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 tracking financial incentives to reduce health care claims costs comprising:
(a) entering in a server 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; (b) entering in said server data for at least one plan activity requiring participation from said plurality of members; (c) entering in said server a target level of participation by said plurality of members in said plan activity; (d) determining at said server a number of members in a said health care plan; (e) determining at said server a number of members in said health care plan participating in said plan activity; (f) comparing at said server said number of members in said health care plan to said number of members participating in said plan activity to calculate a level of participation for said member population; (g) calculating by said server a difference between said level of participation and said target level of participation; (h) calculating by said server a claims cost target for said sponsor according to said difference between said level of participation and said target level of participation wherein said claims cost target is a cap on claims cost growth during an applicable health care plan period; (i) 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; and (j) calculating at said server an administrative fee refunded to said sponsor or paid to said health plan administrator based on said claims cost difference for said member population.