Granted Patent B1

US 12,731,190 · App. 16/659,444 · Granted Sep 8, 2026

Inventors: Anthony Miller (Minneapolis, MN); Henning Chiv (Castro Valley, CA); Matthew Chock (Eagan, MN); Glen Eiden (Forest Lake, MN); Trevor Fast (San Francisco, CA); Charley Hastings (Cape Coral, FL); Jason Haupt (Maple Grove, MN); Shawn Wagoner (Edina, MN); Matthew Wiandt (Bloomington, MN); David Dickey (Minneapolis, MN); Jessica Zeaske (Minneapolis, MN); Nels Marcus Thygeson (San Rafael, CA); Mark Peterson (Eagan, MN)

Assignee: Bind Benefits, Inc.

G06Q40/08G06Q10/067

Abstract

Claims (92)

1 . A system comprising:

one or more processors; and

at least one memory storing processor-executable instructions that, when executed by any one or more of the one or more processors, cause the one or more processors to perform operations comprising:

receiving a coverage search request comprising a coverage search query specified by a member enrolled into a plan;

determining, based at least in part on the coverage search query, a condition associated with the coverage search request;

generating, based at least in part on a use determination risk coverage graph topology data structure (UDRCD), an atomized coverage graph depicting a set of treatment paths associated with the condition, wherein (i) a treatment path of the set of treatment paths is associated with a clinical value, (ii) the treatment path comprises a set of treatment graph topology pathway nodes of the UDRCD, (iii) the atomized coverage graph is a self-updating data structure configured to change its own structure, and (iv) the atomized coverage graph comprises a pointer to one or more callable options for the condition associated with the coverage search request;

receiving a member state data structure comprising clinical data associated with the member;

determining, based at least in part on the member state data structure, a current treatment path location with regard to the set of treatment paths;

generating a high value treatment path of the set of treatment paths that the member can take from the current treatment path location, wherein the high value treatment path is determined according to a ranking of the set of treatment paths based on one or more costs and one or more clinical outcomes of the set of treatment paths;

determining a next treatment on the high value treatment path;

generating, based at least in part on the pointer, a set of providers available for the next treatment;

generating, for a provider in the set of providers, (a) an expected longitudinal treatment value and (b) a copay for the next treatment, wherein the expected longitudinal treatment value reflects a predicted variance of a treatment value based at least in part on one or more attributes of the provider and the condition;

predicting a candidate provider based at least in part on determining the candidate provider is associated with a lowest expected longitudinal treatment value;

generating coverage information for the next treatment for the candidate provider; and

triggering, based at least in part on the coverage information for the next treatment, self-updating of the atomized coverage graph.

2 . The system of claim 1 , wherein the operations further comprise:

determining a treatment object of the atomized coverage graph corresponding to the coverage search query.

3 . The system of claim 2 , wherein the operations further comprise:

determining a clinical condition object linked to the treatment object.

4 . The system of claim 1 , wherein the condition associated with the coverage search request is determined based at least in part on clinical data associated with the member.

5 . The system of claim 3 , wherein determining the set of treatment paths associated with the condition further comprises determining a treatment paths object in the atomized coverage graph associated with the clinical condition object.

6 . The system of claim 3 , wherein the operations further comprise:

determining a set of provider objects in the atomized coverage graph linked to the treatment object; and

determining a subset of the set of provider objects that are in a region associated with the member.

7 . The system of claim 6 , wherein the operations further comprise:

determining a provider object in the set of providers available for the next treatment corresponding to the provider;

generating a propensity ranking based on practice patterns data associated with the provider object;

generating a propensity weight based on the current treatment path location;

generating an expected episodic cost for the next treatment based on treatment cost data associated with the provider object;

generating an episodic cost weight based on the current treatment path location; and

generating the expected longitudinal treatment value for the provider as a weighted average of the propensity ranking and the expected episodic cost for the next treatment weighted by their respective weights.

8 . The system of claim 7 , the operations further comprising:

generating a base copay for the next treatment based on an average longitudinal treatment value for one or more providers in the set of providers;

generating a price factor for the provider, wherein the price factor indicates relative expense of the expected longitudinal treatment value for the provider as compared with the average longitudinal treatment value for the one or more providers in the set of providers; and

generate a copay for the next treatment for the provider as the base copay for the provider adjusted by the price factor for the provider.

9 . The system of claim 1 , wherein a copay for the next treatment is further adjusted based on a treatment path move sequence associated with the member.

10 . The system of claim 1 , wherein a copay for the next treatment is adjusted based on a determination that the member state data structure associated with the member indicates that the member has been diagnosed with the condition.

11 . The system of claim 1 , wherein the coverage information comprises coverage information for the next treatment for a member requested provider.

12 . The system of claim 1 , further, comprising:

determining that the next treatment on the high value treatment path does not match a member specified treatment in the coverage search query;

determining a set of providers available for the member specified treatment;

generating, for a provider in the set of providers available for the member specified treatment, (a) an expected longitudinal treatment value assuming that the member utilizes the member specified treatment next and (b) a copay for the member specified treatment; and

determining a best provider from a second set of providers, wherein the best provider from the second set of providers is associated with the lowest expected longitudinal treatment value assuming that the member utilizes the member specified treatment next, wherein the coverage information comprises coverage information for the member specified treatment for the best provider from the second set of providers.

13 . The system of claim 1 , further comprising:

generating, via a coverage search user interface, instructions for a graphic user interface (GUI) widget structured as to obtain at least one of a member specified treatment or a member requested provider.

14 . The system of claim 13 , further comprising:

generating, via the coverage search user interface, a second GUI widget structured to indicate coverage information for an atomized add-in that provides coverage for the member specified treatment;

generating, via the coverage search user interface, a third GUI widget structured to provide coverage information for an atomized add-in that provides coverage for the next treatment;

receiving, via the coverage search user interface, an atomized add-in selection from the member; and

generating, via the coverage search user interface, a fourth GUI widget structured as to provide coverage information regarding providers available for the atomized add-in selection, in which the candidate provider is highlighted for the member.

15 . The system of claim 14 , wherein the second GUI widget, the third GUI widget, and the fourth GUI widget correspond to a single combined GUI widget.

16 . One or more non-transitory computer-readable storage media storing processor-executable instructions that, when executed by one or more processors, cause the one or more processors to perform operations comprising:

receiving a coverage search request comprising a coverage search query specified by a member enrolled into a plan;

determining, based at least in part on the coverage search query, a condition associated with the coverage search request;

generating, based at least in part on a use determination risk coverage graph topology data structure (UDRCD), an atomized coverage graph depicting set of treatment paths associated with the condition, wherein (i) a treatment path of the set of treatment paths is associated with a clinical value, (ii) the treatment path comprises a set of treatment graph topology pathway nodes of the UDRCD, (iii) the atomized coverage graph is a self-updating data structure configured to change its own structure, and (iv) the atomized coverage graph comprises a pointer to one or more callable options for the condition associated with the coverage search request;

receiving a member state data structure comprising clinical data associated with the member;

determining, based at least in part on the member state data structure, a current treatment path location with regard to the set of treatment paths;

generating a high value treatment path of the set of treatment paths that the member can take from the current treatment path location, wherein the high value treatment path is determined according to a ranking of the set of treatment paths based on one or more costs and one or more clinical outcomes of the set of treatment paths;

determining a next treatment on the high value treatment path;

generating, based at least in part on the pointer, a set of providers available for the next treatment;

generating, for a provider in the set of providers, (a) an expected longitudinal treatment value and (b) a copay for the next treatment, wherein the expected longitudinal treatment value indicates a predicted variance of a treatment value based at least in part on one or more attributes of the provider and the condition;

predicting a candidate provider based at least in part on determining the candidate provider is associated with a lowest expected longitudinal treatment value;

generating coverage information for the next treatment for the candidate provider; and

triggering, based at least in part on the coverage information for the next treatment, self-updating of the atomized coverage graph.

17 . A system comprising:

means to store processor-executable instructions; and

means to process processor-executable instructions, wherein the processor-executable instructions are configured to cause the means to process processor-executable instructions to perform operations comprising:

receiving a coverage search request comprising a coverage search query specified by a member enrolled into a plan;

determining, based at least in part on the coverage search query, a condition associated with the coverage search request;

generating, based at least in part on a use determination risk coverage graph topology data structure (UDRCD), an atomized coverage graph depicting a set of treatment paths associated with the condition, wherein (i) a treatment path of the set of treatment paths is associated with a clinical value, (ii) the treatment path comprises a set of treatment graph topology pathway nodes of the UDRCD, (iii) the atomized coverage graph is a self-updating data structure configured to change its own structure, and (iv) the atomized coverage graph comprises a pointer to one or more callable options for the condition associated with the coverage search request;

receiving a member state data structure comprising clinical data associated with the member;

determining, based at least in part on the member state data structure, a current treatment path location with regard to the set of treatment paths;

generating a high value treatment path of the set of treatment paths that the member can take from the current treatment path location, wherein the high value treatment path is determined according to a ranking of the set of treatment paths based on one or more costs and one or more clinical outcomes of the set of treatment paths;

determining a next treatment on the high value treatment path;

generating, based at least in part on the pointer, a set of providers available for the next treatment;

generating, for a provider in the set of providers, (a) an expected longitudinal treatment value and (b) a copay for the next treatment, wherein the expected longitudinal treatment value indicates a predicted variance of a treatment value based at least in part on one or more attributes of the provider and the condition;

predicting a candidate provider based at least in part on determining the candidate provider is associated with a lowest expected longitudinal treatment value;

generating coverage information for the next treatment for the candidate provider; and

triggering, based at least in part on the coverage information for the next treatment, self-updating of the atomized coverage graph.

18 . A processor-executed method comprising:

receiving, by one or more processors, a coverage search request comprising a coverage search query specified by a member enrolled into a plan;

determining, by the one or more processors and based at least in part on the coverage search query, a condition associated with the coverage search request;

generating, based at least in part on a use determination risk coverage graph topology data structure (UDRCD), an atomized coverage graph depicting a set of treatment paths associated with the condition, wherein (i) a treatment path of the set of treatment paths is associated with a clinical value, (ii) the treatment path comprises a set of treatment graph topology pathway nodes of the UDRCD, (iii) the atomized coverage graph is a self-updating data structure configured to change its own structure, and (iv) the atomized coverage graph comprises a pointer to one or more callable options for the condition associated with the coverage search request;

receiving, by the one or more processors, a member state data structure comprising clinical data associated with the member;

determining, by the one or more processors and based at least in part on the member state data structure, a current treatment path location with regard to the set of treatment paths;

generating, by the one or more processors, a high value treatment path of the set of treatment paths that the member can take from the current treatment path location, wherein the high value treatment path is determined according to a ranking of the set of treatment paths based on one or more costs and one or more clinical outcomes of the set of treatment paths;

determining, by the one or more processors, a next treatment on the high value treatment path;

generating, by the one or more processors and based at least in part on the pointer, a set of providers available for the next treatment;

generating, by the one or more processors and for a provider in the set of providers, (a) an expected longitudinal treatment value and (b) a copay for the next treatment, wherein the expected longitudinal treatment value indicates a predicted variance of a treatment value based at least in part on one or more attributes of the provider and the condition;

predicting, by the one or more processors, a candidate provider based at least in part on determining the candidate provider is associated with a lowest expected longitudinal treatment value;

generating, by one or more processors, coverage information for the next treatment for the candidate provider; and

triggering, based at least in part on the coverage information for the next treatment, self-updating of the atomized coverage graph.

Assignments (1)

Continuity (7)

References Cited (400)