Value-Based Benefits System for Member-Specific Health Plan Incentives
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Conventional health insurance systems lack the ability to provide member-specific benefits, leading to administrative burdens and inefficiencies in managing incentives, tracking member eligibility, and communicating program details to members and providers, resulting in complex and inflexible systems that fail to effectively reward health-promoting actions.
Innovation Solution
A value-based benefits system that allows for member-specific benefits to be applied within a single health insurance plan, enabling different co-pay levels for services based on completed health education programs or conditions, with a centralized platform for managing and tracking incentives, eligibility, and reward distribution.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If member-specific benefits are implemented in conventional systems, then members can receive personalized incentives, but the system complexity and administrative burden increase significantly
Solution Approach 1:
The patent segments benefits into base benefits (from the primary medical plan) and value-based benefits (from incentive programs). This separation allows member-specific customization without requiring multiple complete medical plans, reducing system complexity while maintaining adaptability.
Solution Approach 2:
The patent creates a universal incentive program framework that can apply to multiple members within a single medical plan. The system provides multi-functionality by handling both standard plan benefits and customized value-based benefits through a unified platform, eliminating the need for separate plan structures.
2Adaptability or versatility
If multiple medical plans are created to offer different co-pay levels, then members can access differentiated benefits, but the administrative burden and management complexity increase
Solution Approach 1:
The patent segments the benefit structure into base benefits (defined in the primary medical plan) and value-based benefits (added through incentive programs). This allows differentiated co-pay levels without creating separate medical plans, as the base plan remains unchanged while incentive layers provide customization.
Solution Approach 2:
The patent implements dynamic benefit adjustment where co-pay levels can change based on member actions and incentive program completion. Benefits are not static but can be modified in real-time through the incentive platform, allowing differentiated treatment without structural plan changes.
3Adaptability or versatility
If manual plan transfers are used to provide lower co-pay benefits, then members can receive incentives, but the process becomes cumbersome and difficult to track
Solution Approach 1:
The patent implements real-time dynamic benefit adjustment within the same medical plan. When a member completes an incentive program, their co-pay level changes immediately without requiring manual plan transfers. The system dynamically updates benefit levels based on member actions, eliminating time-consuming administrative processes.
Solution Approach 2:
The patent enables automated incentive program management where the system automatically enrolls members, tracks their completion of health-promoting actions, and adjusts their benefits without manual intervention. This self-service approach eliminates the need for administrative staff to manually process plan transfers.
4Ease of operation
If conventional claims systems are used, then all members receive the same benefits, but the system lacks flexibility for member-specific configurations
Solution Approach 1:
The patent creates a universal incentive program platform that works within the existing medical plan structure. The system provides multi-functionality by handling both standard uniform benefits and customized member-specific benefits through a single integrated framework, maintaining ease of operation while enabling adaptability.
Solution Approach 2:
The patent introduces an incentive program layer as an intermediary between the base medical plan and the member. This intermediary layer handles all member-specific customization logic, allowing the underlying claims system to remain simple while the incentive layer provides adaptability for individual member needs.
Data Source
AI summary
Systems and methods for managing a health plan are described. In one embodiment, a method for managing a health plan includes presenting options for a health plan and an incentive program of the health plan, presenting options for configuring a health plan and an incentive program of the health plan, and receiving a selection of an incentive program. In other aspects, the method further comprises receiving a selection of a health plan and an incentive program, storing information about the selected health plan and incentive program, storing information regarding participation in the incentive program, and requesting a reward for a member for completion of the incentive program. In other aspects, the method may further include determining eligibility for an incentive program and a reward of the incentive program.