My First Patent Issued: Routing Claims from Automatic Adjudication System to User Interface
I am pleased to announce the team I worked on at Collective Health was awarded a patent for our claim adjudication product we built to support the scaling of Collective Health’s offerings. This is my first ever patent. In mid 2017, I started working on a home-built product for claims processing. We received the patent, in October 2022, for the novel ways we achieved some of the highest industry accuracy and automation in the healthcare industry; and the innovative human-centered approach to processing claims when they fell out of automation. This system also allowed for innovative value-based plan designs that are hard to administer accurately by traditional claims systems.
Figure 2 from patent: has a high level overview of the UI in patent form
Conventional manual review of claims can be expensive, time-consuming, and error-prone, especially when dealing with a large number of claims and 1000s of plan designs. The system uses new methods of automatic adjudication to ease the burden on human claims adjustors and decrease the time it takes to adjudicate claims overall. If a claim cannot be handled by the automatic adjudication system, it can be redirected to a user interface for manual review that combines claims, eligibility, plan, and accumulator statuses all on one screen. The product provides contextual information and attention to detail that allows human claims adjustors to evaluate the claim with unheard-of efficiency and accuracy.
The thing that really gives me pride about this achievement is how much of the intellectual property of this work was authored by myself and my design partner, Heather Grates. Of the 20 claims in the patent 9 were partially accredited to design. This invention was not just limited to the UX and UI but how the core functioning of the automation worked.
We achieved this by doing generative research, identifying how the best human claims processors thought about their work. We were able to as a team back out the logic that these extreme users who either excelled at productivity or accuracy were using to do that work and apply it to both automation and a novel user interface. Bringing the best practices to the average human claims processor and super powers to the automation.
Huge congratulations to the entire team listed on the patent:
Also, many thanks to the big team of folks not mentioned above over the years who helped this team take this from invention to reality and all the operations associates that inspired the insights that drove this direction.
This product is both some of the nerdiest design work of my career and one of the biggest potential long term impacts i have made to the cost of healthcare and lessening the burden on families confused and challenged by navigating the US healthcare system. The link to the full patent is below.