- Document Number:
20250095015
- Appl. No:
18/884290
- Application Filed:
September 13, 2024
- نبذة مختصرة :
In an illustrative embodiment, methods and systems for modeling health care affordability across a population includes segmenting the population by demography and/or geography, determining chronic condition distribution across the population segments, modeling, across the population segments, medical service utilization distribution for a set of medical services, and calculating, using unit costs for each of the set of medical services, utilization costs for each population segment. The methods and systems may include calculating relative affordability metrics based on the utilization costs.
- Assignees:
Aon Global Operations SE, Singapore Branch (Singapore, SG)
- Claim:
1. A system for simulating health expense affordability, the system comprising: one or more chronic condition models trained to estimate likely numbers of a population having each of a set of chronic conditions, each chronic condition model being trained to estimate a chronic condition distribution based at least in part on geography and/or demography; and processing circuitry configured to perform operations comprising obtaining census data regarding a population of individuals, the census data comprising, for each individual, an age or an age range, a gender, and a geographic location, applying the census data to the one or more chronic condition models to obtain, for each chronic condition of the set of chronic conditions, a respective estimated chronic condition distribution among a plurality of census divisions of the population, using the census data and the respective estimated chronic condition distribution for each chronic condition of the set of chronic conditions, model, for each respective census division of the plurality of census divisions, a respective estimated utilization of a set of medical plan features for individuals of the population belonging to the respective census division, determining, for each respective medical plan feature of the set of medical plan features, a unit cost of the respective medical plan feature, using the unit costs of the set of medical plan features, calculating a set of estimated costs comprising, for each respective census division of the plurality of census divisions, a respective estimated cost to the individuals of the population belonging to the respective census division, and calculating, based on income levels across the population, at least one set of metrics representing relative affordability in light of the set of estimated costs.
- Claim:
2. The system of claim 1, wherein the processing circuitry is further configured to perform operations comprising calculating an estimated total spend exceeding a threshold percentage of income.
- Claim:
3. The system of claim 2, wherein the processing circuitry is further configured to perform operations comprising calculating, using a respective medical plan contribution level associated with each individual of the population, a respective estimated total spend per census division of the population and further per the respective medical plan contribution level.
- Claim:
4. The system of claim 1, wherein the processing circuitry is further configured to perform operations comprising imputing, for a subscriber segment of the population of individuals, estimated census data for a plurality of dependents comprising one or more dependents of each subscriber of at least a portion of the subscriber segment, wherein the census data comprises the estimated census data.
- Claim:
5. The system of claim 1, wherein the processing circuitry is further configured to perform operations comprising imputing, for each respective individual of at least a portion of a subscriber segment of the population of individuals, an estimated income level of the respective individual, wherein calculating the at least one set of metrics comprises calculated based on the estimated income levels.
- Claim:
6. The system of claim 1, wherein the processing circuitry is further configured to perform operations comprising modeling, for each respective census division of the plurality of census divisions, a respective estimated risk factor distribution for each risk factor of a set of risk factors.
- Claim:
7. The system of claim 6, wherein the set of risk factors comprises tobacco use, alcohol abuse, obesity, and/or poor nutrition.
- Claim:
8. The system of claim 1, wherein the processing circuitry is further configured to perform operations comprising modeling, based at least in part on the respective estimated chronic condition distribution for each census division of the plurality of census divisions, an estimated time away from work across the plurality of census divisions for medical reasons.
- Claim:
9. The system of claim 1, wherein the processing circuitry is further configured to perform operations comprising calculating, based on the respective estimated utilization of one or more medical plan features of the set of medical plan features, an estimated utilization rate for each census division of the plurality of census divisions.
- Claim:
10. The system of claim 9, wherein the one or more medical plan features comprises at least one of emergency room visits, preventative care visits, behavioral health visits, inpatient hospital visits, or outpatient surgical visits.
- Claim:
11. The system of claim 1, wherein modeling the respective estimated utilization of one or more medical plan features of the set of medical plan features comprises modeling based at least in part on provider shortage distributions across geographic divisions of the population.
- Claim:
12. The system of claim 1, wherein the processing circuitry is further configured to perform operations comprising calculating, based on geographic distributions across the population, at least one set of social determinants metrics representing relative levels of social determinant of health risk across the population.
- Claim:
13. A method for modeling health care affordability and health care availability across a population of individuals, the method comprising: modeling the health care affordability by determining, by processing circuitry, census data regarding the population of individuals, the census data comprising, for each individual, an age or an age range, a gender, and a geographic location, determining, by the processing circuitry, an income level distribution across the population of individuals, using the census data, segmenting, by the processing circuitry, the population of individuals into a plurality of census divisions, for each chronic condition of a set of chronic conditions, determining, by the processing circuitry, a respective estimated chronic condition distribution among the plurality of census divisions, by the processing circuitry, using the census data and the respective estimated chronic condition distribution for each chronic condition of the set of chronic conditions, modeling, for each respective census division of the plurality of census divisions, a respective estimated utilization of a set of medical plan features for a subset of the population of individuals belonging to the respective census division, for each respective medical plan feature of the set of medical plan features, determining, by the processing circuitry, at least one unit cost of the respective medical plan feature, by the processing circuitry, using the unit costs of the set of medical plan features, calculating a set of estimated costs comprising, for each respective census division of the plurality of census divisions, at least one respective estimated cost to a portion of the population of individuals belonging to the respective census division, and using the income level distribution, calculating, by the processing circuitry based at least in part on the set of estimated costs, at least one set of metrics representing relative affordability; modeling the health care availability by using the geographic location of the census data for each member of the population of individuals, calculating, by the processing circuitry, at least one distribution of health provider shortages for the population of individuals; and preparing, by the processing circuitry for presentation via a graphical user interface, a presentation comprising the at least one set of metrics and the at least one distribution of health provider shortages.
- Claim:
14. The method of claim 13, wherein modeling the health care availability comprises, using the geographic location of the census data for each member of the population, calculating, by the processing circuitry, at least one distribution of social determinants of health risks for the member population.
- Claim:
15. The method of claim 13, wherein the at least one distribution of health provider shortages comprises a distribution of mental health provider shortages, and a distribution of primary care physician shortages.
- Claim:
16. The method of claim 13, wherein: modeling the respective estimated utilization of the set of medical plan features comprises applying the census data to one or more utilization models to obtain, for each medical plan feature of the set of medical plan features, a respective estimated medical plan feature utilization distribution among the plurality of census divisions of the population, wherein each utilization model of the one or more utilization models was trained to estimate a feature utilization distribution based at least in part on demography.
- Claim:
17. The method of claim 13, further comprising: for each individual of the population of individuals, determining, by the processing circuitry, a respective medical plan of a set of possible medical plans; wherein, for at least a portion of the set of medical plan features, determining the at least one unit cost comprises modeling, for each respective medical plan of the set of possible medical plans, an estimated unit cost for subscribers of the respective medical plan.
- Claim:
18. The method of claim 13, further comprising: for each individual of the population of individuals, determining, by the processing circuitry, a respective medical plan of a set of possible medical plans; wherein calculating the at least one set of metrics representing relative affordability comprises calculating the at least one set of metrics based further on an employee contribution corresponding to each respective medical plan of the set of possible medical plans.
- Claim:
19. The method of claim 13, wherein the presentation is an interactive web-based presentation.
- Current International Class:
06; 06; 06; 06; 16; 16
- الرقم المعرف:
edspap.20250095015
Processing Request
No Comments.