Alternative Therapy Identification System for Real-Time Benefit Checks

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Solution Overview

Problem

Healthcare providers lack the ability to efficiently select alternative therapies for patients when the initial prescription is not covered by the patient's benefits or is too costly, leading to inefficient and costly options for patients.

Innovation Solution

An improved alternative therapy identification system that allows healthcare providers to communicate prescription benefit check requests in real-time, automatically searching for alternative therapies based on average drug costs and patient payment thresholds, and providing these options to the healthcare provider for selection.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Productivity

If healthcare providers manually check patient benefits and select alternative therapies, then they can identify cost-effective options, but the process is inefficient and time-consuming

Engineering Contradiction:

Improveefficiency of alternative therapy selectionVSAvoidtime required for benefit inquiry and alternative therapy identification

Core Design Contradiction:

ProductivityVSLoss of time

Solution Approach 1:

The system performs preliminary actions by automatically checking patient benefits and identifying alternative therapies before the healthcare provider needs to make a decision. The processor proactively queries the benefit information system, retrieves coverage status, and generates alternative therapy options in advance, eliminating the need for manual sequential checking and reducing both time and effort required.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system enables self-service by allowing the processor to autonomously perform benefit inquiries and alternative therapy identification without requiring manual intervention from healthcare providers. The system automatically accesses benefit information, compares drug costs, and presents alternative options, making the process efficient and reducing the time loss associated with manual operations.

Inventive Principle:

Principle #25Self-service

2Adaptability or versatility

If healthcare providers lack automated benefit inquiry capability, then they cannot efficiently identify alternative products, but implementing such a system requires additional technology infrastructure

Engineering Contradiction:

Improveability to perform benefit inquiry and identify alternative productsVSAvoidsystem infrastructure for automated therapy identification

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The processor is designed with multi-functionality, serving both as the core computing unit for benefit inquiries and as the decision-making engine for alternative therapy identification. The system integrates multiple functions including benefit checking, cost comparison, alternative drug identification, and result presentation within a single processing platform, enhancing adaptability while avoiding the need for separate specialized systems.

Inventive Principle:

Principle #6Universality (Multi-functionality)

Solution Approach 2:

The system introduces an intermediary processor that acts as a mediator between the healthcare provider and the benefit information system. This intermediary handles all complex interactions including querying benefits, retrieving alternative therapy data, and presenting options to the provider, thereby adding versatility without requiring the provider's existing system to become more complex.

Inventive Principle:

Principle #24Intermediary (Mediator)

3Measurement precision

If the system searches for alternative therapies based on average drug costs, then it can identify cost-effective options for patients, but it requires access to comprehensive drug cost data

Engineering Contradiction:

Improveaccuracy in identifying cost-effective alternative therapiesVSAvoidcomprehensive drug cost data required for accurate comparison

Core Design Contradiction:

Measurement precisionVSLoss of information

Solution Approach 1:

The system performs preliminary data collection by gathering comprehensive drug cost information from the benefit information system before conducting alternative therapy comparisons. By pre-retrieving cost data for multiple drugs within the same therapeutic class, the system ensures accurate cost-effective identification without requiring additional information searches during the decision-making process.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system uses feedback from the benefit information system to continuously refine alternative therapy recommendations. By comparing actual drug costs against average costs and patient benefit coverage, the system provides accurate feedback on which alternatives are truly cost-effective for each patient's specific benefit structure, improving measurement precision while managing information requirements efficiently.

Inventive Principle:

Principle #23Feedback

Data Source

PatentUS12165756B1Alternative therapy identification system

Publication Date: 2024.12.10 MCKESSON CORPORATION

AI summary

An improved alternative therapy identification system increases the efficiency for obtaining information for alternative therapies. The alternative therapy identification system automates alternative therapy identification information from both a product level and a drug cost level. The improved alternative therapy identification system may also increase the efficiency by improving alternative therapy selection to occur at the prescriber level.