U.S. patent application number 14/271006 was filed with the patent office on 2016-12-08 for computerized health behavior reward system and method.
This patent application is currently assigned to HUMANA INC.. The applicant listed for this patent is Humana Inc.. Invention is credited to David Bartley, Kirk McIver, Jeremy Watson.
Application Number | 20160357931 14/271006 |
Document ID | / |
Family ID | 50552905 |
Filed Date | 2016-12-08 |
United States Patent
Application |
20160357931 |
Kind Code |
A1 |
Bartley; David ; et
al. |
December 8, 2016 |
COMPUTERIZED HEALTH BEHAVIOR REWARD SYSTEM AND METHOD
Abstract
A computerized health behavior reward system and method is
disclosed. Engagement of rewards program members is based on
rewards for participation in a variety of health activities. Health
activities are recommended to members based on demographic and
health profile information and include general health activities
such as participation in fitness programs as well as disease
management and clinical programs, educational campaigns, online,
interactive, and social networking activities, and community based
activities. Each activity may relate to a particular participation
event so that members are rewarded for enrolling in a program as
well as for ongoing participation. Members earn points for each
health activity in which they participate. The points are
accumulated in a rewards account accessible from a web site portal
and can be redeemed. The computerized system and method provides
flexibility to allow a reward program sponsor to respond to
different needs of the rewards program population at the consumer
level.
Inventors: |
Bartley; David; (Louisville,
KY) ; Watson; Jeremy; (Shelbyville, KY) ;
McIver; Kirk; (Louisville, KY) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Humana Inc. |
Louisville |
KY |
US |
|
|
Assignee: |
HUMANA INC.
Louisville
KY
|
Family ID: |
50552905 |
Appl. No.: |
14/271006 |
Filed: |
May 6, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12752765 |
Apr 1, 2010 |
8719056 |
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14271006 |
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61165649 |
Apr 1, 2009 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
G06Q 50/22 20130101;
G16H 50/30 20180101; G06Q 10/10 20130101; G06Q 30/0226 20130101;
G06F 19/328 20130101; G06Q 40/08 20130101 |
International
Class: |
G06F 19/00 20060101
G06F019/00 |
Claims
1. A computerized method for rewarding health behaviors comprising:
(a) storing in a computer health activity data comprising for each
of a plurality of health activities: (1) identifying data for said
health activity; and (2) participation criteria for said health
activity; (b) receiving from a plurality of members of a member
population response data to an opt-in request for a rewards
program, said response data comprising: (1) an agreement to
participate in said rewards program; and (2) an agreement to
receive communications related to said rewards program; (c)
executing at said computer a segmentation process which defines a
segment of members from said plurality of members to target and
which requests participation in at least one of said health
activities, said segment comprising members identified according
to: (1) member health claim data; and (2) participation criteria
for said least one of said health activities; (d) receiving at said
computer a communication to be transmitted to each member in said
segment said communication comprising: (1) an offer to participate
in said at least one of said health activities; and (2) a reward
for participating in said at least one of said health activities;
(e) using member identifying data for each member, transmitting
said communication to each member in said segment; (f) receiving at
said computer responses from members of said segment accepting said
offer in said communication to participate in said least one of
said health activities; (g) updating at said computer a reward
account for each member in said segment accepting said offer to
participate in said at least one of said health activities with
said reward for said at least one of said health activities; and
(h) providing a web site reward account portal configured with
interface elements which enable each member in said segment to
access said reward account and view details of said reward.
2. The computerized method of claim 1 wherein said plurality of
health activities are selected from the group consisting of: (1)
general health activities appropriate for all members; and (2)
specialized health activities for members with specified health
conditions.
3. The computerized method of claim 1 wherein said plurality of
health activities comprise an educational campaign informing
members about a health condition.
4. The computerized method of claim 1 wherein said plurality of
health activities comprise a health-related tool at said web
site.
5. The computerized method of claim 1 wherein said plurality of
health activities comprise a health risk assessment.
6. The computerized method of claim 1 wherein receiving at said
computer responses from said members in said segment comprises
receiving responses through said reward account portal for said
members.
7. The computerized method of claim 1 wherein receiving at said
computer responses from said members in said segment comprises
receiving at least one response through a computerized enrollment
process completed for the member by a third party.
8. The computerized method of claim 1 wherein said plurality of
health activities comprise clinical health activities, fitness
health activities, lifestyle health activities, social media health
activities, partnership health activities, profile health
activities, and transparency tool activities.
9. The computerized method of claim 1 wherein said plurality of
health activities are selected from the group consisting of:
enrollment activities; and engagement activities.
10. The computerized health behavior reward system comprising: (a)
a database storing (1) health activity data for a plurality of
health activities comprising for each health activity: (A)
identifying data for said health activity; and (B) participation
criteria for said health activity; (2) reward accounts for members
of a rewards program; (b) a computer in communication with said
database executing instructions to: (1) execute a segmentation
process to define a segmented group of members from a member
population to target and to request participation in at least one
of said health activities, said segmented group comprising members
identified according to: (A) member health claim data; and (B)
participation criteria for said least one of said health
activities; (2) receive for transmission to each member in said
segmented group a communication comprising: (A) an offer to
participate in said at least one of said health activities; and (B)
a reward for participating in said at least one of said health
activities; (3) use member identifying data for each member to
transmit said communication to each member in said segmented group;
(4) receive responses from said members in said segmented group
accepting said offer to participate in said at least one of said
health activities; (5) update said reward accounts in said database
for members in said segmented group accepting said offer to
participate in said at least one of said health activities with
said reward; and (6) provide a web site reward account portal
configured with interface elements which enable each member of said
segmented group to access said reward account and view details of
said offer to participate.
11. The computerized system of claim 10 wherein said plurality of
health activities are selected from the group consisting of: (1)
general health activities appropriate for all members; and (2)
specialized health activities for members with specified health
conditions.
12. The computerized system of claim 10 wherein said plurality of
health activities comprise an educational campaign informing
members about a health condition.
13. The computerized system of claim 10 wherein said plurality of
health activities comprise a health-related tool at said web
site.
14. The computerized system of claim 10 wherein said plurality of
health activities comprise a health risk assessment.
15. The computerized system of claim 10 wherein said instruction to
receive at said computer responses from said members in said
segmented group comprises receiving responses through said reward
account portal for said members.
16. The computerized system of claim 10 wherein said instruction to
receive at said computer responses from said members in said
segmented group comprises receiving at least one response through a
computerized enrollment process completed for the member by a third
party.
17. The computerized system of claim 10 wherein said plurality of
health activities comprise clinical health activities, fitness
health activities, lifestyle health activities, social media health
activities, partnership health activities, profile health
activities, and transparency tool activities.
18. The computerized system of claim 10 wherein said plurality of
health activities are selected from the group consisting of:
enrollment activities; and engagement activities.
19. The computerized method for rewarding health behaviors
comprising: (a) storing in a computer health activity data
comprising for each of a plurality of health activities: (1)
identifying data for said health activity; (2) participation
criteria for said health activity; (b) executing at said computer a
segmentation process to define a segment of members from a member
population to target for participation in at least one of said
health activities, said segment comprising members identified
according to: (1) member health claim data; and (2) participation
criteria for said at least one of said health activities; (c)
generating at said computer an offer to participate in said at
least one of said health activities, said offer comprising a
participation reward; (d) using member identifying data for each
member, transmitting to each member in said segment said offer to
participate; (e) receiving at said computer responses from members
in said segment accepting said offer to participate in said at
least one of said health activities; (f) updating at said computer
a reward account for each member in said segment accepting said
offer to participate in said at least one of said health activities
with said participation reward for said at least one of said health
activities; and (g) providing a web site reward account portal
configured with interface elements which enable each member of said
segment to access said reward account and view details of said
participation reward.
20. The computerized method of claim 19 wherein said plurality of
health activities are selected from the group consisting of:
enrollment activities; and engagement activities.
Description
CROSS-REFERENCES TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 12/752,765, filed Apr. 1, 2010, now U.S. Pat.
No. 8,719,056, issued May 6, 2014, titled SYSTEM AND METHOD FOR
USING REWARDS TO ENCOURAGE HEALTHY BEHAVIOR and is a
non-provisional patent application claiming the priority benefit of
U.S. Provisional Patent Application Ser. No. 61/165,649, filed Apr.
1, 2009, titled SYSTEM AND METHOD FOR USING REWARDS TO ENCOURAGE
HEALTHY BEHAVIOR, both of which are incorporated herein by
reference in their entirety.
FIELD OF THE INVENTION
[0002] The present invention relates generally to computerized
reward program systems and methods. In particular, the disclosed
embodiment is a computerized health behavior reward system and
method for offering and tracking rewards for a member population to
encourage healthy behaviors.
BACKGROUND OF THE INVENTION
[0003] Preventable illnesses and accidents constitute a large
percentage of US healthcare costs. Although many illnesses and
accidents are preventable, most available healthcare dollars are
spent on illnesses and restoration while only a very small
percentage of healthcare dollars are devoted to prevention. One way
to substantially reduce healthcare costs in the US is to prevent
illnesses and accidents from occurring. Because preventive efforts
can have a substantial impact on healthcare costs, many companies
that cover the healthcare costs of individuals and groups of
individuals have introduced "wellness incentives" to their covered
members, employees, etc.
[0004] Preventive efforts that many companies have adopted include
having individuals complete health risk assessments and participate
in health management programs for various illnesses and diseases.
Wellness incentives are tied to the preventive efforts, and
individuals are rewarded when they complete or participate in a
specified activity. Point values may be assigned to various
activities and awarded to individuals when they complete or
participate in the activities. Points may then be redeemed for
items such as sporting goods, electronics, house wares, etc. or
discounts or gift certificates to national or specialty retailers.
The array of reward options available to individuals may be
significant to increase the likelihood that each individual finds
an item that he or she likes and for which he or she is willing to
work.
[0005] Although many companies have adopted wellness incentive or
reward programs to reward individuals for participation in various
healthy activities, typically the various health activities are not
appropriate for all individuals. Each covered member may have
specific health needs based on sex, age, and known health
conditions (e.g., diagnosed illnesses or diseases, chronic
conditions, etc.) Certain disease management programs may be
appropriate for some members while informational or exercise
programs may be appropriate for other members. It is important for
individuals to be directed to the program or programs that meet
their needs. Members are more likely to participate in programs
that meet their needs and that are beneficial to them and
therefore, increase the likelihood that they will receive a
reward.
[0006] Health reward systems and methods today typically rely on
individuals to select and enroll in programs of their own choosing.
Individuals may be provided with information about various health
programs and encouraged to participate in specific programs based
on their known health conditions. For a variety of reasons,
however, they may choose not to participate. Some individuals may
not see a need to participate in the programs. Other individuals
may not understand the health benefits of the programs. For some
individuals, the availability of a health benefit may simply not be
enough to encourage them to participate, even if the program is
appropriate. Finally, when presented with so many different
programs and options, they may not understand which programs
actually meet their needs and therefore, simply choose not to
participate at all.
[0007] There is a need for a computerized health behavior reward
system and method that allows individuals to learn about and earn
rewards for participating in various health programs. There is a
need for a computerized health behavior reward system and method
that matches individuals to appropriate health programs, offers
them opportunities to enroll and participate, and rewards them for
enrolling and participating. There is a need for a computerized
health behavior reward system and method that uses various criteria
to segment a member population into various groups according to
their needs and to offer activity rewards based on groups. There is
a need for a computerized health behavior reward system and method
that records data related to enrollment and participation
activities for various health programs and that evaluates the
program participation data to determine whether additional programs
may be appropriate for an individual. There is a need for a
computerized health behavior reward system and method that
encourages individuals to become engaged in their own health by
rewarding them for participation in a variety of health
programs.
SUMMARY OF THE INVENTION
[0008] A computerized health behavior reward system and method is
disclosed. In an example embodiment, a reward program supported by
the computerized system and method uses a phased approach to
familiarize participants with health activities and then rewards
them for participating in the activities. Each reward provides
encouragement to an individual as the individual takes action
toward improving his or her health. The reward program may be
sponsored by a party that determines what health activities may be
offered as well as the rewards associated with the activities. The
sponsor may be an insurance company that provides insurance
services to individual customers or a customer of an insurance
company that provides insurance to a group of individuals (e.g., an
employer).
[0009] In an example embodiment, engagement of individuals is based
on rewards for participation in general health programs as well as
specialized health programs. Two or more program categories are
defined and within each category, specific activities are defined.
A single health program may be subdivided into activities or events
with related participation points for each activity (e.g.,
enrollment, renewal, 1-month participation, completion of a goal,
etc.) Reward points are associated with each activity within a
program.
[0010] Members of an insured or other population may be eligible
for general health as well as specialized health activities.
Specialized health activities are suggested to individuals based on
demographic or profile information or based on an analysis of their
specific health conditions. Members are rewarded for participating
in the activities. Members that have not started participating in a
program that is appropriate for them may be rewarded for completing
an enrollment activity related to the program. Members may also be
rewarded for completing a goal activity related to a program. In
addition, ongoing participation may be rewarded. The incorporation
of specialized health activities into the reward program results in
engagement of individuals based on their specific needs.
Individuals earn points for each health activity in which they
participate and are then provided with opportunities to redeem the
points.
[0011] The computerized system and method allows individuals to
have a more personalized experience the more engaged they become in
the reward program. Members may be rewarded initially for
completing a health assessment and then receive further health
activity recommendations based on their answers and assessment
data. Rewards are offered to encourage the member to enroll in the
programs, to continue participation in the programs, and to reach
goals related to the programs. The computerized system and method
may further suggest types of rewards based on the individual's
lifestyle, current exercise routines, health conditions, age,
gender, and location. Rewards may also be provided for a variety of
events such as birthdays, anniversaries, holidays, and even for
working out.
[0012] The computerized health behavior reward system and method
provides flexibility to allow a reward program sponsor to respond
to different needs of an insured population at the consumer level.
The reward program may include general health activities as well as
specialized health activities so all members of the insured
population may be engaged in their health. A variety of activities
result in rewards for the individual so that the more a member
participates in the activities, the greater the reward.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1 is a block diagram of the primary components of a
reward program according to an example embodiment.
[0014] FIG. 2 is a block diagram of a reward program design
according to an example embodiment.
[0015] FIG. 3 is a flowchart of a segmentation process for reward
opportunities according to an example embodiment.
[0016] FIG. 4 is a flowchart of a selection process according to an
example embodiment
[0017] FIG. 5 is a screen shot of a reward account portal for an
example embodiment.
[0018] FIG. 6 is a diagram illustrating reward program account data
according to an example embodiment.
[0019] FIG. 7 is a sample rewards program sponsor summary statement
according to an example embodiment.
[0020] FIG. 8 is a block diagram of computer components according
to an example embodiment.
DETAILED DESCRIPTION OF EXAMPLE EMBODIMENT(S)
[0021] Referring to FIG. 1, a block diagram of the primary
components of a computerized reward program according to an example
embodiment is shown. Members of a reward program accumulate points
for participating in various health related activities 100 such as
completing a health risk assessment, enrolling and participating in
a disease management program, or participating in a health coaching
program (telephonic or online). Information regarding the
activities they complete 102 is stored in a rewards account 104.
The points that each member earns for each activity may be redeemed
for rewards such as merchandise or discounts 106.
[0022] Referring to FIG. 2, a block diagram of a reward program
design according to an example embodiment is shown. In an example
embodiment, various health activities are promoted throughout the
calendar year 200. Initially, members of an insured or other
population opt-in to the reward program 202. Part of the opt-in
procedure may involve the members agreeing to receive
communications about the program electronically. Completing the
opt-in procedure may result in a first reward for the member and
agreeing to receive communications electronically may result in a
second reward. Members may be asked to complete a health assessment
204 which is also eligible for a reward. In the health assessment,
a member provides identifying and demographic information and
answers questions about various health factors. For example, the
member may be asked to provide height and weight information as
well as information about alcohol and tobacco use, known heart,
blood, or other conditions, prior illnesses or accidents, etc. The
health assessment data is stored in a database and may be used to
identify health activities relevant to the member's health factors
and conditions.
[0023] Another activity in which a member may be invited to
participate is a biometric screening 206. The biometric screening
may include requesting health status information 214 such as a
member's height and weight, a blood pressure reading, cholesterol
and glucose levels, etc. Other health activities include health
counseling and coaching through online and/or telephonic systems
216. Participation in the screening and coaching activities may be
rewarded.
[0024] Certain activities may be categorized as "general engagement
activities," "general health activities," or "everyday earning" 208
activities. Such activities may be used to engage the entire member
population. These activities are typically more preventive in
nature and may or may not have an immediate and direct impact on
health. The goal with these activities is to get members engaged in
their own health and health education. As such, the immediate
impact on health insurance claims may be lower, but they provide a
greater long-term opportunity for the sponsor of the reward program
to get its members involved in their health and the reward
program.
[0025] A specific number of reward points may be assigned to each
activity in the general health category and may include activities
such as health club visits. A member may be rewarded for every
health club visit he or she makes during a calendar year. To
receive rewards, members may register with a health club in the
sponsor's network and indicate that they are part of the reward
program. Members may then be rewarded monthly based on the number
of visits they make in a month. For example, a member that visits
the club eight times a month may be awarded 500 bonus points.
Twelve visits in a month may result in an award of 1,000 bonus
points.
[0026] Other activities may be categorized as "specialized
engagement activities," "specialized health activities," or "core
health activities" 210. Certain members within the member
population may have specific needs related to their health
conditions. Some members may require an activity as simple as an
annual checkup while other members have a need for an activity that
is part of a program for managing a specific disease. Rather than
broadcasting these activities to the entire member population, the
computerized system and method targets members that may have a need
for such health activities. Furthermore, members are offered
rewards at the time they are engaged in making the decision
regarding the activity to increase the likelihood that they will
enroll in the program and continue to participate. By introducing a
reward opportunity at the time of decision making, the reward
program more effectively influences changes in the behavior of the
member population.
[0027] In another aspect of the claimed invention, the reward
program comprises campaigns throughout the calendar year 212. In an
example embodiment, campaigns are introduced quarterly. A first
campaign may involve electronic communications regarding various
general health activities while another campaign involves
introducing web tools or education modules at a web site. Another
example campaign may involve completing an insights survey to
obtain feedback from members. The feedback may be used to improve
existing activities and programs, to determine whether there is a
need for additional activities or programs, to revise the rewards
offered for various activities or programs, or to determine whether
a particular member has additional needs that could be met through
one or more activities or programs. Participation in each campaign
allows an individual to accumulate additional rewards.
Participation may include reviewing information, completing
questionnaires, etc.
[0028] Whether new campaigns or identification of specific health
needs, each member is presented with a list of activities that he
or she can complete to receive rewards. This list is dynamic
according to the member's needs and is generated by the
computerized system and method using data from various information
sources. For example, females over age 40 are presented with a
reward opportunity for a mammogram. Females that are pregnant may
be presented with a reward opportunity for enrolling and
participating in a pre-natal program. All members over age 50 may
be presented with a reward opportunity for completing a colon
cancer screening. Referring to Table 1, a list of sample activity
categories and sample activities within each category is provided.
Each activity may have an associated reward point value. A program
may have multiple activities associated with it such that a member
is rewarded for enrolling in the program and then completing
additional participation events for the program (e.g., visiting a
doctor, attending meetings).
TABLE-US-00001 TABLE 1 Categories and Activities Category Activity
Points Clinical Asthma Disease Management Enrollment 1,000 Clinical
Congestive Heart Failure Disease 1,000 Management Enrollment
Clinical Diabetes Disease Management 1,000 Enrollment Clinical
Coronary Artery Disease Management 1,000 Enrollment Clinical
Chronic Kidney Disease Management 1,000 Enrollment Clinical Asthma
Disease Management Engagement 1,500 Clinical Congestive Heart
Failure Disease 1,500 Management Engagement Clinical Diabetes
Disease Management 1,500 Engagement Clinical Coronary Artery
Disease Management 1,500 Engagement Clinical Chronic Kidney Disease
Management 1,500 Engagement Clinical Healthcare for Expectant
Mothers 1,000 Enrollment Clinical Personal Nurse Enrollment 1,000
Clinical Personal Nurse Engagement 1,500 Fitness 8 Health Club
Visits 500 Fitness 12 Health Club Visits 1,000 Fitness
Self-Reported Health Activities 200 Fitness Walking Trails 400
Fitness Device with Uploaded Data 500 Fitness Challenges - group
1,000 Fitness Challenges - individual 1,000 Fitness Run, Walk,
Wheelchair a Race 1,000 Fitness Bicycle Usage 1,000 Health
Biometric Screening 1,000 Health Biometric Results - Cholesterol
Ideal 1,000 Health Biometric Results - BMI Ideal 1,000 Health
Biometric Results - Blood Pressure Ideal 1,000 Health Biometric
Results - Tobacco Free 1,000 Health Mammogram 1,500 Health Pap
Smear 1,500 Health Colonoscopy 1,500 Health Smoking Cessation
Program Online 1,500 Health Weight Management Program Online 1,500
Health Back Care Program Online 1,500 Health Stress Management
Program Online 1,000 Health Nutrition Program Online 1,000 Health
Smoking Cessation Program by Telephone 1,500 Health Weight
Management Program by 1,500 Telephone Health Back Care Program by
Telephone 1,500 Health Stress Management Program by Telephone 1,000
Health Nutrition Program by Telephone 1,000 Health BMI Calculator
500 Health Stay Smart Stay Healthy Videos 500 (reward for each)
Health Walk-in Clinic Visits 500 Health Sleep Program 1,000 Health
New Baby and Pre-natal 1,000 Health Child Immunizations 1,000
Health Learning first aid, CPR etc. 500 Health Meal Plans - Set,
Track & Complete 500 Lifestyle Fitness Tips (tip of the day)
500 Lifestyle Nutrition Tips (tip of the day) 500 Lifestyle Healthy
Recipes 500 Lifestyle Farmers Markets - Find 500 Lifestyle Calorie
Counter and Other Calculators 500 Lifestyle Food Calorie Content -
Restaurants etc. 500 Lifestyle Other Lifestyle items 500 Lifestyle
Brain Games 500 Lifestyle Activity Games 500 Lifestyle Reward
Taking Bus, Car-pooling, Biking, 500 Walking Lifestyle Behavioral
Change Offerings 500 Lifestyle Employee Incentives 500 Overall
Suggestions/Website Feedback 500 Overall Monthly Newsletter 500
Overall Surveys 500 Overall Contributions to Health Savings Account
500 Overall Access Card Activation (health savings 500 account,
personal care account, and healthcare flexible spending account
Overall Participation in Activities at Guidance 500 Centers Social
Media Social Networking on Health Topics 500 Social Media Health
Blog/Message Board Participation 500 Partnerships Four Square Deal
- reward for activity 500 Partnerships Health Device Use
(pedometer, GPS 1,000 fitness tracking) Partnerships Health Mobile
Applications 500 Partnerships Partner Health Services 500
Partnerships Health Tracking and Comparison Services 500
Partnerships Health Books and Materials 500 Partnerships Health
Website Visits 500 Partnerships Recycling/Environmental Activities
500 Partnerships Point of sale Discounts from Healthy 500 Merchants
Partnerships Charitable Activities 500 Partnerships Career
Well-being Activities 500 Profile Information Reward Program
Enrollment 1,000 Profile Information Reward program Enrollment
Bonus within 1,500 120 days Profile Information Health Assessment
2,000 Profile Information Health Assessment Bonus within 120 days
2,500 Profile Information Health Alerts 500 Profile Information
Birthday Bonus 500 Profile Information Renewal Bonus 500 Profile
Information Multiple Insurance Products (dental, 500 vision, etc)
Transparency Tools Electronic Explanation of Benefits Option 500
Transparency Tools Electronic Statement Option 500 Transparency
Tools Electronic Notification of Other Insurance 500 Option
Transparency Tools Electronic Maximize Your Pharmacy 500 Benefits
Option Transparency Tools Drug Pricing Details Tool 500
Transparency Tools Pharmacy Locator Tool 500 Transparency Tools
Health Record Accessed 500 Transparency Tools Prescription
Calculator 500 Transparency Tools Find a Doctor Service 500
Transparency Tools Compare Hospitals Tool 500 Transparency Tools
Compare Doctors Tool 500 Transparency Tools Insights Survey 500
Transparency Tools Generic Prescriptions 1,000
[0029] As indicated in the activity list, points may be awarded for
different participation activities or events within a program. For
example, points may be awarded for enrolling in a program and then
for ongoing participation in a program. Points may also be awarded
for renewing enrollment in a program. Additional incentives may be
awarded for enrolling within a specified time period (e.g., 120
days). The offering of rewards in connection with a variety of
activities for one or more program allows individuals to be
rewarded frequently. The use of frequent rewards allows individuals
to become engaged in their own health very quickly and to continue
that engagement.
[0030] The types of health-related activities that may be rewarded
are numerous so that all members of the reward program are provided
with an opportunity to receive rewards for their participation. The
variety of opportunities allows each member to be engaged in a way
that is individually meaningful and relevant. Many of the
activities involve wellness and preventive care activities so that
members are engaged in their health and the reward program even
when they are not sick. As members become familiar with and active
in the reward program while they are well, they are more likely to
remain involved if they become ill. They further continue the
engagement in their own health.
[0031] Referring to FIG. 3, a flowchart of a segmentation process
for reward opportunities according to an example embodiment is
shown. The segmentation process results in the identification of
members for activities that are targeted to their specific needs.
Member registration information 300 as well as member questionnaire
data 302 is received at a computer server where the segmentation
process executes. Reward accounts for each member may be
established at a database. The member registration and member
questionnaire data may be stored in a separate reward account for
each member.
[0032] Data from various computerized systems and databases is
aggregated at a rewards server to identify activities that are
relevant for various segments of the member population 304. For
example, each clinical program included in the reward program may
have eligibility criteria for participation in the program. The
eligibility criteria may relate to specific demographic data and
health conditions (e.g., over 45, elevated blood pressure, etc.) as
well as whether the program is covered under an insurance plan.
Various computerized processes executing at other servers may be
employed to collect the eligibility criteria and identify the
members from the population eligible for the various programs. The
rewards server uses this information from various other servers to
apply to rewards participants. The rewards server executes a
process to "flag" or identify participants as eligible for certain
activities and then track the participants' progress in engaging in
and completing those activities. Individuals that do not have a
need to participate in disease management or clinical programs may
still be provided with opportunities to participate in general
health activities such as health club visits or other fitness
activities.
[0033] The segmentation process receives identifying data for
individuals that have been identified as eligible for the programs
but have not yet enrolled or engaged in the programs. Information
about members that are eligible but not yet enrolled or engaged
provides a reward opportunity. In addition, member responses to the
questionnaire may be considered in the activity recommendations
304. Certain answers or information from the questionnaire may
serve as indicators for the types of activities that are most
likely to be of interest to the member and therefore, determine the
applicable segment.
[0034] Each group of segmented members may be informed about a
specific activity and further, offered a reward for enrolling or
engaging the program at the time the activity is presented 306.
Members that may not be motivated solely by the health benefits of
the activity may be motivated by the associated reward and decide
to enroll or engage in the program at the time the offer is
presented. Table 2 provides a list of example segments and
programs.
TABLE-US-00002 TABLE 2 Example Member Segments and Programs Member
Segment Program Members that need help and support in caring
Caregivers Program 308 for others Members that understand how to
manage their Active Management health and actively do so Program
310 Members identified with high risk conditions Self-care,
Preventive 312 Members that require help managing a specific
Clinical Program 314 health condition
[0035] The process for enrolling or engaging in programs varies
depending upon the program. Some programs may have online
enrollment or registration procedures. Members may access a reward
account portal and make their selections of enrollment or
engagement activities through the portal. For example, members that
would like to participate in health club programs may register with
a health club in the sponsor's network and indicate that they are
part of the reward program. For other activities, members maybe
contacted by a representative that is informed of the member's
eligibility. For example, members in need of care management for a
specific condition may be contacted by a nurse who informs the
member of the available service. If the member agrees to
participate at the time he or she is contacted, the nurse may
complete the computerized enrollment process for the member. The
member's reward account may then be updated so that the member
receives the enrollment activity reward. The service may be a
disease management program or a personal nurse program.
[0036] Referring to FIG. 4, a flowchart of a selection process
according to an example embodiment is shown. The selection process
may be used to match members with various programs. Health claims
data 400 as well as other personal data (e.g., questionnaires) is
analyzed to determine which programs are appropriate for a member.
Selection criteria for the programs are applied to the member claim
data for the various programs 402. In an example embodiment, the
output for the selection process is a list of members that meet the
selection criteria for a program 404.
[0037] Various items within the claim data such as a specific
diagnosis (e.g., asthma, diabetes, kidney problem, or congestive
heart failure) or event (e.g., pre-natal checkup) is matched with
program selection criteria to identify an appropriate program 406.
Activities associated with the programs may then be presented to
the members based on their program matches. For example, members
that have not yet enrolled in a program may be presented with an
enrollment activity. If the member agrees to the enrollment
activity, the member's reward account is updated to reflect the
member's selection of the enrollment activity and award of the
points associated with the activity. Member responses to activities
may be tracked to determine a member's level of participation in a
particular program.
[0038] Referring to FIG. 5, a screen shot of a reward account
portal for an example embodiment is shown. Members that enroll in
the reward program may view details regarding their reward account
500 by accessing it through a web site. Each activity in which the
member participates may be listed as well as the participation date
and associated reward. Members may view information about the
reward opportunities 502 that have been selected for them as well
as redeeming their reward points 504. Various aspects of the reward
program may be supported by the computerized system and method
including member account management. Reward account data may be
reviewed and analyzed periodically by the reward program
administrator to determine participation levels, identify new
activities and rewards, identify possible enhancements to the
program, etc.
[0039] Referring to FIG. 6, a diagram illustrating reward program
account data according to an example embodiment is shown. Each
member of the member population is presented with different reward
opportunities and for a variety of reasons, selects different
opportunities. As a result, the reward program is different for
every member. For example, a first member 600 may accumulate points
for participation in preventive care activities and in campaigns. A
second member 602 may accumulate points for participation in
preventive care activities and campaigns as well as telephonic
health coaching activities. A third member 604 may accumulate
points for participation in telephonic health coaching activities
as well as disease management activities. All three members may
receive points for opting in to the reward program (1,000 points)
and completing a health assessment (2,000 points). The activities
are targeted toward members according to their needs and results in
a different user experience for each member.
[0040] Referring to FIG. 7, a sample rewards program sponsor
summary statement according to an example embodiment is shown. The
summary statement identifies various activities related to the
rewards program and related participation data. The summary
statement provides feedback to the sponsor and may assist the
sponsor in modifying and improving the rewards program.
[0041] Referring to FIG. 8, a block diagram of computer components
according to an example embodiment is shown. Members of the reward
program may access the reward program server 802 using their
personal computers 800 or other computing devices. Depending upon
the size of the rewards program, multiple servers may be used to
service the member base. Member rewards account data as well as
data related to reward program may be stored at one or more
databases 804 accessible to the server 802 or servers.
[0042] The computerized system and method of the present invention
allows an insurance company or sponsor to engage members in their
health by rewarding a variety of healthy activities. Because
wellness and preventive care activities as well as activities for
clinical and disease management programs are incorporated into the
reward program, all members are provided with opportunities to
become engaged. When the member is contacted about the program, he
or she is also informed of the participation incentive. The
incentives for activities are offered at the time decisions are
made to encourage behavior change.
[0043] Having shown and described a preferred embodiment of the
present invention, those skilled in the art will realize that many
variations and modifications may be made to the described invention
and still be within the scope of the claimed invention. Thus many
of the elements indicated above may be altered or replaced by
different elements which will provide the same or substantially the
same result and fall within the spirit of the claimed invention.
The types and nature of the activities that are offered may be
changed and fall within the spirit of the claimed invention. The
programs and activities that are offered as well as the
segmentation process may be varied to meet the needs of the sponsor
and its member population and fall within the spirit of the claimed
invention. Therefore, as can be understood from a review of the
foregoing description and accompanying drawing figures, the
computerized system and method supports a reward program to
encourage healthy behavior. Consequently, while certain exemplary
embodiments of the present invention are described in detail above,
the scope of the invention is not to be considered limited by such
disclosure, and modifications are possible without departing from
the spirit of the invention as evidenced by the following
claims:
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