A system and method for managing an electronically-implemented membership
based health care program without utilizing primary care medical
insurance includes providing a health clinic having doctors to provide
medical services to its members. An electronic database which may
be connected to computer network manages member records, including
a purchase arrangement by which services may be obtained. Enrolled
members in good payment standing may receive primary care medical
services from the clinic, including unlimited office visits. Clinic
employees receive the medical services as an employee benefit. The
clinic may be owned by another company not related to health care
and having employees who also receive the medical services, the
company paying the clinic according to the purchase arrangement.
Neither the clinic nor its members utilize primary care insurance.
The method results in dramatically decreased healthcare costs and
higher effective employee compensation.
1. An electronically-implemented method for providing and managing
a membership healthcare program not utilizing primary care insurance,
said method comprising the steps of: providing a health care clinic
for administering the membership health care program, said clinic
employing at least one doctor and a plurality of clinic employees
for providing medical services to members of the program without
utilizing primary care medical insurance; providing an electronic
database having a plurality of member records, each member record
having a member identifier and a purchase arrangement data field;
enrolling new members into the program by transacting a predetermined
purchase arrangement between said new members and said clinic, said
step of enrolling new members including receiving a predetermined
fee and establishing a schedule of level-pay fees; storing a respective
member identifier and purchase arrangement data in a respective
member record for each enrolled member; and rendering said medical
services to a respective enrolled member when a corresponding purchase
arrangement data field is indicative of paid fees, whereby said
medical services are provided at a cost to said clinic and said
members that is comparatively lower than a cost thereto when utilizing
primary care health insurance.
2. The method as in claim 1 wherein each member record includes
an employment data field, said method further including the steps
of: determining during enrollment whether a prospective member is
employed by said clinic; storing employment status data in a corresponding
employment data field of a corresponding member record associated
with said prospective member; and if said prospective member is
employed by said clinic, waiving all fees associated with said purchase
arrangement and automatically setting said purchase arrangement
data field associated with said prospective member to indicate paid
3. The method as in claim 2 further comprising the step of proceeding
with said step of rendering said medical services to a respective
member if a corresponding employment data field associated with
said respective member is indicative that said respective member
is not employed by said clinic but that a corresponding purchase
arrangement data field associated with said respective member is
indicative of paid fees.
4. The method as in claim 1 wherein said medical services include
primary care medical services, unlimited office visits, labs, x-ray,
and predetermined in-clinic procedures.
5. The method as in claim 1 wherein said purchase arrangement includes
predetermined individual and family level-pay fee arrangements.
6. The method as in claim 1 wherein said method includes notifying
said members regarding availability of supplemental catastrophic
and hospitalization insurance.
7. The method as in claim 1 wherein: said clinic is owned by a
company not otherwise associated with health care and having a plurality
of company employees; said method further comprising the step of
automatically setting respective purchase arrangement data fields
of respective member records associated with said company employees
to indicate paid fees.
8. The method as in claim 7 further comprising the step of said
company paying to said clinic all fees associated with respective
purchase arrangements of said company employees; and wherein said
step of enrolling new members includes electronically receiving
enrollment data through a computer network.
9. The method as in claim 8 wherein said step of paying said respective
fees includes paying said respective fees by electronic funds transfer.
10. The method as in claim 2 wherein: said clinic is owned by a
company not otherwise associated with health care and having a plurality
of company employees; and said plurality of clinic employees of
said clinic includes said company employees, wherein respective
employment data fields of respective member records associated with
said company employees are set to indicate employment by said clinic
such that all purchase arrangement fees are waived.
11. A system for managing a membership healthcare program not utilizing
primary care insurance, comprising: an electronic information management
system having a central processing unit ("CPU") and a
database electrically connected to said CPU, said database having
a plurality of member records, each member record having a member
identifier and a purchase arrangement data field; a health clinic
for utilizing said information management system to administer the
program, said clinic employing at least one doctor and a plurality
of clinic employees for providing a predetermined set of medical
services to a plurality of members of the program, said clinic establishing
a purchase arrangement by which said medical services may be obtained
by said members; means for enrolling a new member into the program
by transacting said purchase arrangement between said clinic and
said new member, said means for enrolling said new member including
means for receiving payment of a predetermined fee and establishing
a schedule of level-pay fees; means in said CPU for storing a respective
member identifier and purchase arrangement in a respective member
record of said database for each enrolled member; wherein said doctor
is authorized to render said medical services to a respective member
when a corresponding purchase arrangement data field associated
with said respective member is indicative of paid fees, whereby
said medical services are rendered at reduced cost to said members
and said clinic by not utilizing primary care insurance.
12. The system as in claim 11 wherein said enrolling means includes
means for electronically transacting said purchase arrangement and
means for electronically receiving payment of said predetermined
13. The system as in claim 11 further comprising means in said
CPU for setting respective purchase arrangement data fields associated
with said clinic employees to indicate paid fees, wherein said medical
services are provided to said clinic employees as an employee benefit.
14. The system as in claim 11 wherein: said health clinic is owned
by a company not otherwise associated with health care and having
a plurality of company employees; said system further comprising
means in said CPU for setting respective purchase arrangement data
fields of respective member records associated with said company
employees to indicate paid fees, whereby membership in the program
is given to said company employees as a company employee benefit.
15. The system as in claim 14 further comprising means in said
CPU for electronically receiving funds from said company corresponding
to purchase arrangement fees associated with said company employees,
whereby said company pays said purchase arrangement fees to said
16. The system as in claim 11 wherein: said health clinic is a
network of health clinics employing a plurality of network doctors
and a plurality of network employees; said information management
system is electrically connected to a wide-area network for electronic
communication between said network of health clinics, said database
including respective member records corresponding to said network
of health clinics.
17. The system as in claim 16 wherein each member record includes
a clinic identifier for identifying a respective clinic is associated
with a respective member.
BACKGROUND OF THE INVENTION
 This invention relates generally to methods of administering
healthcare and, more particularly, to an electronically-implemented
business method and system for managing a membership based healthcare
program that does not utilize or involve primary care health insurance.
 The high cost, inefficiency, and bureaucracy of medical
insurance has overwhelmed both patients and physicians. Many doctors
complain that too large a portion of their time is spent filing
and managing insurance claims and that honoring the large number
of insurers for their patients adds significantly to the overhead
cost of their practice. Consequently, much of this cost gets passed
along to their patients, increasing the cost of healthcare and further
frustrating everyone concerned.
 Various proposals have been made, in both the public and
private sectors, to streamline the health care system and to hold
down the rising costs. However, efforts to shore up a broken system
founded on primary care insurance have not been successful. Specifically,
patent application 2002/0184052 to Parker proposes an elective organization
of selected doctors for providing medical services to organization
members. The '052 proposal, however, provides no method or structure
for lowering the overall cost of primary healthcare by not utilizing
primary care health insurance. In fact, an object of the '052 patent
application is merely to increase the number of locations at which
a member may obtain medical services and that the organization still
honors whatever medical insurance the member already has. Further,
the '052 patent does not teach a method for dramatically reducing
the cost to clinics of providing medical services or dramatically
decreasing the cost to patient members. The '052 certainly does
not suggest such cost savings as a result of avoiding the traditional
primary care health insurance system.
 Therefore, it is desirable to have an method and electronic
information management system for establishing and managing a member
based health clinic program that does not utilize or involve primary
medical insurance, reduces the cost to both clinics and patients,
and establishes more efficient provision of primary medical services.
The present method and system clearly produces the tangible results
of increased profits to health clinics through reduced staffing
and insurance premium avoidance as well as a literal or effective
increased compensation to clinic employees.
SUMMARY OF THE INVENTION
 A method and system for providing and managing a membership-based
health care program without utilizing or involving primary care
medical insurance includes providing a health care clinic to administer
the program and providing an electronic information system to manage
member records and to determine eligibility for services. The clinic
employs at least one doctor and a plurality of other clinic employees
to provide primary medical services to members of the program.
 In a broad aspect of the invention, the membership program
of the present invention dramatically reduces the cost of health
care, both to the doctor or clinic and to the patient, by no longer
utilizing primary care insurance. This enables the clinic to reduce
staff previously needed for processing insurance claims to multiple
insurers, thus increasing the clinic's bottom line. Further, the
previous high cost of the clinic's overhead no longer needs to be
passed along to the patient and insurer.
 The present invention also proposes a membership based program
in which members enter into a purchase arrangement with the clinic
for level monthly payments in order to obtain a predetermined comprehensive
set of medical services, such as unlimited office visits, labs,
x-rays, and other in-clinic procedures. The level payments may be
lower than traditional insurance premiums due to the cost savings
to the clinic described above. Therefore, the cost of healthcare
both to the clinic and patient members is dramatically reduced.
This methodology also has the tangible effect of increasing the
overall compensation to clinic employees, either literally or effectively.
 Another aspect of the inventive methodology involves an
electronic information management system ("IMS") having
a central processing unit ("CPU") connected to an electronic
database. The database includes a plurality of member records with
each record including at least a member identifier and a purchase
arrangement data field. The IMS and database are used to analyze
and indicate when services are authorized to be rendered.
 Still another aspect of the present method and system allows
even greater cost savings to be realized by the clinic itself. Specifically,
the clinic may waive membership purchase arrangements to its own
employees and provide the medical services as an employment benefit.
As the clinic's own doctors and staff perform the medical services,
the cost of providing healthcare to its employees is less expensive
than paying traditional insurance premiums. Again, this presents
a large savings to both the clinic and to its employees. As will
be described in greater detail later, a medium to large sized company
may actually own its own clinic and treat its employees like the
clinic's employees so as to eliminate the need for third party insurance
and to experience dramatic cost savings.
 It should be appreciated that all of these steps are electronically
managed by the corresponding information management system. Specifically,
the information management system manages the treatment of clinic
employee members, owner company employee members, outside/non-employee
members, and the purchase arrangements of each. In fact, it is contemplated
that a network organization utilizing the information management
system may centrally manage a plurality of clinics using wide-area
 Therefore, a general object of this invention is to provide
a method and system for providing and managing a membership based
clinic healthcare program that does not utilize primary care insurance.
 Another object of this invention is to provide a method
and system, as aforesaid, which reduces the cost of primary healthcare
for both health clinic providers and member healthcare recipients.
 Still another object of this invention is to provide a method
and system, as aforesaid, which increases cash flow to a health
clinic while reducing paperwork.
 Yet another object of this invention is to provide a method
and system, as aforesaid, which completely removes the bureaucratic
health insurance industry from primary healthcare.
 A further object of this invention is to provide a method
and system, as aforesaid, which manages a healthcare system with
an electronic information management system.
 A still further object of this invention is to provide a
method and system, as aforesaid, which provides dramatic cost savings
to a health clinic and its employees by eliminating payment of primary
care insurance premiums by either.
 A particular object of this invention is to provide a method
and system, as aforesaid, for electronically managing ownership
of a membership-based health clinic by a medium to large sized company
otherwise unrelated to healthcare services.
 Another object of this invention is to provide a method
and system, as aforesaid, that notifies members about catastrophic
and hospitalization insurance.
 Other objects and advantages of this invention will become
apparent from the following description taken in connection with
the accompanying drawings, wherein is set forth by way of illustration
and example, embodiments of this invention.
BRIEF DESCRIPTION OF THE DRAWINGS
 FIG. 1 is a block diagram illustrating a system and method
for administering a membership based healthcare program according
to one embodiment of the present invention;
 FIG. 2 is a block diagram illustrating an aspect of the
method and system as in FIG. 1 where the clinic is itself owned
and controlled by a company not otherwise associated with healthcare;
 FIG. 3 is a schematic diagram illustrating a member record
stored in a database of an information management system managing
the healthcare program as in FIG. 1;
 FIG. 4 is a flowchart showing the logic performed by the
information management system according to the invention as in FIG.
 FIG. 5 is a block diagram illustrating a system and method
for administering a membership based healthcare program according
to another embodiment of the present invention; and
 FIG. 6 is a flowchart illustrating the logic of an enrollment
process according to the system and method of FIG. 1.
DESCRIPTION OF THE PREFERRED EMBODIMENT
 An electronically-implemented method and system for administering
and managing a membership-based clinic healthcare program that does
not utilize or involve primary healthcare insurance will now be
described in detail with reference to FIGS. 1 through 6 of the accompanying
 According to a now preferred embodiment of the present method
and system 10, a health clinic 12 is established or selected to
administer a membership-based healthcare program (FIG. 1). The healthcare
program does not utilize or participate in any primary care insurance
plan. In other words, the clinic 12, according to the program, does
not submit insurance claims or receive money paid on claims by a
primary care insurance carrier. The clinic 12 established or chosen
to administer and manage the healthcare program preferably employs
at least one doctor 14 and a plurality of clinic support employees
14, such as nurses, lab technicians, physicians' assistants, and
the like for providing medical services.
 According to the preferred method, the healthcare program
is limited to members of the program and therefore requires new
members to become enrolled, as will be described in more detail
below. Enrolled members who complete enrollment procedures, which
may or may not include payment of fees, are eligible to receive
a predetermined set of medical services, including, but not limited
to, unlimited office visits, labs, x-rays, and other in-clinic procedures.
Medical care related to workman's compensation may also be included
in membership. Supplemental catastrophic/hospitalization insurance
is recommended to program members to cover services not provided
by the program.
 The present method and system 10 further includes an information
management system ("IMS") 20 having a central processing
unit ("CPU") 22 electrically connected to a database 24.
The database 24 includes a plurality of member records 26, each
member record having data fields associated with a member identifier
28, employment status 30, and purchase arrangement 32 data, as to
be more discussed more fully later. As shown in FIG. 3, other data
fields may also be included in each member record 26.
 The purchase arrangement for each member is predetermined
by the clinic 12 and includes a level payment component such as
a monthly membership fee. The structure of the purchase arrangement
may include single or family plan arrangements or some other arrangement
determined by the clinic 12. The details of the purchase arrangement,
including payment status 34, are stored in respective member records
26 of the database 24 (FIG. 3).
 All persons who desire to participate in the clinic healthcare
program must go through an enrollment process 36 (FIG. 6). It is
understood that enrollment 36 may be completely performed via a
computer network connection between the IMS 20 and potential member's
personal computer, or with assistance of a clinic employee making
use of the IMS 20. Member records 26 associated with all members
are updated to reflect a purchase arrangement or status of an enrollment
transaction and whether or not the initial level payment fee has
been satisfied. Enrollment 36 of all members will be described in
more detail later.
 Before discussing enrollment 36, however, another aspect
of the present invention is shown in FIG. 2. According to this aspect,
a company 40 may own and control the clinic 10, the company 40 being
otherwise unrelated or not directly associated with providing primary
healthcare. For reasons that will become evident below, the company
40 employs a plurality of company employees 42 who will become enrolled
members of the program.
 Now, the enrollment 36 of new members may be described relative
to the method and system shown in FIGS. 1 and 2. FIG. 6 illustrates
the logic performed by the CPU 22 in an enrollment transaction between
a potential new member and the clinic 12. Specifically, the CPU
22, aided or unaided by a clinic employee, solicits employment data
from the potential member at process step S1. The CPU 22, at process
step S2, asks if the new member is an employee of the clinic 12.
If so, the purchase arrangement field of a respective new member
record is set to indicate "paid" fees at process step
S3 and the employment data is also stored at process step S4.
 If not a clinic employee 16, the CPU 22, at process step
S5, determines if the new member is an employee of an owner company
40. If so, the purchase arrangement field of a respective new member
record is set to indicate "paid" fees at process step
S3 and the employment data is also stored at process step S4. In
this case, owner company employees 42 are classified and treated
the same as clinic employees 16, i.e. all purchase arrangement fees
are automatically considered to be "paid" even though
neither the clinic 12, owner company 40, nor employees actually
paid them. Alternatively, the owner company 40 may actually pay
the fees to the clinic 12 which, since the clinic 12 is owned by
the company, is like paying itself. This payment may be made by
electronic funds transfer or through electronic accounting means
since the clinic is owned by the company. Of course, a company may
choose to only pay part of the enrollment of each employee and,
in that case, only the predetermined percentage would be forwarded.
 The doctor 14 and clinic employees 16 provide the needed
primary care medical services automatically and both insurance premiums
and insurance inefficiencies are eliminated. It should also be appreciated
that the enrollment transaction also includes agreement between
the clinic and member that regular level payments must continue
to made in order for medical services to be rendered. In the company-owned
clinic scenario, it should be appreciated that money that would
otherwise be paid to a third party insurance carrier is kept within
the company's own financial system and provides greater control
 Further to member enrollment 36, if a new member is neither
a clinic employee or owner company employee, as determined at process
step S6 the CPU 22 automatically deduces that the new member must
be a non-employee of the clinic 12 or owner company 40 and automatically
sets the purchase arrangement data field to "unpaid fees"
at process step S7 and stores the employment data at S4 (FIG. 6).
 As indicated by process step S8, the CPU 22 directs that
a notice be given, either electronically or by a clinic employee,
regarding the existence of supplemental catastrophic or hospitalization
 The logic of the CPU 22 for operation of electronically
implemented method and system is illustrated in FIG. 4. More particularly,
the CPU 22 determines at process step S10 if a new member enrollment
is desired. If so, the CPU 22 proceeds to step S11 to determine
if a clinic network is implemented, clinic networks being more fully
described later with reference to FIG. 5. In any case, the CPU 22
proceeds to manage the enrollment process as indicated by step S12
and as previously described with reference to FIG. 6. Following
enrollment 36, the database 24 is updated at step S13 and control
is returned to the start 50 of the method operation.
 If enrollment is not desired, then the CPU 22 proceeds at
process step S15 to determine if medical services are being requested.
If so, then it is determined at step S16 if the requester is a member.
If not, control is returned to the start 50 of the method. Otherwise,
the CPU 22 queries the database 24 to determine if the member is
a clinic employee, owning company employee, or non-employee member
who has paid membership fees, as indicated by steps S17 to S19.
If any of these cases is affirmative, then the CPU 22 indicates
that medical services may be rendered S20 and, presumably, such
services are in fact rendered to qualified members.
 A method and system 70 for providing and managing a membership
based healthcare program according to another embodiment of the
present invention is shown as a block diagram in FIG. 5. The method
and system according to this embodiment is substantially similar
to the method and system previously described except as specifically
noted below. Specifically, an information management system 72 is
located at a central healthcare network organization or central
server 74 and electronically connected to a plurality of clinics
76a, 76b using a wide-area computer network 78 such as the Internet.
Therefore, this embodiment of the system allows electronic management
of the plurality of clinics 76a, 76b operating in a manner substantially
similar to the method and system first described.
 Each member record 26 may include a clinic identifier field
33 as well (FIG. 3) to facilitate electronic management of multiple
clinics. The information management system 72 also makes use of
this information during the enrollment process. If the CPU 22 determines
that a multiple clinic arrangement is being utilized, as indicated
at step S11 of FIG. 4, then control proceeds to step S11a and a
predetermined purchase arrangement specific to an identified clinic
is utilized in enrollment 36.
 As illustrated, this embodiment of the system 70 allows
management of clinics 76a that only service its own employees without
utilizing medical insurance, e.g. merely as a company healthcare
benefit, or management of clinics 76b owned and controlled by a
larger company, e.g. to provide medical services to its employees.
And, of course, each clinic 12 may also provide services to members
17 who are neither clinic employees 16 nor company employees 42.
In all case, medical services may be provided without utilizing
traditional primary care insurance.
 It should be remembered that the present method does not
utilize primary health care insurance and, therefore, does not require
the personnel (and cost) necessary to process insurance claims.
Operation of the disclosed method and illustration of the tangible
results produced are even better illustrated by an example. The
example health clinic operating, according to the disclosed methodology
would include 1,000 annual health care purchase plans, providing
health care services to individuals and families. The ratio of family
and individual plan enrollees would be fifty-percent (50%) each.
The example health care clinic would provide primary health care
services to enrollees whether employees of an industry or a business-owned
clinic or individual/family-community enrollees. A clinic of this
size, operating seven (7) days a week, could provide an average
of twenty-five (25) office visits per day. Specifically, an individual
purchase arrangement may include an approximate eighty-three dollar
($83.00) per month fee and a family purchase arrangement may include
about a one-hundred twenty-five dollar ($125.00) per month fee.
 The clinic, applying the present method, could generate
over one million dollars ($1,000,000.00) annually in revenue and
be self-funded. When combined with optional hospitalization, dental,
or optical insurance plans offered by another entity, this represents
a cost savings of about thirty percent (30%) regardless of the number
of enrollees per community-based clinic and a fifty percent (50%)
savings to an industry or business-owned clinic when compared to
the traditional insurance-based models. The increased savings for
the employers and clinics is primarily due to direct healthcare
service being provided without necessary payment by the employer
of health insurance premiums or payment to a third-party healthcare
 An industry or business-owned clinic reaps further dividends
when considering the current high costs of Workers' Compensation
benefits and claims. Specifically, an industry or business saves
significantly by sending its injured workers to its own clinic.
As described above, primary health care services are provided directly
by the self-owned clinic, without payments of insurance premiums
or payment to third-party healthcare providers. Further, the industry
or business has total control over the healthcare costs related
to clinic services provided to the injured employees.
 It should also be appreciated that a major tangible result
of the disclosed method is that members, clinic employees, and owner
company employees receive increased compensation. Specifically,
these employees may receive higher actual compensation from their
employers as a result of the employer's dramatic cost savings, or
they receive indirect compensation by not having to pay insurance
premiums or claim deductibles.
 Accordingly, this system for administering a membership-based
health care system not utilizing primary care insurance, whether
involving only a single clinic, company-owned clinic, or network
of clinics communicating via the Internet, dramatically decreases
the cost of health care both to clinics and patients. Further, the
computer implementation of the present method provides an important
aspect of efficient operation that further lower the cost of health
care which provides greater compensation to patients.