Centralized Accumulator for Healthcare Cost Tracking
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Current health insurance systems face challenges in managing shared deductible and out-of-pocket limits across multiple benefit types, leading to timing issues and increased costs due to the need for numerous interfaces and batch processing, which can result in members being incorrectly charged when reaching their out-of-pocket maximum.
Innovation Solution
A centralized accumulator system manages the exchange and acknowledgement of accumulator updates between claim adjudication engines, using a computer-implemented method to receive, route, and validate cost accumulator data, generating cross-reference records and routing messages to ensure accurate tracking and reporting of healthcare costs across multiple systems.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Device complexity
If batch processing is used to exchange accumulator updates between systems, then system complexity is reduced, but timing accuracy deteriorates causing members to be incorrectly charged
Solution Approach 1:
The patent introduces a central accumulator system as an intermediary hub that receives accumulator updates from multiple claim adjudication systems and distributes them to other systems. This mediator approach replaces complex direct peer-to-peer interfaces between N systems with simplified star-topology connections to the central hub, reducing system complexity while enabling real-time update propagation that maintains timing accuracy
Solution Approach 2:
The central accumulator system serves multiple functions: it acts as a receiving endpoint for all systems, a distribution hub for propagating updates, a storage mechanism for accumulator states, and a coordination point for managing shared deductibles and out-of-pocket limits across different benefit types. This multi-functional design consolidates what would otherwise require separate specialized interfaces
2Loss of time
If direct interfaces are created between all claim systems, then timing accuracy is improved, but device complexity increases dramatically
Solution Approach 1:
The central accumulator system serves as a mediator that eliminates the need for direct interfaces between all pairs of claim systems. Instead of N*(N-1)/2 direct connections, each system only needs a single interface to the central hub, reducing complexity from quadratic to linear scaling while maintaining real-time communication capabilities
Solution Approach 2:
The patent merges the functions of multiple direct interfaces into a single centralized communication hub. The central accumulator system consolidates the roles of multiple separate interface endpoints into one unified system that handles all accumulator update exchanges, reducing the number of interfaces from O(N^2) to O(N)
3Device complexity
If multiple separate accumulators are used for different benefit types, then system complexity is reduced, but measurement precision deteriorates leading to incorrect cost tracking
Solution Approach 1:
The patent segments the accumulator data structure into multiple independent accumulator records, each tracking a specific benefit type (medical, pharmacy, behavioral). Each record contains separate fields for deductible and out-of-pocket tracking. This segmentation allows precise tracking of costs by benefit type while the central accumulator system manages the coordinated updates across all segments
Data Source
AI summary
Healthcare costs accumulated across a plurality of claims systems are managed using a centralized accumulator, which receives cost accumulator data for adjudicated claims from multiple sending claim systems. An accumulator record type is identified from the cost accumulator data and used to generate a cross-reference record. The record type includes an adjudicated claim. A routing message is generated for at least one receiving claim system according to the identified accumulator record type, the cost accumulator data received from the sending claim system, and an identity of the at least one receiving claim system. In response to sending the routing message to the receiving claim system, an acknowledgement is received, which is used to update the cross-reference record by the processor.