Abstract: The Use Determination Risk Coverage Datastructure for On-Demand and Increased Efficiency Coverage Detection and Rebalancing Apparatuses, Methods and Systems (“UDRCD”) transforms coverage enrollment request, event signal, ACGG request, search request inputs via UDRCD components into coverage enrollment response, add-in recommendation, ACGG response, search response outputs. A set of clinical conditions is determined. A set of treatments is determined for each clinical condition. Treatment paths data that specifies a set of treatment paths, wherein each treatment path comprises an ordered subset of treatments, is determined for each clinical condition. Providers are determined for each treatment. Practice patterns data that specifies, for each clinical condition treated by each provider, how likely the respective provider is to utilize each of the treatment paths is determined.

Abstract: The Use Determination Risk Coverage Datastructure for On-Demand and Increased Efficiency Coverage Detection and Rebalancing Apparatuses, Methods and Systems (“UDRCD”) transforms coverage enrollment request, event signal inputs via UDRCD components into coverage enrollment response, add-in recommendation outputs. A coverage enrollment request from a user is obtained. Available options for an enrollment user interface are configured based on the plan sponsor settings. Copay setting selections for individual core coverage services, atomized condition add-in selections, and atomized procedure add-in selections are obtained via the enrollment user interface. A core coverage cost and add-in coverage costs are calculated using the associated modeling data. A user cost for the user is calculated based on the core coverage cost, the subsidization settings for the core coverage cost, the add-in coverage costs, and the subsidization settings for the add-in coverage costs.

Abstract: A system and method for providing a consumer healthcare guide receive a set of search criteria and retrieve one or more health-related listings based on the set of search criteria. The health-related listings may include healthcare quality data and/or consumer cost data, which may include provider listings and/or facility listings. The provider listings may include a consumer cost rating based upon provider costs associated with a selected healthcare product or service. The facility listings may include a consumer cost rating based upon facility charges associated with a selected healthcare product or service. The consumer guide may also provide quality data, such as a healthcare quality rating corresponding to a quality score based on predetermined criteria. The consumer guide further may provide cost and/or quality information on a variety of aspects of healthcare including, for example, hospitals and other facilities, doctors and other providers, pharmaceuticals, and health insurance plans.