Coverage Plan Matching With Prescription and Provider Inputs
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Solution Overview
Problem
Healthcare consumers face difficulty in determining optimal health insurance coverage packages due to the complexity of interacting parameters in regulated insurance options.
Innovation Solution
A system and method for automatically calculating optimal coverage parameters by receiving geographical location, prescription medicines, pharmacies, and preferred physicians' information to identify suitable coverage plans.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If a healthcare consumer manually determines optimal coverage packages, then they can understand the details of each plan, but the process is time-consuming and complex due to the vast array of interacting parameters
Solution Approach 1:
The system enables self-service by automatically calculating optimal coverage parameters based on user-provided information such as geographical location, prescription medicines, pharmacies, and preferred physicians. The system processes this information to generate personalized plan recommendations without requiring manual analysis of complex insurance parameters by the consumer.
Solution Approach 2:
The patent replaces the manual mechanical process of reviewing and comparing insurance plans with an automated computational system. The system uses algorithms to process multiple interacting parameters (geographical location, medical needs, pharmacy preferences) and automatically determines optimal coverage packages, substituting human manual analysis with automated digital processing.
2Measurement precision
If the system collects detailed information about prescription medicines, pharmacies, and physicians, then the coverage recommendations become more personalized and accurate, but the system complexity increases
Solution Approach 1:
The system segments the complex insurance selection problem into distinct data collection modules: geographical location parameters, prescription medicine lists, pharmacy identifiers, and physician identifiers. Each segment is collected and processed independently, then integrated to generate comprehensive coverage recommendations, making the overall system more manageable despite the detailed information requirements.
3Productivity
If the system automatically calculates optimal coverage parameters, then the selection process becomes simpler and faster, but the system requires complex processing of multiple interacting parameters
Solution Approach 1:
The system introduces an intermediary processing layer that receives raw user information (geographical location, prescriptions, pharmacy and physician identifiers) and transforms it into optimized coverage parameters. This intermediary layer handles the complex processing of interacting parameters, separating the complexity from the user interface and enabling fast automated recommendations without exposing the user to the underlying computational complexity.
Data Source
AI summary
Systems and methods are disclosed for identifying a set of suitable coverage plans for a healthcare consumer. A starting coverage year and geographical location are received. The healthcare consumer is presented with an option to provide a list of prescription medicines as well as an option to provide an identification of one or more pharmacies and one or more preferred physicians. The healthcare consumer is presented with a user interface component for creating an account. A list of plans is presented based on the one or more geographical location parameters, the list of prescription medicines, and pharmacies, and the identification of one or more preferred physicians.