physical examination result;

[0062] Figure 7 A structural block diagram of a server in some embodiments of this specification is shown;

[0063] Figure 8 It shows the structural block diagram of the server in other embodiments of this specification.

[0064] [Description of Reference Numerals]

[0065] 10. Server;

[0066] 20. Health insurance database;

[0067] 30. Client;

[0068] 40. Physical examination institution end;

[0069] 51. First customer service terminal;

[0070] 52. Second customer service terminal;

[0071] 71. Fishing module;

[0072] 72. Get module;

[0073] 73. Prediction module;

[0074] 74. Push module;

[0075] 75. Receiving module;

[0076] 76. Determine the module;

[0077] 77. Sending module;

[0078] 802, server;

[0079] 804, processor;

[0080] 806. Memory;

[0081] 808, driving mechanism;

[0082] 810, input / output interface;

[0083] 812. Input device;

[0084] 814. Output device;

[0085] 816. Presentation equipment;

[0086] 818. Graphical user interface;

[0087] 820, network interface;

[0088] 822, communication link;

[0089] 824. Communication bus. DETAILED DESCRIPTION

[0090] In order to enable those skilled in the art to better understand the technical solutions in this specification, the technical solutions in the embodiments of this specification will be clearly and completely described below in conjunction with the drawings in the embodiments of this specification. Obviously, the described embodiments are only part of the embodiments of this specification, not all of the embodiments. Based on the embodiments in this specification, all other embodiments obtained by ordinary technicians in this field without creative work should fall within the scope of protection of this specification.

[0091] In view of the high claims cost and low user experience of the traditional health insurance claims processing method (i.e., the insured initiates an insurance claim application to the insurer after the accident, and the insurer passively settles the claim), the embodiments of this specification provide a new data processing solution for health insurance business. In the embodiments of this specification, health insurance may include but is not limited to disease insurance, medical insurance, and nursing insurance. It should be noted that the physical examination, health support, vital signs data collection, medical treatment, etc. involved in the following embodiments of this specification may be free, but may also be paid, and can be selected according to the actual business scenario needs. It should also be pointed out that for the sake of ease of explanation, the policyholder in the embodiments of this specification is the insured in the health insurance.

[0092] refer to Figure 1 As shown, in some embodiments, a data processing system for health insurance business is provided, which may include a server 10, a health insurance database 20, a client 30 and a physical examination institution end 40. Among them, the server 10 can be configured to: retrieve the target insured from the health insurance database 20; obtain the health data of the target insured from the client 30 corresponding to the target insured; use the health data as input, call the health risk prediction model to predict the health risk value of the target insured; when the health risk value reaches the health risk threshold, push a physical examination notice for the target insured to the client 30; the physical examination notice carries the information of the physical examination institution; receive the physical examination result of the target insured sent by the physical examination institution end 40; determine the health support strategy for the target insured according to the physical examination result; send a notification to the client 30 to execute the health support strategy for the target insured.

[0093] Based on the data processing system for the health insurance business of the embodiments of this specification, for the insured, since the insurer can obtain the insured's health data in a timely manner (for example, regularly) and proactively determine whether it is necessary to provide the insured with physical examinations, health support and other services, this is conducive to the timely discovery and treatment of the insured's condition, and to avoiding the deterioration of the insured's condition, and there is no need for the insured to initiate the process, thereby greatly improving the insured's user experience; for the insurer, by proactively providing the insured with physical examinations, health support and other services, since the insured's condition can be discovered and treated in a timely manner, there is a high probability that the insured's condition will deteriorate due to failure to discover and treat it in a timely manner, thereby avoiding the high treatment costs caused by the deterioration of the insured's condition, and substantially reducing the insurer's claims costs.

[0094] The server 10 is the core of data processing for realizing health insurance business. In some embodiments, the server 10 may be an electronic device with computing and network interaction functions; or it may be software running in the electronic device to provide business logic for data processing and network interaction. Among them, the above-mentioned "server 10 is configured to" generally means that the server 10 has the function of performing one or more tasks during operation. Thus, even if the server 10 is not currently performing a task, the server 10 has the ability to perform one or more tasks during operation.

[0095] The health insurance database 20 stores the basic information of the insured (e.g., name, ID number, age, gender, address, etc.) and information related to the health insurance contract (e.g., validity period of the health insurance contract, coverage, premium rate, etc.). In some embodiments, the health insurance database 20 may include: a server and a database that provide health insurance data services (e.g., health insurance data query, etc.). In an exemplary embodiment, the health insurance database 20 may be a distributed database or a centralized database as needed.

[0096] In the data processing system of the health insurance business, the client 30 is a communication terminal for the insurer side to communicate with the policyholder side. In some embodiments, the client 30 can be a self-service terminal device, a mobile terminal (i.e., a smart phone), a display, a desktop computer, a tablet computer, a laptop computer, a digital assistant or a smart wearable device, etc. Among them, smart wearable devices may include smart bracelets, smart watches, smart glasses or smart helmets, etc. Of course, the client 30 is not limited to the above-mentioned electronic devices with a certain entity, and it can also be software running in the above-mentioned electronic devices (such as an APP client).

[0097] The physical examination institution end 40 refers to the service end of the physical examination institution. For example, in some embodiments, the service end of the physical examination institution can be the physical examination information system of the physical examination institution. The physical examination institution end 40 can provide a physical examination result query service, and can also provide services such as physical examination appointments. Taking into account factors such as user information security and convenient management, the physical examination institution carried in the physical examination notice can be one or more designated physical examination institutions. These designated physical examination institutions have signed contracts with the insurer in advance, so that the server 10 can legally obtain the physical examination results of the insured from the designated physical examination institutions. Among them, the designated physical examination institutions can be qualified hospital physical examination centers (such as XX Hospital Physical Examination Center), public professional physical examination centers (such as YY City Physical Examination Center), private professional physical examination institutions (ZZ Physical Examination Center), etc.

[0098] In some embodiments, the server 10 can retrieve the target policyholder from the health insurance database 20 on a regular basis (e.g., every day, etc.). In the health insurance database 20, not only is the information of policyholders whose health insurance contracts have come into effect and are currently within the duration of the health insurance contract saved, but also the information of policyholders whose health insurance contracts have expired and the information of policyholders whose health insurance contracts have not yet come into effect may be recorded. However, the objects of health insurance claims are generally: policyholders whose health insurance contracts have come into effect and are currently within the duration of the health insurance contract (i.e., the validity period of the health insurance). Therefore, the target policyholder should be the policyholder who meets the preset conditions. For example, the target policyholder should be limited to the scope of policyholders whose health insurance contracts have come into effect and are currently within the duration of the health insurance contract, otherwise it is meaningless.

[0099] In addition, in order to actively control the cost of claims while maintaining the health of the insured, the server 10 can regularly provide physical examinations, health support and other services to the insured whose health insurance contract has come into effect and who is currently in the duration of the health insurance contract. In this case, in addition to meeting the conditions that the health insurance contract has come into effect and the insured is currently in the duration of the health insurance contract, the target insured retrieved from the health insurance database 20 also needs to meet other preset conditions. For example, in some embodiments, other preset conditions may be: within the validity period of the health insurance, the current distance to the insured's health insurance effective date reaches a set time; and / or, within the validity period of the health insurance, the current time interval from the last time the insured's health data was obtained reaches a set time, etc.

[0100] For example, in an exemplary embodiment, taking the example of the server 10 retrieving the target policyholders from the health insurance database 20 every day, the health insurance of policyholder A is valid from August 1, 2021 to December 31, 2025. If the set duration is half a year, and the current time is September 10, 2021, since the current time is not the set duration from the effective date of policyholder A's health insurance (August 1, 2021), the target policyholders retrieved by the server 10 from the health insurance database 20 this time will not include policyholder A.

[0101] For example, in another exemplary embodiment, taking the example of the server 10 retrieving the target policyholders from the health insurance database 20 every day, the health insurance of policyholder B is valid from January 1, 2021 to December 31, 2025. If the set duration is four months, the current time is September 1, 2021, and the time interval from the last time (ie, May 1, 2021) to the last time the health data of policyholder B was obtained just reaches the set duration, then the target policyholders retrieved by the server 10 from the health insurance database 20 this time will include policyholder B.

[0102] In some embodiments, the server 10 obtains the health data of the target insured from the client 30 corresponding to the target insured, which may include: sending a health questionnaire to the client 30 corresponding to the target insured; receiving the health survey results returned by the client 30; the health survey results carry the health data of the target insured. In one embodiment, the health questionnaire may be an online health questionnaire to facilitate user operation. Specifically, the online health questionnaire is displayed on the client 30 in the form of an interactive page, and the online health questionnaire may be configured with text options and / or text input items for understanding the health status of the target insured; for example, in an example scenario, the online health questionnaire may include but is not limited to: age, gender, height, weight, sleep duration and other text options and / or text input items. The target insured can operate the online health questionnaire page displayed by its client 30 (such as selection operation, input operation, submission operation, etc.) to complete the reply to the online health questionnaire; in this way, the client 30 can automatically return the online health survey results to the server 10 for processing. In another embodiment, the health questionnaire can be an offline file (i.e., the server 10 sends the questionnaire to the client 30 in the form of a discrete file); based on user operations, the client 30 can download the offline file and return it to the server 10 for processing after the user completes the offline filling.

[0103] In other embodiments, the data processing system of the health insurance business may also include an intelligent question-and-answer system (e.g., an intelligent voice question-and-answer system); the server 10 may obtain the health data of the target policyholder from the client 30 corresponding to the target policyholder by calling the intelligent question-and-answer system. For example, in an example scenario, taking the intelligent voice question-and-answer system as an example, the server 10 may call the intelligent question-and-answer system to initiate an intelligent voice conversation to the target policyholder's smartphone, and obtain the health data of the target policyholder in the form of a voice conversation. In some other embodiments, the server 10 may also obtain the health data of the target policyholder in the form of a short message (or short message).

[0104] The health status of different target policyholders may be different, and the health status of the same target policyholder may also change at different times. In order to identify whether each target policyholder has a health risk, the health data can be used as input to call a health risk prediction model to predict the health risk value of the target policyholder. In some embodiments, the health risk prediction model can be a prediction model with a certain expression. For example, in an example scenario, the health data may include height, weight, and gender, and the health risk prediction model may be a standard weight calculation formula:

[0105] Male: (height cm-80cm)×70%=standard weight;

[0106] Female: (height cm-70cm)×60%=standard weight;

[0107] For the above-mentioned prediction model with a certain expression, a health risk threshold can be preset, and the server 10 can compare the health risk value of the target policyholder with the health risk threshold. When the health risk value reaches the health risk threshold, the server 10 can push a physical examination notification for the target policyholder to the client 30.

[0108] In other embodiments, the health risk prediction model may also be a pre-trained machine learning model. Among them, the pre-trained machine learning model can be obtained by training the initial machine learning model. In some embodiments, the initial machine learning model may be, for example, an artificial neural network, a Bayesian learning model, etc. When training the initial machine learning model, the data set required for training may be generated based on user information obtained from the health insurance database 20 or a third-party database. It should be noted that in the embodiments of this specification, the user information (including but not limited to user device information, user personal information, etc.) and data (including but not limited to data for analysis, stored data, displayed data, etc.) involved are all information and data authorized by the user and fully authorized by all parties. In addition, the user information obtained from the health insurance database 20 or a third-party database may also be information after information desensitization processing (for example, deleting the name, ID number, mobile phone number, home address, etc.).

[0109] refer to Figure 2 As shown, in some embodiments, the data processing system of the health insurance business may also include a first client terminal 51. Correspondingly, the server 10 pushes a physical examination notification for the target policyholder to the client 30, which may include: when the health risk value reaches the health risk threshold, the server 10 generates a first follow-up task and sends it to the first client terminal 51, so that the first client terminal 51 initiates a first remote follow-up to the target policyholder according to the first follow-up task, so as to further understand and verify the health status of the target policyholder and the living habits that may affect their health status (such as eating habits, work and rest habits, medication habits, etc.). Among them, the first follow-up task may include: basic information (such as name, age, mobile phone number) and health data (especially the health risk value that reaches the health risk threshold) of the person being followed up (i.e., the target policyholder) and other information.

[0110] In some embodiments, the first client terminal 51 can be a mobile terminal (i.e., a smart phone), a desktop computer, a tablet computer, a laptop computer, or an APP client, etc. of a specific customer service personnel (e.g., a doctor, a health manager, a pharmacist, etc.). Based on the first client terminal 51, the specific customer service personnel can initiate a voice session or a video session with the client 30 of the target policyholder, and conduct a remote follow-up visit to the target policyholder in the form of a voice session or a video session, thereby obtaining the follow-up results. According to the follow-up results, the specific customer service personnel can decide whether it is necessary to provide health insurance data services to the target policyholder (i.e., determine whether to recommend the target policyholder to undergo a physical examination), so that the physical examination recommendation notification is generated by the first client terminal 51 according to the follow-up results of the first remote follow-up. When receiving the physical examination recommendation notification for the target policyholder sent by the first client terminal 51, the server 10 pushes the physical examination notification for the target policyholder to the client 30.

[0111] For example, in an exemplary scenario, when it is learned through follow-up that the target policyholder has recently been severely sleep deprived due to recent work pressure, the specific customer service personnel may not recommend the target policyholder to undergo a physical examination; when it is difficult to determine the inducing factors of the target policyholder's recent severe lack of sleep through follow-up, the specific customer service personnel may recommend the target policyholder to undergo a physical examination (that is, the specific customer service personnel may send a physical examination recommendation notification for the target policyholder to the server 10 through the first customer service terminal 51).

[0112] Please continue to refer to Figure 2 As shown, in some embodiments, the data processing system of the health insurance business may also include a second client terminal set; the second client terminal set includes one or more second client terminals 52 for health classification management. In this scenario, the server 10 determines the health support strategy for the target insured person according to the physical examination results, which may include: the server 10 performs optical character recognition (OCR) on the physical examination results to obtain the physical examination conclusion and / or physical examination suggestion of the target insured person; the server 10 queries the matching second client terminal 52 from the second client terminal set according to the physical examination conclusion and / or physical examination suggestion; generates a second follow-up task and sends it to the second client terminal 52, so that the second client terminal 52 initiates a second remote follow-up to the target insured person accordingly; when receiving the first health support suggestion for the target insured person sent by the second client terminal 52, generates a health support strategy for the target insured person according to the first health support suggestion. Among them, the second follow-up task may include: basic information (such as name, age, mobile phone number) and physical examination results of the person being followed (i.e., the target insured person). This will help to more objectively and accurately identify target policyholders who need health support.

[0113] In the physical examination results, the physical examination conclusion and physical examination suggestions can both summarize or centrally reflect the abnormal health conditions of the target policyholder. Therefore, the physical examination conclusion and / or physical examination suggestions in the physical examination results can be extracted as interesting information content for subsequent analysis and processing. Since the physical examination results are generally electronic files of physical examination reports in image format or PDF format, the server 10 can perform optical character recognition on the electronic files of the physical examination reports to obtain the physical examination conclusion and / or physical examination suggestions in text format.

[0114] The second client terminal 52 also refers to a mobile terminal (i.e., a smart phone), a desktop computer, a tablet computer, a laptop computer, or an APP client, etc. of a specific customer service staff. However, unlike the first client terminal 51, the specific customer service staff corresponding to the second client terminal 52 can be a professional classified according to the clinical department classification (or health care classification); in other words, each second client terminal 52 can correspond to a clinical department professional (or health care professional). For example, in an exemplary scenario, taking the classification according to clinical departments as an example, some second client terminals 52 can correspond to cardiovascular medicine professionals, cerebrovascular medicine professionals, respiratory medicine professionals, renal medicine professionals, endocrinology professionals, etc.

[0115] Different physical examination conclusions or physical examination suggestions correspond to different health conditions. For example, in some exemplary scenarios, high blood pressure and high blood lipids indicate that the target customer has a potential risk of cardiovascular and cerebrovascular diseases; lack of sleep indicates that the target customer has a potential risk of hypoxia, etc. In order to objectively and accurately identify the health status of the target policyholder, the server 10 can query the matching second client 52 from the second client set based on the physical examination conclusion and / or physical examination suggestion. For example, in an exemplary scenario, when the physical examination conclusion is high blood pressure, the second client 52 corresponding to the cardiovascular medicine professional or the cerebrovascular medicine professional can be matched from the second client set.

[0116] Based on the second client terminal 52, the corresponding professional can initiate a voice conversation or a video conversation with the client terminal 30 of the target policyholder, and conduct a remote follow-up of the target policyholder in the form of a voice conversation or a video conversation, so as to obtain the follow-up results. It should be noted that compared with the remote follow-up initiated based on the first client terminal 51, the remote follow-up initiated based on the second client terminal 52 is more professional and meticulous (similar to a remote consultation). According to the follow-up results, the corresponding professional can decide whether it is necessary to provide further health support to the target policyholder, so that the first health support recommendation notification is generated by the second client terminal 52 according to the follow-up results of the second remote follow-up.

[0117] When the server 10 receives the first health support suggestion for the target insured person sent by the second client terminal 52, a health support strategy for the target insured person may be generated based on the first health support suggestion. In some embodiments, a general health support strategy template may be pre-configured, and the first health support suggestion may include parameter information such as which vital signs of the target insured person are monitored and collected; thus, part or all of the parameter information in the first health support suggestion is added to the health support strategy template, and a health support strategy for the target insured person may be generated.

[0118] The health support strategy can be executed by the server 10. In some embodiments, the health support strategy may include: regularly collecting designated vital sign data of the target insured; generating the health status change trend of the target insured according to the designated vital sign data; when the health status shows a downward trend and reaches a set threshold, generating a third follow-up task and sending it to the second client terminal 52 of the target insured, so that the second client terminal 52 initiates a third remote follow-up to the target insured according to the third follow-up task; receiving the second health support suggestion for the target insured sent by the second client terminal 52; determining whether to send a medical consultation notification to the client 30 of the target insured according to the second health support suggestion. The second health support suggestion can be generated by the second client terminal 52 according to the follow-up result of the third remote follow-up.

[0119] In the embodiments of the present specification, the equipment required for collecting the designated vital sign data of the target policyholder may be provided by the insurer. The time interval and set threshold value of the timed collection may be provided by the first health support suggestion, that is, the first health support suggestion may include the time interval and set threshold value of the timed collection.

[0120] In some embodiments, generating the health status change trend of the target policyholder based on the designated vital sign data may refer to: drawing a curve of each designated vital sign data of the target policyholder changing over time. For example, in an exemplary scenario, the designated vital sign data include blood oxygen and blood pressure, then a curve of the target policyholder's blood oxygen changing over time, and a curve of the target policyholder's blood pressure changing over time may be drawn respectively. In other embodiments, the above-mentioned curve of the change of designated vital sign data over time may also be a sliding window change curve of the designated vital sign data. For example, with a sliding window length of one week, the change trend of each week relative to the previous week may be drawn. This can help eliminate short-term ups and downs, thereby facilitating obtaining a more accurate health status change trend.

[0121] For any designated vital sign data, when the server 10 determines based on its change curve that the health status of the target insured person in the designated vital sign is on a downward trend and reaches a set threshold, a third follow-up task can be generated and sent to the second client terminal 52 corresponding to the target insured person, so that the second client terminal 52 can initiate a third remote follow-up to the target insured person according to the third follow-up task; when the server 10 receives the second health support suggestion for the target insured person sent by the second client terminal 52, it can determine whether to send a medical consultation notification to the client terminal 30 corresponding to the target insured person according to the second health support suggestion. The medical consultation notification can specify a range of hospitals that can be selected by the user.

[0122] The purpose of initiating the third remote follow-up is mainly to confirm and verify the degree and cause of the deterioration of the health status of the target policyholder, and to determine whether hospitalization is necessary; if hospitalization is required, the corresponding professional can send a second health support suggestion containing hospitalization and other contents to the server 10 through the second client terminal 52. When the second health support suggestion contains hospitalization and other contents, the server 10 can send a medical consultation notice to the client corresponding to the target policyholder. When the second health support suggestion does not contain hospitalization content, but contains "continued observation" or other non-medical consultation suggestion content, the server 10 will not send a medical consultation notice to the client corresponding to the target policyholder.

[0123] For any specified vital sign data, when the server 10 determines based on its change curve that the health status of the target policyholder in the specified vital sign shows an upward or stable trend and the duration reaches a time threshold, a notification of terminating the execution of the health support strategy can be sent to the client 30 (i.e., the client corresponding to the target policyholder) to further control the insurer's claims costs.

[0124] Considering the huge amount of data, the server 10, the first client terminal 51, and the second client terminal 52 corresponding to each clinical department in the data processing system of the health insurance business can be configured as multiple, and can be processed in parallel in a cluster (or group) manner, which is conducive to improving the data processing efficiency of the health insurance business in the data processing system of the health insurance business. Of course, when the first client terminal 51 and the second client terminal 52 corresponding to each clinical department are configured as multiple, specific customer service personnel should also be increased adaptively.

[0125] The embodiment of this specification also provides a data processing method for health insurance business, which can be applied to the data processing system side of the health insurance business, specifically, can be applied to the server side of the data processing system of the health insurance business. Figure 3 As shown, in some embodiments, the data processing method for the health insurance business may include the following steps:

[0126] S301. Retrieve the target policyholder from the health insurance database.

[0127] S302: Acquire the health data of the target policyholder from a client corresponding to the target policyholder.

[0128] S303: Using the health data as input, calling a health risk prediction model to predict the health risk value of the target policyholder.

[0129] S304. When the health risk value reaches the health risk threshold, a physical examination notice for the target policyholder is pushed to the client; the physical examination notice carries information of the physical examination institution.

[0130] S305: Receive the physical examination result of the target policyholder sent by the physical examination institution.

[0131] S306: Determine a health support strategy for the target policyholder based on the physical examination result.

[0132] S307: Send a notification to the client to execute the health support policy for the target policyholder.

[0133] In some embodiments, the target policyholder is a policyholder who meets preset conditions; the preset conditions include: within the validity period of the health insurance, the current time interval from the policyholder's health insurance effective date reaches a set time length; and / or, within the validity period of the health insurance, the current time interval from the last time the policyholder's health data was obtained reaches a set time length.

[0134] Combination Figure 4 As shown, in some embodiments, obtaining the health data of the target policyholder from the client corresponding to the target policyholder in S302 may include:

[0135] S401. Send a health questionnaire to a client corresponding to the target policyholder.

[0136] S402: Receive the health survey result returned by the client; the health survey result carries the health data of the target policyholder.

[0137] Combination Figure 5 As shown, in some embodiments, pushing a physical examination notification for the target policyholder to the client in S304 may include:

[0138] S501. When the health risk value reaches a health risk threshold, a first follow-up task is generated and sent to a first client terminal, so that the first client terminal initiates a first remote follow-up to the target policyholder according to the first follow-up task.

[0139] S502. When receiving the physical examination recommendation notification for the target policyholder sent by the first client end, push the physical examination recommendation notification for the target policyholder to the client end; wherein the physical examination recommendation notification is generated by the first client end according to the follow-up result of the first remote follow-up.

[0140] Combination Figure 6 As shown, in some embodiments, determining the health support strategy for the target insured person according to the physical examination result in S306 may include:

[0141] S601. Perform optical character recognition on the physical examination result to obtain the physical examination conclusion and / or physical examination suggestion of the target policyholder.

[0142] S602: According to the physical examination conclusion and / or physical examination suggestion, query a matching second client terminal from a set of second client terminals for health classification management.

[0143] S603: Generate a second follow-up task and send it to the second client terminal, so that the second client terminal can initiate a second remote follow-up to the target policyholder accordingly.

[0144] S604. When receiving the first health support suggestion for the target policyholder sent by the second client terminal, generate a health support strategy for the target policyholder according to the first health support suggestion; wherein the first health support suggestion is generated by the second client terminal according to the follow-up result of the second remote follow-up.

[0145] In some embodiments, the health support strategies may include:

[0146] Regularly collecting designated vital sign data of the target policyholder;

[0147] Generating a health status change trend of the target insured person according to the designated vital sign data;

[0148] When the health status shows a downward trend and reaches a set threshold, a third follow-up task is generated and sent to the second client end, so that the second client end initiates a third remote follow-up to the target policyholder according to the third follow-up task;

[0149] receiving a second health support suggestion for the target policyholder sent by the second client end; the second health support suggestion is generated by the second client end according to the follow-up result of the third remote follow-up;

[0150] Determine whether to send a medical consultation notification to the client according to the second health support suggestion.

[0151] In some embodiments, the health support strategy may further include: when the health status shows an upward or stable trend and the duration reaches a duration threshold, sending a notification to the client to terminate the execution of the health support strategy.

[0152] Although the process flows described above include multiple operations that occur in a particular order, it should be clearly understood that the processes may include more or fewer operations, which may be performed sequentially or in parallel (eg, using parallel processors or a multi-threaded environment).

[0153] Corresponding to the above-mentioned data processing method for health insurance business, the embodiment of this specification also provides a server, referring to Figure 7 As shown, in some embodiments, the server may include: a retrieval module 71, an acquisition module 72, a prediction module 73, a push module 74, a receiving module 75, a determination module 76 and a sending module 77. Among them:

[0154] The retrieval module 71 can be used to retrieve the target policyholder from the health insurance database;

[0155] The acquisition module 72 may be used to acquire the health data of the target insured person from the client corresponding to the target insured person;

[0156] The prediction module 73 may be used to use the health data as input and call a health risk prediction model to predict the health risk value of the target insured person;

[0157] The push module 74 may be used to push a medical examination notice for the target insured person to the client when the health risk value reaches the health risk threshold; the medical examination notice carries information of the medical examination institution;

[0158] The receiving module 75 may be used to receive the physical examination result of the target insured person sent by the physical examination institution;

[0159] A determination module 76, which can be used to determine a health support strategy for the target insured person according to the physical examination result;

[0160] The sending module 77 may be configured to send a notification of executing the health support policy for the target policyholder to the client.

[0161] For the convenience of description, the above device is described in various units according to their functions. Of course, when implementing this specification, the functions of each unit can be implemented in the same or multiple software and / or hardware.

[0162] The embodiment of this specification also provides a server. Figure 8As shown, in some embodiments of the present specification, the server 802 may include one or more processors 804, such as one or more central processing units (CPUs) or graphics processing units (GPUs), and each processing unit may implement one or more hardware threads. The server 802 may also include any memory 806, which is used to store any kind of information such as code, settings, data, etc. In a specific embodiment, the computer program on the memory 806 and can be run on the processor 804, when the computer program is run by the processor 804, the instructions of the data processing method of the health insurance business described in any of the above embodiments may be executed. Non-limitingly, for example, the memory 806 may include any one or more combinations of the following: any type of RAM, any type of ROM, flash memory device, hard disk, optical disk, etc. More generally, any memory may use any technology to store information. Further, any memory may provide volatile or non-volatile retention of information. Further, any memory may represent a fixed or removable component of the server 802. In one case, when the processor 804 executes an associated instruction stored in any memory or combination of memories, the server 802 may perform any operation of the associated instruction. The server 802 also includes one or more drive mechanisms 808 for interacting with any storage, such as a hard disk drive mechanism, an optical disk drive mechanism, etc.

[0163] The server 802 may also include an input / output interface 810 (I / O) for receiving various inputs (via input devices 812) and for providing various outputs (via output devices 814). A specific output mechanism may include a presentation device 816 and an associated graphical user interface 818 (GUI). In other embodiments, the input / output interface 810 (I / O), input device 812, and output device 814 may not be included, and the server may only be a server in the network. The server 802 may also include one or more network interfaces 820 for exchanging data with other devices via one or more communication links 822. One or more communication buses 824 couple the components described above together.

[0164] The communication link 822 may be implemented in any manner, for example, through a local area network, a wide area network (e.g., the Internet), a point-to-point connection, etc., or any combination thereof. The communication link 822 may include any combination of hardwired links, wireless links, routers, gateway functions, name servers, etc. governed by any protocol or combination of protocols.

[0165] The present application is described with reference to the flowcharts and / or block diagrams of the methods, devices (systems), and computer program products of some embodiments of the present specification. It should be understood that each process and / or box in the flowchart and / or block diagram, as well as the combination of the processes and / or boxes in the flowchart and / or block diagram, can be implemented by computer program instructions. These computer program instructions can be provided to a processor of a general-purpose computer, a special-purpose computer, an embedded processor, or other programmable data processor to produce a machine, so that the instructions executed by the processor of the computer or other programmable data processor generate instructions for implementing the processes in the flowchart and / or block diagram. Figure 1 A process or multiple processes and / or boxes Figure 1 A device that provides the functions specified in a block or multiple blocks.

[0166] These computer program instructions may also be stored in a computer-readable memory capable of directing a computer or other programmable data processor to operate in a specific manner, so that the instructions stored in the computer-readable memory produce an article of manufacture including an instruction device, which implements the process Figure 1 A process or multiple processes and / or boxes Figure 1 A function specified in one or more boxes.

[0167] These computer program instructions can also be loaded onto a computer or other programmable data processor so that a series of operational steps are executed on the computer or other programmable device to produce a computer-implemented process, thereby providing instructions for executing on the computer or other programmable device to implement the process. Figure 1 A process or multiple processes and / or boxes Figure 1 The steps for the functions specified in one or more boxes.

[0168] In a typical configuration, a server includes one or more processors (CPUs), input / output interfaces, network interfaces, and memory.

[0169] The memory may include non-permanent storage in a computer-readable medium, random access memory (RAM) and / or non-volatile memory in the form of read-only memory (ROM) or flash RAM. The memory is an example of a computer-readable medium.

[0170] Computer-readable media include permanent and non-permanent, removable and non-removable media that can be used to store information by any method or technology. Information can be computer-readable instructions, data structures, program modules or other data. Examples of computer storage media include, but are not limited to, phase change memory (PRAM), static random access memory (SRAM), dynamic random access memory (DRAM), other types of random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory or other memory technology, compact disk read-only memory (CD-ROM), digital versatile disk (DVD) or other optical storage, magnetic cassettes, disk storage or other magnetic storage devices or any other non-transmission media that can be used to store information that can be accessed by a server. As defined in this specification, computer-readable media does not include temporary computer-readable media (transitory media), such as modulated data signals and carrier waves.

[0171] Those skilled in the art will appreciate that the embodiments of this specification may be provided as methods, systems or computer program products. Therefore, the embodiments of this specification may take the form of complete hardware embodiments, complete software embodiments or embodiments combining software and hardware. Moreover, the embodiments of this specification may take the form of a computer program product implemented on one or more computer-usable storage media (including but not limited to disk storage, CD-ROM, optical storage, etc.) containing computer-usable program codes.

[0172] The present specification embodiments may be described in the general context of computer-executable instructions executed by a computer, such as program modules. Generally, program modules include routines, programs, objects, components, data structures, etc. that perform specific tasks or implement specific abstract data types. The present specification embodiments may also be practiced in distributed computing environments where tasks are performed by remote processors connected through a communication network. In a distributed computing environment, program modules may be located in local and remote computer storage media, including storage devices.

[0173] It should also be understood that in the embodiments of this specification, the term "and / or" is only a description of the association relationship of the associated objects, indicating that three relationships can exist. For example, A and / or B can represent: A exists alone, A and B exist at the same time, and B exists alone. In addition, the character " / " in this article generally indicates that the associated objects before and after are in an "or" relationship.

[0174] Each embodiment in this specification is described in a progressive manner, and the same or similar parts between the embodiments can be referred to each other, and each embodiment focuses on the differences from other embodiments. In particular, for the method and device embodiments, since they are basically similar to the system embodiments, the description is relatively simple, and the relevant parts can be referred to the partial description of the system embodiment.

[0175] In the description of this specification, the description with reference to the terms "one embodiment", "some embodiments", "example", "specific example", or "some examples" etc. means that the specific features, structures, materials or characteristics described in conjunction with the embodiment or example are included in at least one embodiment or example of the embodiments of this specification. In this specification, the schematic representations of the above terms do not necessarily refer to the same embodiment or example. Moreover, the specific features, structures, materials or characteristics described may be combined in any one or more embodiments or examples in a suitable manner. In addition, those skilled in the art may combine and combine the different embodiments or examples described in this specification and the features of the different embodiments or examples, without contradiction.

[0176] The above is only an embodiment of the present application and is not intended to limit the present application. For those skilled in the art, the present application may have various changes and variations. Any modification, equivalent replacement, improvement, etc. made within the spirit and principle of the present application should be included in the scope of the claims of the present application.

Claims

1. A data processing method for health insurance business, characterized in that: include: Extract target policyholders who meet preset conditions from the health insurance database; The preset condition includes any one of the following: During the validity period of the health insurance, the time from the insured's health insurance effective date reaches the set time; During the validity period of the health insurance, the time interval from the last time the insured's health data was obtained reaches the set time; Acquire the health data of the target insured person from the client corresponding to the target insured person; Taking the health data as input, calling a health risk prediction model to predict the health risk value of the target insured person; When the health risk value reaches the health risk threshold, a physical examination notice for the target insured person is pushed to the client; the physical examination notice carries information of the physical examination institution; Receiving the physical examination result of the target insured person sent by the physical examination institution; Determining a health support strategy for the target insured person according to the physical examination results; A notification of executing the health support policy for the target policyholder is sent to the client.

2. The data processing method for health insurance business according to claim 1, characterized in that: The step of obtaining the health data of the target policyholder from the client corresponding to the target policyholder includes: Sending a health questionnaire to the client corresponding to the target policyholder; The health survey result returned by the client is received; the health survey result carries the health data of the target policyholder.

3. The data processing method for health insurance business according to claim 1, characterized in that: The pushing of a physical examination notification for the target policyholder to the client includes: When the health risk value reaches the health risk threshold, a first follow-up task is generated and sent to a first client terminal, so that the first client terminal initiates a first remote follow-up to the target policyholder according to the first follow-up task; When receiving the physical examination suggestion notification for the target insured person sent by the first client, pushing the physical examination notification for the target insured person to the client; The physical examination recommendation notification is generated by the first client terminal according to the follow-up result of the first remote follow-up.

4. The data processing method for health insurance business according to claim 1, characterized in that: Determining a health support strategy for the target insured person according to the physical examination result includes: Performing optical character recognition on the physical examination results to obtain a physical examination conclusion and / or physical examination recommendation for the target policyholder; According to the physical examination conclusion and / or physical examination suggestion, querying a matching second client terminal from a set of second client terminals for health classification management; Generate a second follow-up task and send it to the second client terminal, so that the second client terminal can initiate a second remote follow-up to the target policyholder accordingly; When receiving the first health support suggestion for the target insured person sent by the second client, generating a health support strategy for the target insured person according to the first health support suggestion; The first health support suggestion is generated by the second client according to the follow-up result of the second remote follow-up.

5. The data processing method for health insurance business according to claim 4, characterized in that: The health support strategies include: Regularly collecting designated vital sign data of the target policyholder; Generating a health status change trend of the target insured person according to the designated vital sign data; When the health status shows a downward trend and reaches a set threshold, a third follow-up task is generated and sent to the second client end, so that the second client end initiates a third remote follow-up to the target policyholder according to the third follow-up task; receiving a second health support suggestion for the target policyholder sent by the second client end; the second health support suggestion is generated by the second client end according to the follow-up result of the third remote follow-up; Determine whether to send a medical consultation notification to the client according to the second health support suggestion.

6. The data processing method for health insurance business according to claim 5, characterized in that: The health support strategies also include: When the health status shows an upward or stable trend and the duration reaches a duration threshold, a notification of terminating the execution of the health support strategy is sent to the client.

7. A data processing system for health insurance business, characterized in that: The system comprises a client, a health insurance database, a physical examination institution terminal and a server, wherein the server is configured as follows: Target policyholders meeting preset conditions are retrieved from the health insurance database; the preset conditions include any one of the following: During the validity period of the health insurance, the time from the insured's health insurance effective date reaches the set time; During the validity period of the health insurance, the time interval from the last time the insured's health data was obtained reaches the set time; Acquire the health data of the target insured person from the client corresponding to the target insured person; Taking the health data as input, calling a health risk prediction model to predict the health risk value of the target insured person; When the health risk value reaches the health risk threshold, a physical examination notice for the target insured person is pushed to the client; the physical examination notice carries information of the physical examination institution; Receiving the physical examination result of the target insured person sent by the physical examination institution; Determining a health support strategy for the target insured person according to the physical examination results; A notification of executing the health support policy for the target policyholder is sent to the client.

8. A server, characterized in that: include: The retrieval module is used to retrieve target policyholders who meet preset conditions from the health insurance database; The preset condition includes any one of the following: During the validity period of the health insurance, the time from the insured's health insurance effective date reaches the set time; During the validity period of the health insurance, the time interval from the last time the insured's health data was obtained reaches the set time; An acquisition module, used for acquiring the health data of the target insured person from a client corresponding to the target insured person; A prediction module, used to use the health data as input and call a health risk prediction model to predict the health risk value of the target insured person; A push module, used for pushing a physical examination notice for the target insured person to the client when the health risk value reaches the health risk threshold; the physical examination notice carries information of the physical examination institution; A receiving module, used for receiving the physical examination result of the target insured person sent by the physical examination institution; A determination module, used to determine a health support strategy for the target insured person according to the physical examination result; The sending module is used to send a notification of executing the health support strategy for the target policyholder to the client.

9. A server comprising a memory, a processor, and a computer program stored in the memory, characterized in that: When the computer program is executed by the processor, the computer program executes the instructions of the method according to any one of claims 1 to 6.

10. A computer storage medium having a computer program stored thereon, characterized in that: When the computer program is executed by a processor of the server, the computer program executes instructions of the method according to any one of claims 1 to 6.

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