Healthcare Fulfillment Routing Through a Centralized PBM Intermediary
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Solution Overview
Problem
Decentralized computing systems face challenges in facilitating communication with fulfilling suppliers due to patient input requirements and exclusive access restrictions, leading to difficulties in navigating and synchronizing prescription claims, managing healthcare needs, and providing personalized content and alerts to patients.
Innovation Solution
A computer-based healthcare needs fulfillment system, owned and operated by a PBM, that coordinates with physicians, suppliers, and patients to manage prescriptions, track status, provide personalized content, and facilitate automatic payments, while eliminating the need for direct patient-supplier communication.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Extent of automation
If a decentralized computing system is used to manage prescription claims, then system autonomy and distributed control are improved, but communication coordination with fulfilling suppliers deteriorates due to patient input requirements and exclusive access restrictions
Solution Approach 1:
The patent introduces a centralized PBM server as an intermediary between the decentralized computing system and fulfilling suppliers. The PBM server receives prescription claims from patient devices, processes them centrally, and coordinates with suppliers, eliminating the need for direct patient-supplier communication while maintaining system autonomy. This mediator resolves the contradiction by centralizing communication functions while preserving distributed system architecture.
2Reliability
If exclusive access restrictions are implemented for pharmacies and specialty providers, then security and controlled access are improved, but patient ability to navigate and communicate with fulfilling suppliers deteriorates
Solution Approach 1:
The PBM server acts as an intermediary that manages exclusive access restrictions while enabling patient navigation. The server maintains controlled access to pharmacies and specialty providers through authentication mechanisms,同时 providing patients with a user interface to view and select from available fulfilling suppliers. This resolves the contradiction by decoupling access control from patient navigation capability.
Solution Approach 2:
The PBM server performs multiple functions: it enforces exclusive access restrictions, manages authentication, provides patient interface for navigating suppliers, and coordinates prescription fulfillment. This multi-functional approach allows the system to maintain security while enabling patient access to fulfilling suppliers through a unified platform.
3Extent of automation
If direct patient-supplier communication is eliminated, then system control and coordination are improved, but the need for centralized interface and data synchronization increases
Solution Approach 1:
The patent merges multiple functions (claim processing, supplier coordination, patient interface, and data synchronization) into a single centralized PBM server. This consolidation improves system control by eliminating direct patient-supplier communication while managing the complexity of centralized interfaces through integration rather than separate components.
Solution Approach 2:
The PBM server is designed as a universal platform that handles diverse functions: receiving claims from patient devices, processing prescriptions, coordinating with multiple fulfilling suppliers, providing patient interface, and synchronizing data across the system. This multi-functionality manages complexity by consolidating interface requirements into a single versatile system.
Data Source
AI summary
Systems and methods for routing healthcare information across multiple platforms over a decentralized computer network. The system includes a network interface communicatively coupled to a computer network having a transmitter. The system includes at least one processor communicatively coupled to the network interface. The processor is configured to route, in response to determining a first patient question received from the patient via a user interface is to be directed to an insurance benefits manager via the communications network, the first patient question electronically to a computing system of the insurance benefits manager via a healthcare hub. The processor is further configured to route a second patient question electronically to a computing system of the professional health services representative via the healthcare hub. The processor is further configured to route a third patient question electronically to a computing system of the suggested pharmacy via the healthcare hub.