SYSTEM AND METHOD FOR USING FINANCIAL INCENTIVES WITH MEMBER ENGAGEMENT METRICS TO REDUCE HEALTH CARE CLAIM COSTS

摘要

A health care plan system and method designed to reduce future claims costs through financial incentives with member engagement metrics. Targets are pre-set for member engagement metrics. Claims cost targets for the sponsor are set based on the sponsor meeting member engagement targets. A percentage of health care plan base administrative fees are at risk based on the sponsor's claims cost performance in relation to the claims cost target. If the claims cost target is missed, the health plan administrator repays or reduces administrative fees charged to the sponsor. If the claims cost target is met, the sponsor pays additional fees to the health plan administrator. Base administrative fees are also repaid or reduced if the health care plan administrator fails to meet service performance targets. The sponsor is appraised on progress of member engagement and service performance metrics through scorecards that are sent during the plan year.

主权项

1. A computerized method for determining health care administration costs comprising:
(a) receiving at a server:
(i) administrative fee data comprising at least one administrative fee charged by a health care plan administrator to a sponsor of a health care plan for a plurality of members of a member population;(ii) plan activity data for at least one plan activity requiring participation from said plurality of members;(iii) a target participation level by said plurality of members in said plan activity; (b) receiving at said server a participation number indicative of members in said health care plan participating in said plan activity; (c) comparing by said server said participation number to a member population number to calculate an actual participation level for said member population; (d) calculating by said server a difference between said actual participation level and said target participation level; (e) calculating by said server a claims cost target for said sponsor according to said difference between said actual participation level and said target participation level wherein said claims cost target is a cap on claims cost growth during an applicable health care plan period; (f) measuring at said server actual claims cost performance against said claims cost target for said applicable health care plan period to determine a claims cost difference for said member population; (g) calculating at said server an administrative fee for said health plan administrator based on said claims cost difference for said member population; (h) adjusting an administrative fee to be paid by a sponsor according to said members' progress toward said target participation level for said plan activity; and (i) generating a claims cost scorecard comprised of a first column indicating a predetermined weight to be given said plan activity, a second column indicating said target participation level for said plan activity, a third column indicating said actual participation level for said plan activity, and a participation score.