Abstract: Systems and methods for intelligently routing a member of an organization to a single point-of-contact within an optimized, secure network to address all the member's healthcare needs are described. The disclosed intelligent routing configurations transform and process, in real-time, vast amounts of member data to generate aggregated diagnoses and a member score specific to each member's household. The scores, among other things, are used to determine an identification of special needs and an appropriate advocate within the organization to route the member, and its account file containing real-time member and household level data.

Abstract: Healthcare costs accumulated across a plurality of claims systems are managed using a centralized accumulator, which receives cost accumulator data for adjudicated claims from multiple sending claim systems. An accumulator record type is identified from the cost accumulator data and used to generate a cross-reference record. The record type includes an adjudicated claim. A routing message is generated for at least one receiving claim system according to the identified accumulator record type, the cost accumulator data received from the sending claim system, and an identity of the at least one receiving claim system. In response to sending the routing message to the receiving claim system, an acknowledgement is received, which is used to update the cross-reference record by the processor.

Abstract: Systems for call processing access and provide structured data about a customer to a representative, where the data is configured and presented through an optimized network are provided. The disclosed call processing systems provide a tailored, interactive graphical user interface (GUI) that provides access to specific user-focused internal and external data resources, presented to the representative, to allow the representative to drive conversations and address the customer's needs quickly.

Abstract: Systems for call processing access and provide structured data about a customer to a representative, where the data is configured and presented through an optimized network are provided. The disclosed call processing systems provide a tailored, interactive graphical user interface (GUI) that provides access to specific user-focused internal and external data resources, presented to the representative, to allow the representative to drive conversations and address the customer's needs quickly.

Abstract: A system, computer program product, and method for activation-based marketing are presented. In one embodiment, the system includes one or more data storage devices configured to store demographic data, healthcare utilization data, and response data associated with a target individual. The system may include a server coupled to the one or more data storage devices. The server may be suitably programmed to determine a life stage associated with a target individual, determine an attitudinal segment associated with the target individual, and determine a response model associated with the target individual. The server may assign the target individual to at least one of a predetermined set of segmentation groups in response to the life stage, the attitudinal segment, and the response model associated with the individual. The system may generate a personalized communication modality tailored to the target individual in response to the segmentation group assigned to the target individual.

Abstract: Systems and methods for intelligently routing a member of an organization to a single point-of-contact within an optimized, secure network to address all the member's healthcare needs are described. The disclosed intelligent routing configurations transform and process, in real-time, vast amounts of member data to generate aggregated diagnoses and a member score specific to each member's household. The scores, among other things, are used to determine an identification of special needs and an appropriate advocate within the organization to route the member, and its account file containing real-time member and household level data.

Abstract: Healthcare costs accumulated across a plurality of claims systems are managed using a centralized accumulator, which receives cost accumulator data for adjudicated claims from multiple sending claim systems. An accumulator record type is identified from the cost accumulator data and used to generate a cross-reference record. The record type includes an adjudicated claim. A routing message is generated for at least one receiving claim system according to the identified accumulator record type, the cost accumulator data received from the sending claim system, and an identity of the at least one receiving claim system. In response to sending the routing message to the receiving claim system, an acknowledgement is received, which is used to update the cross-reference record by the processor.

Abstract: Systems for call processing access and provide structured data about a customer to a representative, where the data is configured and presented through an optimized network are provided. The disclosed call processing systems provide a tailored, interactive graphical user interface (GUI) that provides access to specific user-focused internal and external data resources, presented to the representative, to allow the representative to drive conversations and address the customer's needs quickly.

Abstract: Systems and methods for intelligently routing a member of an organization to a single point-of-contact within an optimized, secure network to address all the member's healthcare needs are described. The disclosed intelligent routing configurations transform and process, in real-time, vast amounts of member data to generate specialized effort scores specific to each member's household. The effort scores, among other things, are used to determine an appropriate tier within the organization to route the member, and its account file containing real-time member and household level data.

Abstract: A method for directing inquiries to available subject matter experts includes storing an expert database in memory and defining presence states to describe present attributes of each subject matter expert with respect to a number of resource elements. Inquiries are directed to the experts, and response histograms are populated based on whether a response was obtained in a given presence state. The response histograms describe or define a response probability for each subject matter expert, as a function of the corresponding present attributes for each of the resource elements.

Abstract: Systems and methods for intelligently routing a member of an organization to a single point-of-contact within an optimized, secure network to address all the member's healthcare needs are described. The disclosed intelligent routing configurations transform and process, in real-time, vast amounts of member data to generate specialized effort scores specific to each member's household. The effort scores, among other things, are used to determine an appropriate tier within the organization to route the member, and its account file containing real-time member and household level data.

Abstract: Systems and methods for intelligently routing a member of an organization to a single point-of-contact within an optimized, secure network to address all the member's healthcare needs are described. The disclosed intelligent routing configurations transform and process, in real-time, vast amounts of member data to generate specialized effort scores specific to each member's household. The effort scores, among other things, are used to determine an appropriate tier within the organization to route the member, and its account file containing real-time member and household level data.

Abstract: Computer program products, methods, systems, apparatus, and computing entities are provided for sessions with participants and providers. For example, in one embodiment, a provider can interact with multiple participants to conduct interactive treatment sessions. Further, a participant can interact with multiple providers to conduct interactive treatment sessions. For the interactive treatment sessions, motion data and video data of the participant can be simultaneously displayed to the provider.

Abstract: Data is obtained from medical service providers. The data includes at least a plurality of available medical service appointments and pricing information. An inquiry for a medical service appointment is received from a user. A number of available medical service appointments are selected based on the inquiry and are then presented to the user. Prices for the available medical service appointments may be included and may be calculated based on current healthcare benefit plan information for the user. In response to a received purchase indication, one of the presented medical service appointments are purchased for the user.

Abstract: In one embodiment, disclosed herein is a method for selecting a treatment care path. The method includes receiving identification of a health condition and at least one medical outcome after treatment of the health condition. Further, the method includes identifying at least one medical treatment to achieve the medical outcome, the treatment care path including the at least one or medical treatment. Additionally, the method includes identifying one or more treatment options for each of the at least one medical treatment; and providing a cost estimate for each of the one or more treatment options. Finally, the method includes optimizing the treatment care path by, for each of the at least one medical treatments, selecting one or more treatment options based on the cost estimate thereof.

Abstract: A telehealth communications network accessible anywhere sufficient bandwidth connection is available facilitates a medical encounter between a patient at a patient site and a provider at a provider site remotely located from the patient, and includes an operating console comprising at least one memory and at least one processor coupled to the network, the operating console configured to execute at least one workflow for facilitating the medical encounter.

Abstract: Consumer healthcare decisions are facilitated using systems, methods and computer program products configured to generate healthcare path recommendations based a consumer engagement with a consumer interface in which consumer-reported information related to a consumer health condition is received and used to generate healthcare path recommendations. The healthcare path recommendations are customized for the consumer based on the consumer's personalized information including the consumer's engagement with the consumer interface. The customized healthcare paths include treatment options for addressing the health of the consumer and may include cost-effective providers.