Patent ID: 10922758

Abstract:
A computing system enables individuals and organizations to self-insure a benefit, e.g., a dental plan benefit. The system leverages a patient-centric data construct that evolves in a multi-dimensional manner as a patient continuously interacts with the system, its providers, participating organizations, etc. Using the patient-centric information repositories about the various participants (and their interactions), the system applies machine learning to the data to create data models that, in turn, provide valuable insights, or to otherwise enable more-efficient settlement processing. For example, a model may be used to determine an optimal patient-dentist match (by looking at utilization best provider outcomes), or a dentist over-provision of certain services (indicated by provider codes, thereby possibly indicative of fraud). Using patient-centric data modeling, the system determines if, when and how an organization can reduce expenses (e.g., by switching to other providers) or otherwise provide better care for participating employees. The data model(s) preferably evolve continuously, and the system dynamically-provisions computing resources as the patient-centric profiles evolve.