WO2000017800A1 - Reducing risk using behavioral and financial rewards - Google Patents

Reducing risk using behavioral and financial rewards Download PDF

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Publication number
WO2000017800A1
WO2000017800A1 PCT/US1999/022020 US9922020W WO0017800A1 WO 2000017800 A1 WO2000017800 A1 WO 2000017800A1 US 9922020 W US9922020 W US 9922020W WO 0017800 A1 WO0017800 A1 WO 0017800A1
Authority
WO
WIPO (PCT)
Prior art keywords
insured
risk
component
benefit
information
Prior art date
Application number
PCT/US1999/022020
Other languages
French (fr)
Other versions
WO2000017800A8 (en
WO2000017800A9 (en
Inventor
Stephen J. Brown
Original Assignee
Health Hero Network, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Health Hero Network, Inc. filed Critical Health Hero Network, Inc.
Priority to AU61589/99A priority Critical patent/AU6158999A/en
Priority to CA002310648A priority patent/CA2310648A1/en
Priority to EP99948399A priority patent/EP1032903A1/en
Publication of WO2000017800A1 publication Critical patent/WO2000017800A1/en
Publication of WO2000017800A8 publication Critical patent/WO2000017800A8/en
Publication of WO2000017800A9 publication Critical patent/WO2000017800A9/en

Links

Classifications

    • GPHYSICS
    • G06COMPUTING; CALCULATING OR COUNTING
    • G06QINFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08Insurance

Definitions

  • Certain kinds of insurance (such as long-term care insurance) also have a
  • the insured person has substantial effect on the family of the insured person.
  • the insured person has substantial effect on the family of the insured person.
  • the insured person has substantial effect on the family of the insured person.
  • the insured person has substantial effect on the family of the insured person.
  • the insured person also has interests against these options.
  • One aspect of this co-pending application is that the insurer can dynami-
  • one such insurance product includes
  • the invention provides a set of techniques and products in which one or
  • the insured persons and associated beneficiaries are coupled to a client-server system that is configured to obtain dynamic measurement of
  • the client-server system is configured to alert the insured persons
  • mium are allocated to one or more components (such as a long-term care benefit or a
  • an insured patient is examined at intervals by
  • sonnel can determine a medical regimen (possibly including diet, exercise, prescribed
  • tions use a client device with a client-server system to provide dynamic medical in-
  • the client device can
  • the client device can periodically question the insured patient or the close relations for information about the insured, such as affect or mentation, diet or exer-
  • a server device receiving that information from the client device can
  • the server device can modify which portions of an insurance premium (or
  • the server device can use
  • Fig.lA shows a block diagram of a system for data collection and inter-
  • Fig. IB shows details of the client device shown in Fig. 1A.
  • Fig. 1C shows devices that may be connected to client device
  • Fig. ID shows details of the data review device
  • Fig. 2 illustrates a data flow diagram indicating some of the data paths
  • Fig. 3A illustrates a process for determining dynamic risk assessment
  • Fig. 3B illustrates a process used to evaluate patient information
  • Fig. 4 illustrates a process used to respond to risk
  • Fig. 5 illustrates a process used to determine feedback information.
  • the invention can be implemented using general-purpose processors or special purpose
  • processors operating under program control, or other circuits, adapted to particular
  • the invention enables dynamic risk determination of an insured' s condi-
  • determination can be used is if the insured is at risk for a medical setback (such as an
  • MI Magnetic ink
  • a stroke but currently is capable of self-care.
  • Yet another example is when the
  • the invention allows the underwriter
  • Fig. 1 A shows a block diagram of a system for data collection and inter-
  • a system 100 includes a client device 110, a server
  • the communication channel 140 may be a simple point-to-point network
  • the client device 110 is disposed locally to a patient
  • the client device 110 is relatively small or compact, and can be
  • the output element 112 includes a display screen 114, on which ques-
  • tions and suggested answers can be displayed for the patient 111, to facilitate informa-
  • the output element 112 can also include a speaker 115, to present infor-
  • ment 112 can also include a bell or other sound element, or a bright light 119 or a flag,
  • the input element 113 includes a plurality of buttons 116A-D for enter-
  • the input element 113 can also include one or more data ports 117A-D
  • 118 can include a medical measurement device, such as a blood glucose meter or a
  • Such other devices 118 can also include a general purpose or
  • special purpose client workstation such as a personal computer or a hand-held digital
  • the server device 120 is disposed logically remotely from the patient
  • remotely refers to a logical
  • the database 121 includes medical history, medical regimen, and risk
  • base 121 also includes the compliance background for the insured indicating how well
  • the server device 120 also includes the program memory 122 that con-
  • the server 120 and database 121 are prefera-
  • a standard network connection such as a .world wide web con-
  • the server 120 and database 121 may include single stand-alone computers
  • the data review element 130 is disposed logically remotely from the pa-
  • tient 111 includes an interface 131 disposed for use by an operator 132.
  • erator 132 can comprise medical personnel, a device operated by medical personnel, or
  • Information entered into the data review element 130 can be en-
  • the data review element 130 is preferably a personal computer, remote
  • the data review element 130 functions as a remote inter-
  • the data review element 130 also functions to provide the professional to evaluate the progression of the insured and to monitor the insured's
  • Fig. 2 illustrates a data flow diagram, indicated by general reference
  • nodes include an insured 201, a client device 203, a server device 205, an accounting
  • data streams transfer data between the nodes connected by the data stream.
  • server device sends patient protocol and interrogatories
  • the insured by sending this information across the server-client data stream 227 to the client device 203.
  • the client device 203 then instructs or queries the insured 201
  • the insured 201 responds to the
  • the client device 203 passes this ac-
  • the server device 205 stores the information acquired from the insured 201.
  • Feedback is provided to the insured 201 by sending feedback informa-
  • the professional 211 uses the work station 209 (passing data over both
  • server device 205 This data is accessed using the server-workstation data stream 229.
  • the professional 211 can also modify the medical regimen for the insured or provide
  • server-client data stream 227 the client device 203, and the client device-insured data
  • the professional 211 using the work station 209 can send information (reflecting benefits to the insured) to the accounting server 207 using the 'workstation-
  • the professional 211 assesses the insured-against risk using both the
  • This assessment includes the insured's compliance with the prescribed
  • Fig. 3 A illustrates a dynamic risk assessment process, indicated by gen-
  • risk assessment process 300 is cyclic in normal circumstances.
  • step 301 obtains medical information (such as bio-medical information)
  • the medical information is gathered according to a protocol
  • This medical information is sent to a server device that performs an 'evaluate patient information' step 303 that determines one or more
  • the dynamic risk assessment process 300 delays for an appropriate time a a delay step
  • This delay can be varied as appropriate for the insured, the insured's condition,
  • the delay step 305 determines the time
  • the delay ends at an 'delay complete' step 307 and the dynamic risk assessment
  • process 300 repeats at the 'gather patient information' step 301 to re-determine the in-
  • step 301 is specific to the insured's current risk and progression of the condition.
  • the insured or caregiver may be periodically instructed to check for sores on
  • the caregiver can provide informa-
  • step 303 can be repeated dependent on the data acquired from the insured
  • the server device 120 can send the client device 110 a protocol to cause the client device 110 to obtain the new information
  • Fig. 3B illustrates an 'evaluate patient information' process, ' indicated by
  • the 'evaluate patient information' process 320 is in-
  • the 'evaluate patient information' process 320 continues to a 'send data
  • the risk includes one or more risk factors.
  • Example risk factors include information such as "patient smokes,” “pa-pa-pa-pa-pa-pa-pa-pa-
  • the 'respond to risk' procedure 329 determines one
  • risk' procedure 327 and the 'respond to risk' procedure 329 need not be performed
  • the dynamic risk assessment process 300 can also continue to a 'determine feedback
  • a 'present feedback information' procedure 335 then presents the feedback informa-
  • the 'determine feedback information' procedure 331 can also provide
  • the client device 110 with additional data gathering protocols that are dependent on the
  • mine feedback information' procedure 331 checks to determine whether the just-
  • gathered information is out-of-limit, indicates a trend, or should be forwarded to a
  • client device 110 and the server device 120 in a different manner.
  • server device 120 For example as the
  • Fig. 4 illustrates a 'respond to risk' process, indicated by general refer-
  • ence character 400 that is configured to adjust the cost of the financial product be-
  • process 400 is invoked by the 'respond to risk' procedure 329 and initiates at a 'start'
  • an 'inform' procedure 409 generates information that will be pro-
  • procedure also provides the new allocations to an accounting database and/or the pay-
  • This payment allocation is structured to pro-
  • Fig. 5 illustrates a 'determine feedback information' process, indicated
  • risk factors' procedure 503 uses the risk factors determined by the 'reassess risk'
  • the 'modify regimen' procedure 507 may change the data
  • diabetes for example, diabetes, and CHD.
  • a 'select feedback language' procedure 509 selects the language
  • dure 509 can also control how much technical jargon is to be included.
  • guage can be customized for the educational and experience level of the insured and/or
  • a 'prepare feedback information' procedure 511 assembles the feed- back information including the suggested medical regimens coded for the language of
  • the 'determine feedback information' process 500 completes through an
  • the 'correlate regimen with risk factors' procedure 503 evaluates the
  • vention uses Bayesian statistical techniques to perform this correlation.

Abstract

The invention provides a set of techniques and products in which one or more insured persons and one or more associated beneficiaries are monitored with regard to dynamic risk reassessment, given feedback information in response to that dynamic risk reassessment, and are encouraged to comply with the feedback. The insured persons and associated beneficiaries are coupled to a client-server system disposed for dynamic measurement of medical information, and the client-server system is disposed for alerting the insured persons and associated beneficiaries to suggested behaviors for reducing risk. The invention includes an insurance product in which portions of the insurance premium are allocated to one or more components, in response to compliance with the suggested behaviors.

Description

APPLICATION FOR UNITED STATES LETTERS PATENT FOR:
REDUCING RISK USING BEHAVIORAL AND FINANCIAL REWARDS
These known methods increase the incentive for the insured entity to re-
duce the insured-against risk. However, these methods are subject to several draw-
backs. Where the insured-against risk is relatively inevitable (such as with life
insurance or long-term care insurance), the insurance company finds if difficult to
avoid the inevitability of a claim. Rather, it is in the underwriter's interest to stave off
the claim for as long as possible.
Certain kinds of insurance (such as long-term care insurance) also have a
substantial effect on the family of the insured person. For example, the insured person
is often faced with the dilemma of either (1) reduction to penury to qualify for gov-
eminent support, or (2) spending their entire estate on long-term care. The family of
the insured person also has interests against these options.
Accordingly, it would be advantageous to provide a method and system
to increase the incentive for the insured entity to reduce the insured-against risk, even
when that insured-against risk is relatively inevitable. In the case of long-term care
insurance, it is in the underwriter's interest to provide incentives for the insured person
and their family to maintain the insured person's health and independence for as long
as possible (quite apart from the emotional incentives they already have).
Application Serial No. , Express Mail Mailing No. EE 261 914
722 US, filed September 23, 1998, in the name of Stephen J. Brown, titled "Dynamic Modeling and Scoring Risk Assessment," assigned to the same assignee, attorney
docket number HHN-003 describes techniques for modeling and scoring risk assess-
ment that are time-dependent, and in one embodiment are responsive to progression of
a disease or degenerative condition in a patient.
One aspect of this co-pending application is that the insurer can dynami-
cally adjust the risk assessment of individual insured persons in response to actions
taken (or not taken) by those insured persons to maintain their own health. The un-
derwriter can thus dynamically adjust the cost or the benefits of the insurance policy in
response to those actions. By doing so, the underwriter, the insured person, and the
insured person's family have the common goal of maximizing the useful .life and inde-
pendence of the insured person.
As described in the co-pending application, dynamic reassessment can
be perfomied in conjunction with a monitoring and scoring system for determining
risk assessment for populations and for individuals with regard to those populations.
It would also be desirable for the insured person (and associated others)
to make use of dynamic risk reassessment to monitor and influence the behavior of the
insured person, to reduce the risk. It would also be desirable to provide the insured
person, and the insured person's family with information available to the underwriter, and to suggest particular prescribed or proscribed actions that would reduce short-term
risk and provide a greater payoff for all concerned.
Accordingly, it would be advantageous to provide the insured person,
and associated others, with feedback information from dynamic reassessment of the
risk associated with the insured person, so that the insured person, and associated oth-
ers, can act to minimize that risk. This advantage is achieved in an embodiment of the
invention in which the insured person and their beneficiaries are provided with feed-
back information and instruction responsive to dynamic risk reassessment, and in
which payments from an associated set of insurance products are allocated dependant
on compliance with that feedback. For example, one such insurance product includes
a long-term care component and a life insurance component, and devotes a fraction of
the product premium to one or the other component in response to compliance with the
feedback offered by the underwriter.
Summary of the Invention
The invention provides a set of techniques and products in which one or
more insured persons and one or more associated beneficiaries are monitored with re-
gard to dynamic risk reassessment, are given feedback information responsive to that
dynamic risk reassessment, and are encouraged to comply with the feedback informa-
tion. In a preferred embodiment, the insured persons and associated beneficiaries are coupled to a client-server system that is configured to obtain dynamic measurement of
medical information (for example, using bio-medical devices or using a question and
answer format), and the client-server system is configured to alert the insured persons
and associated beneficiaries to suggested behaviors for reducing risk. The preferred
embodiment includes an insurance product in which portions of the insurance pre-
mium are allocated to one or more components (such as a long-term care benefit or a
life insurance benefit), in response to compliance with the suggested behaviors. Thus,
• the insured is provided with an incentive for compliance with the suggested behaviors
for reducing risk by receiving a more beneficial allocation of the premium to the com-
ponents of the insurance product.
In a preferred embodiment, an insured patient is examined at intervals by
medical personnel, to determine medical information that can be used as factors for
dynamically determining a risk assessment for that insured patient. The medical per-
sonnel can determine a medical regimen (possibly including diet, exercise, prescribed
medication, or other factors) that are intended to reduce the insured-against risk. The
insured patient, and where appropriate, associated beneficiaries or other close rela-
tions, use a client device with a client-server system to provide dynamic medical in-
formation regarding the condition of the insured. For example, the client device can
periodically measure blood glucose, blood pressure, heart rate, weight, and the like.
Similarly, the client device can periodically question the insured patient or the close relations for information about the insured, such as affect or mentation, diet or exer-
cise, and the like.
In response to the prescribed medical regimen and information from the
insured patient, a server device receiving that information from the client device can
dynamically reassess risk factors associated with that insured .patient, and can alert
medical personnel or close relations in response thereto. In response to dynamic risk
assessment, the server device can modify which portions of an insurance premium (or
other financial product payments) are allocated to one or more components (such as a
long-term care component or a life insurance component). The server device can use
patient compliance with the suggested medical regimen as one measure to be factored
into the dynamic risk assessment.
Description of the Drawings
Fig.lA shows a block diagram of a system for data collection and inter-
pretation for a population;
Fig. IB shows details of the client device shown in Fig. 1A.
Fig. 1C shows devices that may be connected to client device;
Fig. ID shows details of the data review device; Fig. 2 illustrates a data flow diagram indicating some of the data paths
used in a preferred embodiment;
Fig. 3A illustrates a process for determining dynamic risk assessment;
Fig. 3B illustrates a process used to evaluate patient information;
Fig. 4 illustrates a process used to respond to risk; and
Fig. 5 illustrates a process used to determine feedback information.
Description of the Preferred Embodiments
In the following description, a preferred embodiment of the invention is
described with regard to preferred process steps and data structures. Embodiments of
the invention can be implemented using general-purpose processors or special purpose
processors operating under program control, or other circuits, adapted to particular
process steps and data structures described herein. Other embodiments include com-
puter program products that contain computer code embodied in a computer readable
media for causing a computer to perform the process steps. Implementation of the
process steps and data structures described herein would not require undue experi-
mentation or further invention. Related Applications
Inventions described herein can be used in combination or conjunction
with inventions described in the following patent applications. These patent applica-
tions are hereby incorporated by reference as if fully set forth herein:
• Application Serial No. 09/041,809, filed November 21, 1997 in the
name of Stephen J. Brown, titled "Phenoscope and Phenobase," as-
signed to the same assignee, attorney docket number RYA-136;
• Application Serial No. , filed , in the name of Ste-
phen J. Brown, titled "Health Management Process Control System,"
assigned to the same assignee, attorney docket number RYA-114.
• Application Serial No. , filed , in the name of Ste-
phen J. Brown and Erik K. Jensen, titled "On-line Health Education
and Feedback System Using Motivational Driver Profile Coding and
Automated Content Fulfillment," assigned to the same assignee, at-
torney docket number RYA- 115.
• Application Serial No. , filed , in the name of Ste-
phen J. Brown, titled "Multiple Patient Monitoring System for Pro-
active Health Management," assigned to the same assignee, attorney
docket number RYA- 116. • Application Serial No. , filed , in the name of Ste-
phen J. Brown, titled "On-Line Health Education Using Composites
of Entertainment and Personalized Health Information,"- assigned to
the same assignee, attorney docket number RYA-119a.
• Application Serial No. , filed , in the name of Ste-
phen J. Brown, titled "Monitoring System for Remotely Querying In-
dividuals," assigned to the same assignee, attorney docket number
RYA- 126.
• Application Serial No. , filed , in the name of Ste-
phen J. Brown, titled "Multi-User Remote Health Monitoring Sys-
tern," assigned to the same assignee, attorney docket number RYA-
131a.
• Application Serial No. , Express Mail Mailing No. EE 261
914 722 US, filed September 23, 1998, in the name of Stephen J.
Brown, titled "Dynamic Modeling and Scoring Risk Assessment,"
assigned to the same assignee, attorney docket number HHN-003.
System for Reducing Risk
The invention enables dynamic risk determination of an insured' s condi-
tion. An example of when the invention can be used is if the insured has a progressive
condition, which will eventually require long-term care (such as diabetes), but for
which in-home care is currently appropriate. Another example where dynamic risk
determination can be used is if the insured is at risk for a medical setback (such as an
MI or a stroke) but currently is capable of self-care. Yet another example is when the
insured is currently being cared for by family, but the care burden is increasing and the
insured will eventually require long-term care. The invention allows the underwriter
to dynamically determine the current risk to the insured and to provide incentives to
the insured to reduce that risk.
Fig. 1 A shows a block diagram of a system for data collection and inter-
pretation for a population.
Referring to Fig. 1A, a system 100 includes a client device 110, a server
device 120 including a database of information 121 and a program memory 122, and a
data review element 130. These devices are connected via a communication channel
140, such as a communication network as is well known in the art, and as more fully
described in the Phenoscope and Phenobase patent application (serial no. 09/041 ,809). The communication channel 140 may be a simple point-to-point network
(for example a wire connecting the client device 110 with the server device 120), or a
complex network such as the Internet.
Referring to Fig. IB, the client device 110 is disposed locally to a patient
111 (the insured), and includes an output element 112 for presenting information to the
patient 111, and an input element 113 for entering information from the patient 111.
As used herein, "locally" refers to a logical relationship to the patient 111, and does
not have any necessary implication with regard to actual physical position. In a pre-
ferred embodiment, the client device 110 is relatively small or compact, and can be
disposed on a night table or otherwise near the patient 111.
The output element 112 includes a display screen 114, on which ques-
tions and suggested answers can be displayed for the patient 111, to facilitate informa-
tion entry, or on which instructions can be displayed for the patient 111, to instruct the
patient 111. The output element 112 can also include a speaker 115, to present infor-
mation in conjunction with or in alternative to the display screen 114. The output ele-
ment 112 can also include a bell or other sound element, or a bright light 119 or a flag,
to alert the patient 111 that the client device 110 has questions or information for the
patient 111. The input element 113 includes a plurality of buttons 116A-D for enter-
ing information.
The input element 113 can also include one or more data ports 117A-D
for entering information from other devices. Referring to Fig. 1C, such other devices
118 can include a medical measurement device, such as a blood glucose meter or a
blood pressure monitor. Such other devices 118 can also include a general purpose or
special purpose client workstation, such as a personal computer or a hand-held digital
calendar.
The server device 120 is disposed logically remotely from the patient
111, and includes a database 121 of information about the patient 111 antl about other
patients in a related population thereof. As used herein, "remotely" refers to a logical
relationship to the patient 111, and does not have any necessary implication with re-
gard to actual physical position.
The database 121 includes medical history, medical regimen, and risk
progression information for the insured and a similarly situated population. The data-
base 121 also includes the compliance background for the insured indicating how well
the insured follows the prescribed medical regimen and avoids the proscribed activi-
ties. The server device 120 also includes the program memory 122 that con-
tains program code and data to cause the server device 120 to perform subsequently
described processes.
In a preferred embodiment, the server 120 and database 121 are prefera-
bly accessible using a standard network connection (such as a .world wide web con-
nection). The server 120 and database 121 may include single stand-alone computers
or multiple computers distributed throughout a network.
The data review element 130 is disposed logically remotely from the pa-
tient 111, and includes an interface 131 disposed for use by an operator 132. The op-
erator 132 can comprise medical personnel, a device operated by medical personnel, or
a similar device, capable of interacting with the interface 131 to receive information
from the data review element 130 and possibly to enter information into the data re-
view element 130. Information entered into the data review element 130 can be en-
tered for ultimate transmission to the server device 120 or to the client device 110.
The data review element 130 is preferably a personal computer, remote
terminal, web TV unit, Palm Pilot unit, interactive voice response system, or any other
communication technique. The data review element 130 functions as a remote inter-
face for entering server 120 or client device 110 messages and queries to be communi-
cated to the individuals. The data review element 130 also functions to provide the professional to evaluate the progression of the insured and to monitor the insured's
medical regimen.
Other and further information regarding the system 100 is- s own in Ap-
plication Serial No. 09/041/809, titled "Phenoscope and Phenobase," attorney docket
number RYA- 136 and Application Serial No. , titled "Dynamic Modeling
and Scoring Risk Assessment," attorney docket number HHN-003.
Fig. 2 illustrates a data flow diagram, indicated by general reference
character 200, that indicates how data flows within a preferred embodiment. The
nodes include an insured 201, a client device 203, a server device 205, an accounting
server 207, a work station 209, and a professional 211. These nodes are ponnected by
data flows that include an 'insured-client device' data stream 221, an client device-
insured data stream 223, a client-server data stream 225, a server-client data stream
227, a server-workstation data stream 229, a workstation-server data stream 231, a
workstation-professional data stream 233, a professional-workstation data stream 235,
a 'workstation-accounting server' data stream 237, an 'accounting server-insured' data
stream 239, and an 'accounting server-server device' data stream 241. Each of these
data streams transfer data between the nodes connected by the data stream.
In particular the server device sends patient protocol and interrogatories
to the insured by sending this information across the server-client data stream 227 to the client device 203. The client device 203 then instructs or queries the insured 201
utilizing the client device-insured data stream 223. The insured 201 responds to the
queries, instructions, or through bio-medical input devices to the client device 203 us-
ing the 'insured-client device' data stream 221. The client device 203 passes this ac-
quired information to the server device 205 over the client-server data stream 225.
The server device 205 stores the information acquired from the insured 201.
Feedback is provided to the insured 201 by sending feedback informa-
tion from the server device 205 to the client device 203. This feedback information
can include additional medical regimens for the insured 201 to timely follow (for ex-
ample, additional tests that are determined by the server device 205 responsive to the
information just gathered from the insured).
The professional 211 uses the work station 209 (passing data over both
the workstation-professional data stream 233 and the professional-workstation data
stream 235) to access and/or modify data received by, stored on or created on the
server device 205. This data is accessed using the server-workstation data stream 229.
The professional 211 can also modify the medical regimen for the insured or provide
other information for the insured. These modifications are sent to the server device
205 over the workstation-server data stream 231 and then to the insured using the
server-client data stream 227, the client device 203, and the client device-insured data
stream 223. The professional 211, using the work station 209 can send information (reflecting benefits to the insured) to the accounting server 207 using the 'workstation-
accounting server' data stream 237. The status of benefits can be sent directly to the
insured using the 'accounting server- insured' data stream 239 (for example by using
postal mail, FAX or other traditional mechanism) or the information can be sent over
the 'accounting server-server device' data stream 241 to the server device 205 and on
to the insured using previously discussed paths.
The professional 211 assesses the insured-against risk using both the
static data most recently collected from the insured, the progression over time of the
data collected from the insured and information known to, or accessible by the profes-
sional 211. This assessment includes the insured's compliance with the prescribed
medical regimens and other environmental and behavioral factors. This assessment
can also include information and recommendations provided by artificial intelligence
expert systems that are accessible to the professional 211 through the work station 209.
Fig. 3 A illustrates a dynamic risk assessment process, indicated by gen-
eral reference character 300, for determining dynamic risk assessment. The dynamic
risk assessment process 300 is cyclic in normal circumstances. A 'gather patient in-
formation' step 301 obtains medical information (such as bio-medical information)
from the insured (using the client device 110) by using a series of questions or by us-
ing bio-medical sensors. The medical information is gathered according to a protocol
provided by the server device 120. This medical information is sent to a server device that performs an 'evaluate patient information' step 303 that determines one or more
risk factors for the insured as is subsequently described with respect to Fig. 3B. Next,
the dynamic risk assessment process 300 delays for an appropriate time a a delay step
305. This delay can be varied as appropriate for the insured, the insured's condition,
the caregivers, and the insurance provider. The delay step 305 determines the time
interval between gathering information from the insured and is appropriately set to be
(for example and without limitation) some number of days, weeks or months. Eventu-
ally, the delay ends at an 'delay complete' step 307 and the dynamic risk assessment
process 300 repeats at the 'gather patient information' step 301 to re-determine the in-
sured-against risk for the insured.
The medical information gathered by the 'gather patient information'
step 301 is specific to the insured's current risk and progression of the condition. For
example, the insured or caregiver may be periodically instructed to check for sores on
extremities if the insured is diabetic. In addition, the caregiver can provide informa-
tion about affect or mentation. If the insured interacts with the client device 110, the
response time to questions can also be gathered.
The 'gather patient information' step 301 and the 'evaluate patient in-
formation' step 303 can be repeated dependent on the data acquired from the insured
by the previous iteration. Thus, if the previous iteration returned data that indicates
that a subsequent test should be performed, the server device 120 can send the client device 110 a protocol to cause the client device 110 to obtain the new information
from the insured, caregiver, or other person.
Fig. 3B illustrates an 'evaluate patient information' process,' indicated by
general reference character 320 that reassesses the risk based on the gathered informa-
tion and responds to that risk. The 'evaluate patient information' process 320 is in-
voked by the 'evaluate patient information' step 303 of Fig. 3A and initiates at a 'start'
terminal 321. The 'evaluate patient information' process 320 continues to a 'send data
to server device' procedure 323, performed by the client device 110, that sends the
medical information gathered by the client device 110 to the server device 120. The
medical information is stored on the database 121 by a 'store data' procedure 325.
Once the medical information is stored, a 'reassess risk' procedure 327
(as disclosed in Application Serial No. , attorney docket number HHN-003)
can use the medical information, a risk-assessment model and the database 121 to de-
termine the current risk of the insured. The risk includes one or more risk factors.
These risk factors are used to determine an insured-against risk.
Example risk factors include information such as "patient smokes," "pa-
tient has diabetes," "patient has diabetes and doesn't bother to check his blood sugar
regularly," etc. Once the insured-against risk has been determined, the 'evaluate patient
information' process 320 continues to a 'respond to risk' procedure 329 (subsequently
described with respect to Fig. 4). The 'respond to risk' procedure 329 determines one
or more medical regimens for the insured. These medical regimens are selected to re-
duce the risk factors and thus to reduce the insured-against risk of the insured. The
'respond to risk' procedure 329 can also adjust the proportion of the insurance cost
allocated to components of the financial product used by the insured. The 'reassess
risk' procedure 327 and the 'respond to risk' procedure 329 need not be performed
every time data is received by the server device 120. These procedures can be exe-
cuted independent of the following procedures.
Once the medical information is stored by the 'store data' procedure 325
the dynamic risk assessment process 300, can also continue to a 'determine feedback
information' procedure 331 that develops feedback for the insured that can include one
or more medical regimens, display of bio-medical information, encouragement to foi¬
low the suggested medical regimen or follow-on protocols. The feedback information
is sent back to the client device 110 by a 'send feedback information' procedure 333.
A 'present feedback information' procedure 335 then presents the feedback informa-
tion to the insured and/or the caregiver. The 'evaluate patient information' process
320 completes through an 'end' terminal 337. The 'determine feedback information' procedure 331 can also provide
the client device 110 with additional data gathering protocols that are dependent on the
just- gathered information — to obtain additional information. In addition, the 'deter-
mine feedback information' procedure 331 checks to determine whether the just-
gathered information is out-of-limit, indicates a trend, or should be forwarded to a
medical professional.
Other preferred embodiments can allocate these processes between the
client device 110 and the server device 120 in a different manner. For example as the
relative cost/performance ratio changes for the client device 110 and the server device
120, more of these procedures can be moved to the client device 110.
Fig. 4 illustrates a 'respond to risk' process, indicated by general refer-
ence character 400, that is configured to adjust the cost of the financial product be-
tween the components of the financial product for the insured. The 'respond to risk'
process 400 is invoked by the 'respond to risk' procedure 329 and initiates at a 'start'
terminal 401. The 'respond to risk' process 400 then continues to a 'risk change' deci-
sion procedure 403 that determines whether the current insured-against risk has suffi-
ciently changed from the existing insured-against risk retrieved from the database 121.
If the insured-against risk has not sufficiently changed, the 'respond to risk' process
400 completes through an 'end' terminal 405. Otherwise, the 'respond to risk' process
400 continues to an 'allocate benefits' procedure 407 that reallocates the cost to the insured between the components of the financial product to correspond to the new in-
sured-against risk. Where the insured-against risk is reduced, the new allocation re-
wards the insured. However, if the insured-against risk has increased, the insured is
penalized. Next, an 'inform' procedure 409 generates information that will be pro-
vided to the insured and/or the caregiver either using postal mail or as information
provided to the insured by the 'present feedback information' procedure 335. This
procedure also provides the new allocations to an accounting database and/or the pay-
out system for the financial product. Next, the 'respond to risk' process 400 completes
through the 'end' terminal 405.
In a financial product that has at least two components (such as a long-
term care component and a life insurance component) the 'allocate benefits' procedure
407 determines a cost for the long term care component and allocates a first payment
to that component of the financial product. The 'allocate benefits' procedure 407 then
allocates a second payment to the life insurance component of the financial product, to
an annuity, or to another benefit for the insured (such as a refund). The second pay-
ment is a function of the first payment. This payment allocation is structured to pro-
vide an incentive to the insured to conform to the currently suggested medical
regimen.
Fig. 5 illustrates a 'determine feedback information' process, indicated
by general reference character 500, used to assemble the feedback information. The 'determine feedback information' process 500 is invoked by the 'determine feedback
information' procedure 331 and initiates at a 'start' terminal 501. A 'correlate regimen
with risk factors' procedure 503 uses the risk factors determined by the 'reassess risk'
procedure 327 to select one or more medical regimens that can be provided to the in-
sured. An 'evaluate regimen history' procedure 505 then uses the history of medical
regimens suggested to the insured and stored on the database 121 to determine the pre-
ferred selection of medical regimens. Then a 'modify regimen' procedure 507 modi-
fies the existing medical regimen if the existing medical regimen is different from the
preferred medical regimen. The 'modify regimen' procedure 507 may change the data
collection protocol used by the client device 110. These procedures 503, 505, and 507
are all dynamic in that they use historical information collected from the insured and
are responsive to the progressive nature of the information collected about the insured.
This is particularly important for those having a progressive condition or degenerative
disease (for example, diabetes, and CHD).
Next, a 'select feedback language' procedure 509 selects the language
used to present the feedback information to the insured. Often, the selected language
is a natural language such as English. However, the 'select feedback language' proce-
dure 509 can also control how much technical jargon is to be included. Thus, the lan-
guage can be customized for the educational and experience level of the insured and/or
the caregiver. A 'prepare feedback information' procedure 511 assembles the feed- back information including the suggested medical regimens coded for the language of
the insured. The 'determine feedback information' process 500 completes through an
'end' terminal 513.
The 'correlate regimen with risk factors' procedure 503 evaluates the
risk factors, the insured's progression and the information gathered from the insured to
identify medical regimens best suited to gather additional information from the insured
or to help the insured to reduce the insured-against risk. One embodiment of the in-
vention uses Bayesian statistical techniques to perform this correlation.
Alternative Embodiments
Although preferred embodiments are disclosed herein, many variations
are possible which remain within the concept, scope, and spirit of the invention, and
these variations would become clear to those skilled in the art after perusal of this ap-
plication.

Claims

Claims
What is claimed is:
A method including steps of:
dynamically determining an insured-against risk associated with an in-
sured;
providing feedback information to said insured responsive to said in-
sured-against risk; and
providing an incentive to said insured to reduce said insured-against risk.
2. The computer controlled method of claim 1 wherein the step of providing an
incentive further includes steps of:
dynamically determining a cost for a first component of a financial prod-
uct responsive to said insured-against risk;
allocating a first payment to said first component in response to said
cost; and
allocating a second payment, responsive to said first payment, to a sec-
ond component of said financial product;
whereby said first component and second component have different values to
said insured.
3. The computer controlled method of claim 1 wherein the step of dynamically
determining further includes steps of:
determining one or more risk factors associated with said insured at a
plurality of times; and
re-determining said insured-against risk associated with said insured re-
sponsive to the step of determining one or more risk factors.
. The computer controlled method of claim 3 wherein the step of determining
one or more risk factors further includes steps of:
gathering, at a client device, medical information for said insured at said
plurality of times;
sending said medical information from said client device to a server de-
vice remote from said insured; and
comparing, at said server device, said medical information with a risk-
assessment model.
5. The computer controlled method of claim 3 wherein the step1 of providing
feedback information further includes steps of:
associating, at said server device, a medical regimen with at least one of
said one or more risk factors;
sending said medical regimen from said server device to said client de-
vice; and
presenting said medical regimen at said client device.
An apparatus including:
a client-server system having a client device and having a server device that
is logically remote from an insured;
wherein said client device is configured for collecting medical information
regarding said insured and for sending said medical information to said
server device;
wherein said server device is configured to dynamically assess a risk value
associated with said insured in response to said medical information, and to
allocate an incentive responsive to said risk value;
whereby said incentive is responsive to said medical information regarding
said insured.
. A financial product including:
a first component having a cost responsive to a dynamic assessment of
risk associated with an insured, said first component having a first benefit as-
sociated with said insured; and
a second component having a second benefit associated with said in-
sured, said second benefit responsive to said cost;
whereby changes in said dynamic assessment of risk determine a relative al-
location of said first benefit and said second benefit.
8. The financial product of claim 7 wherein the first component includes a long-
term care policy having a long-term care benefit.
9. The financial product of claim 7 wherein the second component includes a
life insurance policy having a life insurance benefit.
0. A method including:
providing a financial product that includes a first component and a sec-
ond component, said first component having a cost responsive to a dynamic
assessment of risk associated with an insured, said first component having a
first benefit associated with said insured, said second component having a
second benefit associated with said insured, said second benefit responsive to
said cost;
obtaining medical information about said insured;
determining said dynamic assessment of risk using said information; and
changing said first benefit and said second benefit responsive to said dy-
namic assessment of risk.
11. The method of claim 10 wherein the first component includes a long-term
care policy having a long-term care benefit.
12. The method of claim 10 wherein the second component includes a life insur-
ance policy having a life insurance benefit.
PCT/US1999/022020 1998-09-23 1999-09-22 Reducing risk using behavioral and financial rewards WO2000017800A1 (en)

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EP99948399A EP1032903A1 (en) 1998-09-23 1999-09-22 Reducing risk using behavioral and financial rewards

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US09/159,058 1998-09-23

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CA2310648A1 (en) 2000-03-30

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