US20200372571A1

US20200372571A1 - Computing system for sharing networks providing dynamic reserving features and related methods

Info

Publication number: US20200372571A1
Application number: US16/876,736
Authority: US
Inventors: Anthony F. Meggs
Original assignee: Sharable LLC
Current assignee: Sharable LLC
Priority date: 2019-05-22
Filing date: 2020-05-18
Publication date: 2020-11-26
Also published as: US20200372554A1; US20200372479A1; US11593777B2; US20200372478A1; US11449847B2

Abstract

A computing device may operate a virtual share exchange (VSE) module and a billing module. The billing module may be configured to receive recurring electronic deposits from VSE members to fund member sharing accounts, with the recurring electronic deposits including a share portion and a dynamic reserve portion to accumulate reserve funds in the member sharing accounts. The billing module may further calculate an aggregate amount of available reserve funds across the member sharing accounts as funds are electronically transferred for payment sharing of the member healthcare bills, compare the calculated aggregate amount of available reserve funds to a reserve target fund range, and adjust the dynamic reserve portion to change the recurring electronic deposits responsive to the calculated aggregate amount of reserve balance falling outside of the reserve balance target range to bring the aggregate amount of reserve balance funds back into the reserve balance target range.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of provisional application Nos. 62/851,282; 62/851,279; 62/851,298; 62/851,395; 62/851,321 filed May 22, 2019, and provisional application No. 62/869,661 filed Jul. 2, 2019, all of which are hereby incorporated herein in their entireties by reference.

TECHNICAL FIELD

The present invention relates generally to computing systems, and more particularly, to computer infrastructures that provide for implementation of Virtual Share Exchange (VSE) platforms.

BACKGROUND

In recent years, health care expense sharing has emerged as a “decentralized” approach to financing and reserving for health care costs. As a “non-insurance” alternative, health care sharing is not subject to typical insurance regulations. Individual participants are legally and ultimately responsible for their own medical bills. However, participants in health care sharing networks willingly and consistently share from their own personal funds to pay each other's medical bills.
Some health care sharing networks implement a technology framework often called a Virtual Share Exchange (VSE). The VSE may include a collection of virtual account management, billing, and payment technologies that form a comprehensive and transparent health care sharing process. The VSE model enables health care sharing networks to facilitate sharing programs on a P2P (or member-to-member) basis to help provide compliance with applicable safe harbor exemptions to insurance regulations.
VSE platforms have enabled healthcare sharing networks to rapidly grow and scale similar to institutional computer network models, like health insurance. Modern VSE platforms have become advanced Fintech applications that integrate all the stakeholders and financial processes that are necessary to facilitate member-to-member sharing via computer networking and electronic payment infrastructure.

SUMMARY

A computing device may include a memory and a processor configured to cooperate with the memory to operate a virtual share exchange (VSE) module. The VSE module may be configured to establish member sharing accounts for respective members of a VSE for sharing payment of member healthcare bills across the member sharing accounts, and electronically transfer funds from the sharing accounts for payment sharing of the member healthcare bills. The processor may further operate a billing module configured to receive recurring electronic deposits from the members to fund the member sharing accounts, where the recurring electronic deposits including a share portion and a dynamic reserve portion to accumulate reserve funds in the member sharing accounts. The billing module may further calculate an aggregate amount of available reserve funds across the member sharing accounts as funds are electronically transferred for payment sharing of the member healthcare bills, compare the calculated aggregate amount of available reserve funds to a reserve target fund range, and adjust the dynamic reserve portion to change the recurring electronic deposits responsive to the calculated aggregate amount of reserve balance falling outside of the reserve balance target range to bring the aggregate amount of reserve balance funds back into the reserve balance target range.
In an example implementation, the reserve target fund range may comprise a real-time minimum aggregate amount of available reserve funds, and a real-time maximum aggregate amount of available reserve funds. In accordance with another example implementation, the reserve target fund range may comprise a forecasted minimum aggregate amount of available reserve funds, and a forecasted maximum aggregate amount of available reserve funds. By way of example, the forecasted minimum and maximum aggregate amounts of available reserve funds may be based upon at least one a of number of net new members to the VSE, an aggregate amount of new funds per member, and net withdrawals per member, over a time period.
In accordance with one example, the billing module may increase the dynamic reserve portion of the electronic deposits by no more than a debit threshold amount for each recurring electronic deposit. In another example, the billing module may decrease the dynamic reserve portion of the electronic deposits by no more than a credit threshold amount for each recurring electronic deposit. The billing module may also change the dynamic reserve portion of the electronic deposits further based upon a cost of living differential associated with respective different geographical locations of the members of the VSE.
A related method may include operating a virtual share exchange (VSE) module and a billing module at a computing device, such as those described briefly above. A related non-transitory computer-readable medium may have computer-executable instructions for causing a computing device to perform steps comprising operating a VSE module and a billing module similar to those described briefly above.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic block diagram of a computing system providing payment sharing across a virtual share exchange (VSE) network platform with dynamic reserving in accordance with an example embodiment.

FIG. 2 is a table illustrating an example health care sharing dynamic reserve engine profile which may be used by the computing system of FIG. 1.

FIG. 3 is a table illustrating an example reserve summary which may be generated by the VSE monitoring service of the system of FIG. 1.

FIG. 4 is a table illustrating an example performance indicator summary which may be generated by the VSE monitoring service of the system of FIG. 1.

FIG. 5A is a table illustrating an example assignment analysis which may be generated by the dynamic reserve engine of the system of FIG. 1.

FIG. 5B is a flow diagram illustrating the steps of the example assignment analysis of FIG. 5A.

FIG. 6 is a display view of a graphical user interface (GUI) generated by the server of the system of FIG. 1 providing a health care sharing statement including member sharing and dynamic reserve portions when an aggregate dynamic reserve is outside of a reserve target range.

FIG. 7 is a display view of the GUI of FIG. 6 providing a health care sharing statement when the aggregate dynamic reserve is within the reserve target range.

FIG. 8 is a schematic block diagram of a processor of the server of FIG. 1 and associated computing modules.

FIG. 9 is a flow diagram illustrating example method aspects associated with the system of FIG. 1.

BRIEF DESCRIPTION OF THE DRAWINGS

Example embodiments will now be described more fully hereinafter with reference to the accompanying drawings, in which the example embodiments are shown. The embodiments may, however, be implemented in many different forms and should not be construed as limited to the specific examples set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete. Like numbers refer to like elements throughout.
Referring initially to FIG. 1, a computing system 30 which provides for payment sharing across different virtual share exchange (VSE) network platforms 31 is now described. By way of background, individuals joining forces as a group to achieve certain benefits and advantages is common in many facets of our everyday life. The power of groups is largely evident in the pooling practice found in the traditional insurance model. By pooling their resources through a centralized insurance company or common fund, groups are able to finance, reserve, and pay the expenses associated with the type of insurance risk. Without being able to rely on the insurance company and its practice of pooling funds, the individuals would be left to bear the cost and risk of a catastrophic loss by themselves.
Historically, traditional insurance companies were largely successful at helping groups of individuals finance and reserve for their expenses and catastrophic risk. By collecting and pooling both the risk and the resources of individuals into centralized group fund, traditional insurance coverage and the benefits obtained therefrom were made more affordable. In the past, the efficiency of pooling and reserving resources in a centralized fund enabled insurance companies to not only provide affordable coverage, but to capture a profit or bounty for pooling those resources into a central fund. Resources that are collected and pooled into the centralized fund are called “premiums”, which is derived from the Latin word “praemium” and defined as a “reward, profit or bounty for a specified act”. Thus, insurance companies were able to generate significant profit by extracting a “premium” from groups of individuals who were unable to pool resources to finance and reserve for their individual risk of catastrophic loss and costs.
Traditionally, the affordability of insurance coverage was predicated upon the overall wellness of the group and their consumption of services. For example, in healthcare, some members' need for medical services could be little more than annual checkups, while other individuals might need to access and consume services much more extensively. It is the latter group that has a greater effect on the overall costs of the group and the subsequent premiums collected. For those that do not frequently draw upon the centralized fund's resources, being lumped with the more extensive users is unfavorable. On the flip side, those who consume a larger share of the benefits may enjoy lower premiums because the individuals that consume little are subsidizing the expense of frequent consumers. In the past, insurance companies would respond to individuals who draw disproportionally on the centralized fund by raising their premiums to maintain group equity and ensure company profits.
With respect to financing and reserving for health care, the average consumer would not be able to afford much more than the very basic of health care services if the pooling of resources was not available through insurance. In fact, based upon current rates being charged by the medical industry, cutting edge or life-saving surgeries, drugs and treatments would be difficult, if not, impossible, for the average consumer to obtain.
However, in recent years the affordability and profitability of the traditional insurance model has been degraded by the enactment of government regulations. New laws and regulations have all but eliminated an insurance company's ability to segment groups of healthy individuals into centralized funds, or plans, that price premiums according to the group's health and draw on resources. Similarly, new regulations have mandated that all centralized funds, or plans, cover new and more extensive medical services not historically offered by health insurance companies. As a result, health insurance companies have been greatly limited in their ability to offer affordable coverage that is reflective of the health condition and medical usage of individual participants, as well offer affordable plans that provide access to the medical services that participants actually desire, versus services the government mandates.
Another disadvantage of the health insurance model and the associated regulations is that individuals of the centralized fund and plan can lead unhealthy or “at risk” lifestyles such as high-risk diets, low exercise, smoking, excessive alcohol intake and the use of illicit drugs, all without consequence. By engaging in such lifestyles, these individuals increase their likelihood of drawing on the resources and benefits of the centralized fund. The more these “high-risk” individuals are allowed to make choices and lead lives without consequences, the more likely that costs and premiums increase for everyone in the fund.
An additional disadvantage of the centralized insurance model is that the plan benefits are distributed to individuals of the group in such a way that no other individual participating in the plan has any real sense of what types of benefits or services are being paid for by the insurance company. The centralized insurance model provides no visibility into the size of the fund, the number of participating individuals, the size of available reserves, the flows of money, or profits pocketed by the insurance company. Thus, participating individuals are unaware of the financial health and wellness of the fund. This lack of transparency also makes individuals feel less responsible for their lifestyle choices that increase their draw of resources, as well as less connected and accountable to their fellow participants who are paying their bills.
The structural inefficiencies, inherent in the design of the centralized health insurance model, have been recently exposed by the new government mandates and regulations in health care. It has caused a rapid and unsustainable rise in premiums and insurance costs. Thus, the centralized health insurance model has become unaffordable and subsequently obsolete. And while the changes have been focused exclusively on healthcare, the aforementioned problems similarly persist in the other insurance markets.
As a result, consumers have sought out new and more innovative ways to organize themselves into groups that leverage the strength of their combined resources to finance and reserve for their health care costs. Unlike the centralized insurance model, consumers are turning to decentralized network models that are enabled by technologies that replace the pooling functions of traditional insurance companies.
In recent years, health care sharing has emerged as the most popular “decentralized” approach to financing and reserving for health care costs. As a “non-insurance” concept, health care sharing is not encumbered by insurance regulations. Individual participants are legally and ultimately responsible for their own medical bills. However, participants in Health Care sharing networks willingly and consistently share from their own personal funds to pay each other's medical bills. Health care sharing networks have been in existence since the early 1980s, but in recent years have grown to become a significant alternative to the centralized insurance model. Today, health care sharing networks enjoy safe harbor exemptions in U.S. health care laws and more than 30 states. Participants of health care sharing networks are sharing billions of dollars worth of medical bills on an annual basis. Free from insurance regulations, health care sharing networks can design and implement programs that are more efficient and affordable than insurance, as well as hold participants more accountable to each other.
As noted above, some health care sharing networks implement a technology framework often called a Virtual Share Exchange or VSE. The VSE may include a collection of computing hardware (e.g., servers or other computing devices including microprocessors and associated memory with non-transitory computer readable instructions) to implement virtual account management, billing, and payment modules that form a comprehensive and transparent health care sharing process. The VSE model enables health care sharing networks to facilitate sharing programs on a P2P (or member-to-member) basis to help ensure that these sharing networks refrain from the practice of insurance, and remain in compliance with the safe harbor exemptions of insurance rules/regulations.
Moreover, contemporary VSE platforms 31 have enabled healthcare sharing networks to rapidly grow and scale their networks by leveraging social trends towards the democratization of centralized institutional business models, like health insurance. Modern VSE platforms 31 have become advanced Fintech applications that integrate all the stakeholders and financial processes that facilitate member-to-member sharing, which will now be discussed further with reference to FIG. 2.
Prospective members 32 are consumers who are applying for membership into the sharing network and its community. In order to complete their application for membership, prospective members 32 set-up and activate their share account 33 through a computing device(s) 34, such as a server. In an example embodiment, the computing device 34 may be part of a cloud computing architecture, although other configurations may be used in different embodiments. Share accounts 33 are activated through a graphical user interface or GUI (often called the Application Center or Activation Center) to access account activation services within a banking module 35 of the computing device 34.
Active members 36 are consumers who have been accepted and are active in the sharing network and associated community. Active members 36 make monthly deposits (called monthly share amounts) electronically into their share account 33 that is held within a VSE/for the benefit of (FBO) module 37 of the computing device 34. To pay (or deposit) their monthly share amount into their share account 33, members 36 access services within the banking module 35 through a graphical user interface, as noted above. The banking module 35 provides services that enable members 36 to link their share account 33 to an external payment method and initiate recurring monthly transactions.
The banking module 35 may be implemented as a cloud-based application that enables both prospective members 32 and active members 36 to activate and manage their participation in the sharing network's program through a financial account (called a share account 33) that the member owns and controls. The banking module 35 enables members 36 to link an external bank account to their share account 33, to fund their share account per the terms of the sharing network, and to manage banking and regulatory compliance.
The billing module 49 may be implemented as a cloud-based application that calculates monthly share prices and creates the monthly share notices for the sharing network. Moreover, the billing module bills, publishes and collects the monthly share notice per the terms of the sharing network.
The VSE/FBO module 37 may also be implemented as a cloud based virtual account management and ledgering system that enables the sharing network to facilitate the member-to-member sharing and payment of member bills. The VSE/FBO module 37 enables member-to-member sharing through virtual accounts 33 that are owned and individually controlled by the members 36 and not the sharing network, as well as to house those virtual accounts in a single FBO account held by a financial institution “for the benefit of” the member 36.
The member share accounts 33 are member owned and controlled virtual accounts maintained by the VSE/FBO module 37, and are required for members 36 to participate in the sharing network. The share accounts 33 enable the sharing network to build distributed reserves in accounts that are owned and controlled by its members 36, and facilitate member-to-member sharing through those accounts.
Sharing network fee accounts 39 are virtual accounts maintained by the VSE/FBO module 37 that are owned and controlled by the sharing network and used to comply with any potential regulatory constraints. The fee accounts 39 help segregate “member owned” funds that are held in share accounts 33 and used for sharing from “network owned” funds, which are operating fees that are billed and collected as a part of a monthly share notice.
Sharing network external accounts 40 are external bank accounts that are owned and controlled by the sharing network and are linked to a specific sharing network fee account 39 that resides in the VSE/FBO module 37. As operating fees are collected through the payment by members 36 of monthly share notices, sharing networks are able to access those funds by transferring them out of the sharing network fee account 39 to its linked external account 40. The sharing network external accounts 40 allow for withdrawing operating funds out of the VSE/FBO module 37.
The member bills 38 are invoices billed by a member's service provider that have been received by the sharing network. The member bills 38 are to be shared by the members of the sharing network per the network's guidelines.
A sharing reserve request 41 represents a member bill from another sharing network that is participating in a federation or collaboration of sharing networks who have agreed to share in each other's member bills per the terms of a shared reserve agreement, as will be discussed further below.
An allocation module 42 may be implemented as a cloud-based bill matching and allocation service enabling sharing networks to facilitate bill sharing, help ensure regulatory compliance, and to generate more meaningful sharing transactions. The allocation module 42 may be used to match and allocate bills on a member-to-member basis, and to draw down distributed bills in a way that is equitable to all members 36.
A publishing module 43 may be implemented as a cloud-based notification and sharing service for initiating member-to-member (P2P) account transfers. The publishing module 43 notifies members 36 as to whose bill they have been matched to, and how much of their available share account 33 balance has been allocated as a contribution to the payment that member's bill, as well as to provide each matched member with the means to voluntarily share (agree) in the payment of that bill.
The provider account 44 is a virtual account within the VSE module 37 that is owned and managed by individual service providers, or a single virtual “settlement” account that aggregates funds for multiple payments made to multiple service providers, or some combination of both. The provider account(s) 44 segregate funds that have been shared and collected for the payment of a bill 38 or 41, and to make those funds available to the appropriate service provider.
An external provider account 45 is a linked external account owned and managed by an individual service provider for transferring funds out of the VSE/FBO module 37 or linked external account owned and managed by a payment processor for transferring multiple payments to be made to multiple service providers. More particularly, the provider external accounts 45 allow for withdrawing bill 38, 41 payments out of the VSE/FBO module 37.
Insurance companies across numerous industries build and retain financial reserves as part of their regulatory obligations. Reserves are required to pay large catastrophic bills, as well as to manage spikes in bill flows that are greater than the ordinary flow of claims. These companies are free to leverage a significant amount of their premium income and reserves into approved financial investments. However, none of the investment profits benefit the policyholders, rather it effectively serves as a free loan to the insurance company.
Even though sharing networks are unregulated, they also need to build, retain, and access reserves to maintain the fiscal health of the network. Like insurance, sharing networks can experience the same spikes in bill flow or be affected by large catastrophic bills. Thus, sharing networks are motivated to build and sustain targeted reserve levels. However, to avoid being deemed an unlawful insurance company, sharing networks do not take receipt of member funds and “pool” those funds to build reserves. To circumvent the risk of being deemed insurance, sharing networks, in the VSE computing platform 31, members 36 build and hold excess amounts in the share accounts 33 that they personally own. This is called distributed reserving or distributed reserves.
Sharing networks can build distributed reserves by pricing the member monthly share amounts higher than what is needed to share and pay the average monthly flows of bills. The distributed reserves build in the share accounts, but the sharing network never takes receipt of member funds. However, the network can access funds in the share accounts 33, per the sharing guidelines and the permissions given to the network by the members 36. Thus, the distributed reserves can be used to absorb catastrophic medical events and to pay member bills quickly.
Generally speaking, the VSE platform 31 is advantageously configured to automatically and dynamically facilitate sharing through share accounts 33 to targeted levels using dynamic reserves. Through enhancements and extensions of the VSE billing module 49, sharing networks can dynamically react to stresses and excesses of targeted reserved levels by engineering a variable bill amount (or dynamic reserve portion) to the monthly share amount (or portion) to sustain its distributed reserves. As reserves grow in excess of targeted levels, member accounts 33 are automatically credited by the VSE module 37. As reserves fall below targeted levels, member accounts 33 are debited a small amount by the VSE module 37. Incorporating a small variable amount in a monthly share notice helps a network regulate reserve targets, as well as deepens the loyalty of members 36 by helping to ensure them that the reserve amounts held in their share accounts 33 will not grow too large or too small.
Referring additionally to FIG. 8, the computing system 30 and related methods allow sharing networks to regulate and sustain targeted reserve levels by dynamically allocating a variable amount to the monthly invoice/statements of its members 36. In the illustrated example, a dynamic reserving engine 50 may be implemented by a processor 60 and associated memory 61 within the billing module 49 of the server 34 to extend the capabilities of the VSE billing module 37. Sharing networks who utilize the VSE platform 31 with a dynamic reserving engine 50 may advantageously monitor key performance and leading indicators to assess and forecast near-term changes in reserve levels. Armed with the necessary intelligence to assess reserve levels, sharing networks may configure the dynamic reserving engine 50 to regulate their reserves through variable amounts that may be credited or debited in a monthly (or other time period) share notice published to members 36.
The dynamic reserving engine 50 extends the VSE platform 31 of a healthcare sharing network, in that it is configured to sustain targeted reserve levels by automatically calculating and allocating a variable amount to be assigned to the monthly share notice. The dynamic reserving engine 50 includes three separate components or services that are used to maintain reserve levels. The first is a dynamic reserve profile (which may be implemented in a database 51 stored in the memory 61), which may be configured to provide triggers and boundaries for billing the variable amount. The second component is a VSE monitoring service or module 52 configured to automatically track and monitor performance indicators used to assess and forecast near-term changes in reserve levels. The third component of the dynamic reserve engine 50 is a variable billing service or module 53, which is configured to automatically calculate and assign the amounts to be billed to the monthly share amount.
Upon initially configuring the virtual share exchange, a health care sharing network enables the dynamic reserving engine (DRE) 50. As previously noted, to enable the DRE 50 the sharing network first configures the dynamic reserve profile 51. The dynamic reserve profile 51 sets the boundaries or thresholds for automatically determining when to assign a variable amount to the share notice, as well as the amount to assign. While the dynamic reserve profile 51 can be configured with many attributes that can be used to trigger and calculate the share notice assignment, two example attributes may be particularly beneficial in the dynamic reserve profile.
Referring additionally to the table 70 and sections 71-74 of FIG. 2, the first attribute is reserve targets 71 in the form of the “minimum” reserve amount and a “maximum” reserve amount. Reserve targets 71 enable the DRE 50 to know when, and when not, to bill a variable amount to member share notices. The “reserve minimum” provides the thresholds to initiate a debit to share notices, to increase distributed reserves, and replenish falling reserve levels. The “reserve maximum” provides the thresholds to initiate a credit to share notices and decrease distributed reserves. Decreasing the excess reserves and crediting share notices is a windfall to members 36 that builds loyalty and sets sharing networks apart from insurance companies. The reserve targets 71 also include the form or type of reserve trigger for the assignment of variable bill amounts. Thus, the reserve profile can be configured to use “actual” reserve amounts as the trigger for dynamic reserving, or it may be configured to use a “forecasted” amount as the DRE 50 trigger.
A second attribute of the dynamic reserve profile is billing parameters 72. Billing parameters also come in the form of “minimums and maximums”, but for the debit or credit amounts that are triggered by the dynamic reserving engine 50 and billed on monthly share notices. The maximum billing parameters 72 set the boundaries to the dynamic reserving engine 50 for how much of a debit amount or credit amount can be billed on the share notices. The maximums set an expectation in the minds of members of how much their share notice might increase or decrease in a given month, so they can plan accordingly. The minimum billing parameters 72 set a minimum amount that can be debited or credited, and may be used to help avoid trivializing the dynamic reserving process in the minds of members 36. There are other attributes that can be embedded in the dynamic reserve profile and used to calculate the variable amounts billed by the dynamic reserving engine. For instance, cost of living differentials 73 can be used to factor the actual variable amounts based on geographical living costs. Program differentials 74 may also be used to assign different variable amounts by program types.
An example of two dynamic reserve profiles for separate networks is provided in FIG. 2. Share network # 1 has set its minimum and maximum reserve triggers in the form of a number of “sharing months”. Network # 1 has set its reserve minimum at 2 months sharing and has set its reserve maximum at 4 months sharing. Network # 2 has set its triggers in terms of nominal amounts; $80,000,000 as its reserve minimum and $160,000,000 as its reserve maximum. Network # 1 intends to use “forecasted” reserves as its dynamic reserve trigger, whereas Network # 2 will use “actual” reserves. Forecasted reserves may be desirable in some implementations as they enable a network to leverage key performance and leading financial indicators to proactively and automatically regulate reserves before the rise above or fall below targeted levels. Network # 1 and Network # 2 have set similar billing parameters. They both have set $5.00 as the minimum credit amount and debit amount that can be assigned as a variable bill amount. Both networks have also set $30.00 as the maximum debit amount that can be billed to share notices. Network # 1 has chosen not to apply cost of living differentials or program differentials in the amounts it assigns to share notices. On the other hand, Network # 2 intends to apply both.
The VSE monitoring service 52 enables the DRE 50 to persistently monitor the sharing accounts of the sharing network and the performance metrics that are used to assess and forecast near-term changes in the distributed reserves. In addition to a persistent monitoring of specific performance metrics and leading indicators, the VSE monitoring service 52 generates periodic reserve summaries (see FIG. 2) that are fed into the variable billing service 53. Sharing networks that facilitate bill sharing through the VSE platform 31 are uniquely positioned to benefit from dynamic reserving because the VSE platform can equip a sharing network to generate reserve summaries that dynamically assess and forecast performance indicators that may be used to implement dynamic reserving, which are now discussed further with reference to the table 80 of FIG. 3.
To accurately assess and forecast near-term reserve levels, a sharing network may desire to estimate, monitor and track their total funds available for sharing (section 82) on a per month basis. Total funds available for sharing are derived from three different input sources. First, the starting available balance may be determined by assessing the reserve dollars that are held in member share accounts (i.e., distributed reserves) at the beginning of the month. Second, new share deposits may be estimated for the current month. New deposits come in the form of share notice payments, minus the admin fees that the network collects as operating expenses. Third, balance withdrawals are estimated over the defined time period to account for members who terminate their membership and withdraw available funds from their share accounts.
By adding the estimated new share deposits to the starting available reserve balance and then subtracting the estimated balance withdrawals, a sharing network can forecast its total funds available for sharing. Referring additionally to the table 90 and sections 91-93 of FIG. 4, while the VSE monitoring service 52 can track multiple key performance indicators (KPIs) and metrics for assessing and forecasting total funds available, the most used metrics (section 91) may be those that generate some manifestation of member growth (net new members), monthly share deposits (new funds per member) and account withdrawals (net withdrawn per member).
Once the DSE 50 estimates its total funds available for sharing, it next assesses and forecasts total funds needed for sharing (section 85). Funds needed for sharing represents the net dollars, in terms of member medical bills 38, that are to be published to the members for sharing during the time period. Funds needed for sharing are typically derived from two primary input sources. First, the DRE 50 calculates the total bill amounts that are eligible for sharing (section 83). This is the aggregate amount of medical bills received by the network that have been reduced by bill amounts that are ineligible for sharing and have been reduced by discounts and audit findings.
The second input source used to calculate funds needed for sharing is to assess and forecast amounts excluded from sharing (section 84). This represents bill amounts that are not published to the members for sharing, but are paid by others. Typically, these are member responsibility amounts paid by bill owners themselves, or amounts paid by third parties. By subtracting the “excluded from sharing” from the “eligible for sharing”, the network is able to derive the total funds needed for sharing.
The VSE monitoring service 52 may be configured to automatically track multiple KPIs and metrics for assessing and forecasting the total funds needed for sharing. However, the most used metrics (section 92) may be those that generate some manifestation of gross billed charges (per member), net bill charges (per member), eligible bill charges (per member) and published bill charges (per member). The VSE platform 31 may also track additional metrics (section 93) such as the bill discount or adjustment rate, audit and error rate, bill ineligible rill rate, member responsibility rate and third-party rate to better assess and forecast changes in the funds needed for sharing.
Armed with the ability to persistently monitor, track and assess the key performance indicators necessary to derive and forecast total funds available for sharing (section 81) and total funds needed for sharing (section 85), the DRE 50 is equipped to late and forecast total funds distributed and reserved for sharing (section 85). Funds distributed and reserved for sharing are those funds that remain in the member share accounts after the funds needed for sharing are subtracted from the available funds for sharing. These are the ending reserves that are available at the end of the month and can be used during the next sharing period. It is these ending funds, the total funds distributed and reserved for sharing that the dynamic reserving engine uses to trigger and assign a variable bill amount to the monthly share notice.
As previously noted, in addition to the persistent monitoring of key performance and leading indicators, the VSE monitoring service 52 generates periodic reserve summaries (FIG. 3) that are fed into the variable billing service 53. As also previously noted, the reserve summary assesses and forecasts the total funds distributed and reserved for sharing, which is used by the variable billing service 53 to determine if any amounts are assigned to the next monthly share notice. For example, in FIG. 2, Sharing Network # 1 has set its reserve targets (section 71) in terms of sharing months to a maximum of four months and a minimum of two months. Network # 1 has also chosen to use “forecasted reserves” as its reserve form and trigger. So, if forecasted reserves were to fall below the threshold of two months, then the dynamic reserving engine 50 would trigger a variable amount (a dynamic portion) to be billed on the next monthly share notice.
The reserve summary example in FIG. 3 illustrates a sharing network that has recently completed its seventh month of sharing. The most recent three months of “actual” performance metrics incorporated in the VSE monitoring service 52 have been tracked, monitored, assessed and recorded in the reserve summary. The next two months have been “dynamically forecasted” by the network's actual performance of the most recent three months, as noted in FIG. 3. This illustrates a significant feature and benefit of the dynamic reserving engine 50 and the VSE platform 31. The persistent and automated monitoring, assessment and forecasting of reserve values enables the network to be more proactive in sustaining reserve levels.
As a further example, in FIG. 3 the actual funds distributed and reserved for sharing (section 85) have fallen to $80,024,800 in Month 7 (the most recent month), and the amount for the 8th Month (the current month) is forecasted to fall to $70,127,294. Per the minimum reserve targets in FIG. 2, the variable billing trigger has been activated for Network # 1 because the forecasted reserve amount has fallen below two months. However, the variable billing trigger has not been activated for Network # 2 because the actual reserve amount has NOT yet fallen below $80,000,000. Therefore, in the case of Network # 1, the reserve summary fed into the variable billing service or engine 53 will initiate a variable bill amount to be assigned to the monthly share notice.
The third component of the dynamic reserving engine 50 is the variable billing service 53. The purpose of the variable billing service 53 is to analyze the results of the reserve summaries provided by the VSE monitoring service 52, and assess the financial health of the network's reserves. As illustrated in FIG. 4, the variable billing service 53 will execute an “assignment analysis” for each summary report. To complete the task, the variable billing analysis undertakes the following steps which are now described with reference to the table 100 of FIG. 5A and accompanying flow diagram 62 of FIG. 5B.
Beginning at Block 63, a first illustrated step is a recent summary review (section 101, Block 64). The variable billing service 53 views the last reserve summary to identify the actual funds distributed and reserved for sharing currently held in the member share accounts, as well as the near term forecasted funds. The reserved funds are reviewed in terms of nominal amounts and months of sharing. In FIG. 5A, the assignment analysis example illustrates that for Month 7 (the most recently completed month) the nominal value of the actual funds distributed and reserved for sharing is $80,024,800, and the forecasted reserves are expected to fall to $70,127,294 in Month 8. In terms of sharing months, the actual value of the reserves at the end of Month 7 is 2.12 sharing months, and the forecasted value for the following month (Month 8) is 1.94 sharing months.
The next step in the illustrated example is a reserve targets review (section 102, Block 65). More particularly, the assignment analysis accesses, validates and records the current reserve targets of the sharing network. In the case of Network # 1, reserves are to be measured in the form of forecasted funds distributed and reserved for sharing. The “maximum” reserve target has been set at (4) sharing months and the “minimum” reserve target has been set at (2) sharing months. In the case of Network # 2, reserves are to be measured in the form of “actual” funds distributed and reserved for sharing. The “maximum” reserve target has been set at a nominal value of $160,000,000, and the “minimum” reserve target has been set at $80,000,000.
A further step is the dynamic reserve analysis (section 103, Block 66). The variable billing service 53 assesses if a variable bill amount has been triggered by comparing the network's reserve targets to the actual funds distributed and reserved for sharing (Month 7) and the forecasted funds distributed and reserved for sharing” (Month 8). If a variable bill has been triggered, then the dynamic reserve deficit (or excess) is calculated. The dynamic reserve deficit (or excess) is calculated by subtracting the actual and forecasted reserve amounts from the reserve targets. If the result is greater than “$0”, then a debit may be assigned to the monthly share notice. If the result is less than “$0”, then a credit may be assigned to the monthly share notice. To calculate the debit or credit amount to be assigned to the monthly share notice, the reserve deficit (or excess) may be divided by the number of active households (section 81).
In the case of Network # 1, the assignment analysis indicates that the dynamic reserve trigger has been activated because the “forecasted” share months has fallen below two months. The dynamic reserve deficit (or excess) has been calculated to be $2,080,064, which suggests that a debit of $14.16 would need to be assigned to the monthly share notice of every active household. In the case of Network # 2, the assignment analysis indicates that the dynamic reserve trigger has not been activated because the “actual” funds distributed & reserved for sharing have not fallen below $80,000,000 or exceeded $160,000,000. Thus, there is no deficit or excess to be evaluated.
The next step in the illustrated example is a billing parameter analysis (section 104, Block 67). As a part of the assignment analysis, the variable billing service 53 assesses the suggested variable bill amount in terms of the billing parameters set in the dynamic reserve profile. If the “suggested” variable bill amount is a debit and it exceeds the “maximum” debit amount, then the variable billing service 53 may assign the maximum debit and not the “suggested” amount. If the “suggested” variable bill amount is a debit and it is below the “minimum” debit amount, then the variable billing service 53 should not assign the “suggested” amount. If the “suggested” variable bill amount is a credit and it exceeds the “maximum” credit amount, then the variable billing service 53 may assign the maximum credit and not the “suggested” amount. If the “suggested” variable bill amount is a credit and it is below the “minimum” credit amount, then the variable billing service 53 should not assign the “suggested” amount.
In the case of Network # 1, the assignment analysis has indicated that the suggested variable amount of $14.16 is greater than the “minimum” debit amount and is less than the “maximum” debit amount. Thus, the suggested variable bill amount is the correct and allowable amount to be assigned to monthly share notice. In the case of Network # 2, the assignment analysis has indicated that the suggested variable amount does not apply, because the dynamic reserve trigger was not activated.
An assigned variable bill amount is the next step of the illustrated assignment analysis (section 105, Block 68), which is to record the assigned variable bill amount and the details of the assignment analysis in the variable billing service 53. The variable billing service 53 then submits the variable bill amount to the variable billing service 53 for billing. The assigned variable bill amount is passed into the variable billing service 53 and recorded in the share notice file for the next share period. On the day of the monthly cycle cut the assigned variable bill amount is published to the monthly share notice (FIG. 6 or 7) and collected during the normal payment process. Thus, the sharing network is enabled to replenish its distributed reserves. The method of FIG. 5B illustratively concludes at Block 69.
In the case of Network # 1, the assignment analysis assigned a $14.16 debit amount to be billed to the monthly share notice. Per the example in graphical user interface 110 shown in FIG. 6, the VSE billing service 53 has added $14.16 to the monthly share notice and is titled as the dynamic reserve portion (section 113). The $14.16 is included in the additional amounts, which are amounts added to total share amount due. The total share amount due is the sum of any previous balances (section 111), the monthly share amount for the current month (section 112) and the additional amounts (section 113). By adding the $14.16 debit to the share notice of every active household, the network is replenishing its reserves with approximately $2,080,528. This process can be repeated again the following month if reserve levels continue to fall below the thresholds.
In the case of Network #2 (FIG. 7), the assignment analysis has assigned $0.00 to the monthly share notice. The assignment is $0.00 because “actual” distributed reserves have not yet fallen below $80,000,000. The variable billing service 53 generates and publishes share notices for every active household and the dynamic reserve portion is billed at $0.00 (section 113 in FIG.7).
The above-described VSE platform 31 advantageously provides a computing infrastructure that provides a dynamic reserving engine 50 equipped to automatically regulate distributed reserves and ensure that reserve levels are sustained to their targeted levels or thresholds. Networks utilizing the dynamic reserve engine 50 are better enabled to compete with the fiscal soundness of insurance, while growing the loyalty of members who are assured that reserves are managed to the appropriate levels.
A related method is now described with reference to the flow diagram 120 of FIG. 9. Beginning at Block 121, the method illustratively includes operating the VSE module 37 for establishing member sharing accounts 33 for respective members 36 of a VSE for sharing payment of member healthcare bills across the member sharing accounts, at Block 121, and electronically transferring funds from or between the sharing accounts for payment sharing of the member healthcare bills, at Block 122. In some embodiments, virtual bill accounts may be used for payment sharing, as discussed further in co-pending application Ser. No. 15/931,767, which is hereby incorporated herein in its entirety by reference. The method further illustratively includes operating the billing module 49 and associated DRE 50 for receiving recurring electronic deposits from the members to fund the member sharing accounts, at Block 123, where the recurring electronic deposits include a share portion and a dynamic reserve portion to accumulate reserve funds in the member sharing accounts. The DRE 50 is also for calculating an aggregate amount of available reserve funds across the member sharing accounts as funds are electronically transferred for payment sharing of the member healthcare bills (Block 124), comparing the calculated aggregate amount of available reserve funds to a reserve target fund range (Block 125), and adjusting the dynamic reserve portion to change the recurring electronic deposits responsive to the calculated aggregate amount of reserve balance falling outside of the reserve balance target range to bring the aggregate amount of reserve balance funds back into the reserve balance target range (Block 127), as discussed further above. The method of FIG. 9 illustratively concludes at Block 128.
The system 30 may be implemented using one or more computing devices such as servers, network interface devices, client devices, etc., including the appropriate hardware (e.g., processor, memory, etc.) and software having non-transitory computer-readable instructions for performing the operations discussed herein. Moreover, in some embodiments the system 30 may be implemented within a cloud computing network, as discussed above. Moreover, it will be appreciated that the systems and methods set forth herein may also be used with other types of cost or expense sharing platforms besides healthcare sharing networks, such as automotive repair bills, home appliance repair bills, veterinary bill sharing, etc. That is, the system 30 may also support other share networks beyond just health care sharing.
Many modifications and other embodiments will come to the mind of one skilled in the art having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is understood that the foregoing is not to be limited to the example embodiments, and that modifications and other embodiments are intended to be included within the scope of the appended claims.

Claims

That which is claimed is:

1. A computing device comprising:

a memory and a processor configured to cooperate with the memory to operate

a virtual share exchange (VSE) module configured to

establish member sharing accounts for respective members of a VSE for sharing payment of member healthcare bills across the member sharing accounts, and

electronically transfer funds from the member sharing accounts for payment sharing of the member healthcare bills; and

a billing module configured to

receive recurring electronic deposits from the members to fund the member sharing accounts, the recurring electronic deposits including a share portion and a dynamic reserve portion to accumulate reserve funds in the member sharing accounts,

calculate an aggregate amount of available reserve funds across the member sharing accounts as funds are electronically transferred for payment sharing of the member healthcare bills,

compare the calculated aggregate amount of available reserve funds to a reserve target fund range, and

adjust the dynamic reserve portion to change the recurring electronic deposits responsive to the calculated aggregate amount of reserve balance falling outside of the reserve balance target range to bring the aggregate amount of reserve balance funds back into the reserve balance target range.

2. The computing system of claim 1 wherein the reserve target fund range comprises a real-time minimum aggregate amount of available reserve funds, and a real-time maximum aggregate amount of available reserve funds.

3. The computing system of claim 1 wherein the reserve target fund range comprises a forecasted minimum aggregate amount of available reserve funds, and a forecasted maximum aggregate amount of available reserve funds.

4. The computing system of claim 3 wherein the forecasted minimum and maximum aggregate amounts of available reserve funds are based upon at least one a of number of net new members to the VSE, an aggregate amount of new funds per member, and net withdrawals per member, over a time period.

5. The computing system of claim 1 wherein the billing module increases the dynamic reserve portion of the electronic deposits by no more than a debit threshold amount for each recurring electronic deposit.

6. The computing system of claim 1 wherein the billing module decreases the dynamic reserve portion of the electronic deposits by no more than a credit threshold amount for each recurring electronic deposit.

7. The computing system of claim 1 wherein the billing module changes the dynamic reserve portion of the electronic deposits further based upon a cost of living differential associated with respective different geographical locations of the members of the VSE.

8. A method comprising:

operating a virtual share exchange (VSE) module at a computing device for

establishing member sharing accounts for respective members of a VSE for sharing payment of member healthcare bills across the member sharing accounts, and

electronically transferring funds from the sharing accounts for payment sharing of the member healthcare bills; and

operating a billing module at the computing device configured for

receiving recurring electronic deposits from the members to fund the member sharing accounts, the recurring electronic deposits including a share portion and a dynamic reserve portion to accumulate reserve funds in the member sharing accounts,

calculating an aggregate amount of available reserve funds across the member sharing accounts as funds are electronically transferred for payment sharing of the member healthcare bills,

comparing the calculated aggregate amount of available reserve funds to a reserve target fund range, and

adjusting the dynamic reserve portion to change the recurring electronic deposits responsive to the calculated aggregate amount of reserve balance falling outside of the reserve balance target range to bring the aggregate amount of reserve balance funds back into the reserve balance target range.

9. The method of claim 8 wherein the reserve target fund range comprises a real-time minimum aggregate amount of available reserve funds, and a real-time maximum aggregate amount of available reserve funds.

10. The method of claim 8 wherein the reserve target fund range comprises a forecasted minimum aggregate amount of available reserve funds, and a forecasted maximum aggregate amount of available reserve funds.

11. The method of claim 10 wherein the forecasted minimum and maximum aggregate amounts of available reserve funds are based upon at least one a of number of net new members to the VSE, an aggregate amount of new funds per member, and net withdrawals per member, over a time period.

12. The method of claim 8 wherein adjusting comprises increasing the dynamic reserve portion of the electronic deposits by no more than a debit threshold amount for each recurring electronic deposit.

13. The method of claim 8 wherein adjusting comprises decreasing the dynamic reserve portion of the electronic deposits by no more than a credit threshold amount for each recurring electronic deposit.

14. The method of claim 8 wherein adjusting further comprises adjusting the dynamic reserve portion of the electronic deposits based upon a cost of living differential associated with respective different geographical locations of the members of the VSE.

15. A non-transitory computer-readable medium having computer-executable instructions for causing a computing device to perform steps comprising:

operating a virtual share exchange (VSE) module for

operating a billing module for

16. The non-transitory computer-readable medium of claim 15 wherein the reserve target fund range comprises a real-time minimum aggregate amount of available reserve funds, and a real-time maximum aggregate amount of available reserve funds.

17. The non-transitory computer-readable medium of claim 15 wherein the reserve target fund range comprises a forecasted minimum aggregate amount of available reserve funds, and a forecasted maximum aggregate amount of available reserve funds.

18. The non-transitory computer-readable medium of claim 15 wherein adjusting comprises increasing the dynamic reserve portion of the electronic deposits by no more than a debit threshold amount for each recurring electronic deposit.

19. The non-transitory computer-readable medium of claim 15 wherein adjusting comprises decreasing the dynamic reserve portion of the electronic deposits by no more than a credit threshold amount for each recurring electronic deposit.

20. The non-transitory computer-readable medium of claim 15 wherein adjusting further comprises adjusting the dynamic reserve portion of the electronic deposits based upon a cost of living differential associated with respective different geographical locations of the members of the VSE.