Abstract: The computer implemented method and system disclosed herein automates business processes of a health plan organization using a plurality of portals. The portals comprise a sales portal, a member portal, an employer portal, an administration portal, and a provider portal. Health plans are listed using the sales portal. A sales agent proposes at least one of the health plans to a consumer using the sales portal. The administration portal generates insurance quotes for the proposed health plans. The consumer enrolls for the proposed health plans using one of the member portal and the employer portal. The consumer is billed for the enrolled health plans based on the insurance quotes using the administration portal. The consumer pays a premium amount online for the enrolled health plans using the member portal or the employer portal. The administration portal then generates commissions for the sales agent for the enrolled health plans.

Abstract: The computer implemented method and system disclosed herein automates business processes of a health plan organization using a plurality of portals. The portals comprise a sales portal, a member portal, an employer portal, an administration portal, and a provider portal. Health plans are listed using the sales portal. A sales agent proposes at least one of the health plans to a consumer using the sales portal. The administration portal generates insurance quotes for the proposed health plans. The consumer enrolls for the proposed health plans using one of the member portal and the employer portal. The consumer is billed for the enrolled health plans based on the insurance quotes using the administration portal. The consumer pays a premium amount online for the enrolled health plans using the member portal or the employer portal. The administration portal then generates commissions for the sales agent for the enrolled health plans.

Abstract: The computer implemented method and system disclosed herein automates business processes of a health plan organization using a plurality of portals. The portals comprise a sales portal, a member portal, an employer portal, an administration portal, and a provider portal. Health plans are listed using the sales portal. A sales agent proposes at least one of the health plans to a consumer using the sales portal. The administration portal generates insurance quotes for the proposed health plans. The consumer enrolls for the proposed health plans using one of the member portal and the employer portal. The consumer is billed for the enrolled health plans based on the insurance quotes using the administration portal. The consumer pays a premium amount online for the enrolled health plans using the member portal or the employer portal. The administration portal then generates commissions for the sales agent for the enrolled health plans.

Abstract: Disclosed herein is a computer implemented method and system for rewarding health care providers using an integrated medical management system. A web application analyzes performance of the health care providers. The web application acquires information from integrated medical management system. The acquired information includes information of health care quality improvement analysis, disease and case based management, utilization analytics, physician profiling, authorizations management, lab and imaging information, and health risk assessment information. The web application determines performance indices for the health care providers based on the acquired information. The performance indices include a quality index, an economic index, and a relative value unit index of the health care providers. The web application analyzes the performance of the health care providers based on the performance indices. The analysis includes identifying health care providers eligible for a reward.

Abstract: Disclosed herein is a computer implemented method and system that addresses the need for utilization analysis and performance evaluation of providers in a health care organization. The health care data comprising health plan information of consumers, providers, claims, and hospitals is collected, translated, and organized in a structured relational format and stored in standard tables. The organized health care data is analyzed by calculating consumer statistics for a health plan using the health plan information of the consumers. The claims of the consumers are processed to classify the claims based on age, gender, disease, and comorbid conditions of the consumers. A plurality of costs of the health care organization is determined using one or more of the health plan information. The performance of the providers is assessed using the determined plurality of costs. The providers comprising primary care physicians are analyzed based on entire population of the associated consumers.

Abstract: The computer implemented method and system disclosed herein automates business processes of a health plan organization using a plurality of portals. The portals comprise a sales portal, a member portal, an employer portal, an administration portal, and a provider portal. Health plans are listed using the sales portal. A sales agent proposes at least one of the health plans to a consumer using the sales portal. The administration portal generates insurance quotes for the proposed health plans. The consumer enrolls for the proposed health plans using one of the member portal and the employer portal. The consumer is billed for the enrolled health plans based on the insurance quotes using the administration portal. The consumer pays a premium amount online for the enrolled health plans using the member portal or the employer portal. The administration portal then generates commissions for the sales agent for the enrolled health plans.

Abstract: Disclosed herein is a computer implemented method and system that addresses the need for an online disease based and case based management of medical care. An online disease and case management system is provided. The information of the patients is retrieved from multiple information sources. The patient information is used to identify one of a disease condition in a patient population and a patient with a disease condition. Further, the patients are enrolled. The enrolled patients are educated about the disease condition for self monitoring of the disease condition. The status of the self monitored disease condition is recorded in a disease log. Visits to a provider are scheduled for medical treatment of the enrolled patients. The enrolled patients are monitored for medical progress based on the medical treatment provided. Further, the disease and case management of medical care are evaluated and reported based on clinical and financial outcomes.

Abstract: Disclosed herein is a computer implemented method and system for rewarding health care providers using an integrated medical management system. A web application analyzes performance of the health care providers. The web application acquires information from integrated medical management system. The acquired information includes information of health care quality improvement analysis, disease and case based management, utilization analytics, physician profiling, authorizations management, lab and imaging information, and health risk assessment information. The web application determines performance indices for the health care providers based on the acquired information. The performance indices include a quality index, an economic index, and a relative value unit index of the health care providers. The web application analyzes the performance of the health care providers based on the performance indices. The analysis includes identifying health care providers eligible for a reward.

Abstract: Disclosed herein is a computer implemented method and system that addresses the need for an online disease based and case based management of medical care. An online disease and case management system is provided. The information of the patients is retrieved from multiple information sources. The patient information is used to identify one of a disease condition in a patient population and a patient with a disease condition. Further, the patients are enrolled. The enrolled patients are educated about the disease condition for self monitoring of the disease condition. The status of the self monitored disease condition is recorded in a disease log. Visits to a provider are scheduled for medical treatment of the enrolled patients. The enrolled patients are monitored for medical progress based on the medical treatment provided. Further, the disease and case management of medical care are evaluated and reported based on clinical and financial outcomes.

Abstract: Disclosed herein is a computer implemented method and system that addresses the need for utilization analysis and performance evaluation of providers in a health care organization. The health care data comprising health plan information of consumers, providers, claims, and hospitals is collected, translated, and organized in a structured relational format and stored in standard tables. The organized health care data is analyzed by calculating consumer statistics for a health plan using the health plan information of the consumers. The claims of the consumers are processed to classify the claims based on age, gender, disease, and comorbid conditions of the consumers. A plurality of costs of the health care organization is determined using one or more of the health plan information. The performance of the providers is assessed using the determined plurality of costs. The providers comprising primary care physicians are analyzed based on entire population of the associated consumers.

Abstract: The computer implemented method and system disclosed herein automates business processes of a health plan organization using a plurality of portals. The portals comprise a sales portal, a member portal, an employer portal, an administration portal, and a provider portal. Health plans are listed using the sales portal. A sales agent proposes at least one of the health plans to a consumer using the sales portal. The administration portal generates insurance quotes for the proposed health plans. The consumer enrolls for the proposed health plans using one of the member portal and the employer portal. The consumer is billed for the enrolled health plans based on the insurance quotes using the administration portal. The consumer pays a premium amount online for the enrolled health plans using the member portal or the employer portal. The administration portal then generates commissions for the sales agent for the enrolled health plans.