Systems and methods for evaluating experience of a health care provider

• US 10,354,755 B2
• Filed: 09/10/2014
• Issued: 07/16/2019
• Est. Priority Date: 09/10/2013
• Status: Active Grant

• Current Assignee: Accolade, Inc.
• Original Assignee: MD Insider, Inc. (Accolade, Inc.)
• Inventors: Norris, David Lee, Goldstein, Susanne Beth, Calvert, Jay W., Conroy, Brian Patrick, Chatterjee, Kingshuk
• Primary Examiner(s): Kanaan, Maroun P
• Application Number:
  US14/482,997
• Publication Number:
  US 20150073833A1
• Time in Patent Office: 1,770 Days
• CPC Class Codes: G06F 16/24575 using context
• CPC Class Codes: G06Q 10/06393 Score-carding, benchmarking or key performance indicator [KPI] analysis
• CPC Class Codes: G06Q 30/0627 using item specifications
• CPC Class Codes: G06Q 50/22 Social work or social welfare, e.g. community support activities or counselling services
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Abstract

In one embodiment, a method comprises identifying one or more health-care-providers associated with one or more medical-specializations, wherein each medical-specialization is associated with a specialty class and at least one geographic area. A number of patient-diagnosis codes is received, each patient-diagnosis code corresponding to one of the health-care-providers and representing a patient-visit to the health-care-provider. The patient-diagnosis code includes at least one diagnosis within a condition-group for the patient visit, and a severity-factor for the diagnosis. The method further comprises determining all patient-diagnosis codes corresponding to the health-care-providers. A patient-volume is calculated for each health-care-provider, based on the patient-diagnosis codes and associated severity-factors. A variety-score is calculated for each health-care-provider based on the patient-diagnosis codes. An experience-score is calculated for each health-care-provider based on the patient-volume and variety-score.

Claims

1. A method comprising:

identifying, by one or more computing devices of an experience-engine system, one or more health-care-providers associated with one or more medical-specializations, each medical-specialization associated with a specialty class and at least one geographic area;

receiving, by one or more computing devices, a plurality of patient-diagnosis codes corresponding to the one or more health-care-providers, wherein each patient-diagnosis code represents a patient visit to the health-care-provider and comprises;

at least one diagnosis given for the patient visit, the diagnosis being associated with a condition-group; and

a severity-factor associated with the diagnosis;

determining, by one or more computing devices, all patient-diagnosis codes corresponding to the one or more health-care-providers;

for a particular health-care-provider from the one or more health-care-providers, calculating, by one or more computing devices, a patient-volume for each condition-group, wherein the patient-volume is calculated based on a relative number of cases within a particular condition-group for the particular health-care-provider compared to the total number of cases within the particular condition-group for all health-care-providers in the medical-specialization, the patient-volume being based on a number of the patient-diagnosis codes corresponding to the health-care-provider, wherein the number of the patient-diagnosis codes is further weighted by the severity-factor for each patient-diagnosis code corresponding to the health-care provider;

for each health-care-provider, calculating, by one or more computing devices, a variety-score based at least in part on the patient-diagnosis codes corresponding to the health-care- provider;

for each health-care-provider, calculating, by one or more computing devices, an experience-score based on the patient-volume and variety-score; and

sending, by one or more computing devices, the one or more experience-scores for the one or more health-care-providers to a matching engine system, wherein the one or more experience-scores are used with a physician performance-score to determine whether a reference to a health-care-provider of the one or more health-care-providers should be sent to a client computing device of a user in response to a request for information about health-care-providers.

2. The method of claim 1, wherein the geographic area comprises a state.

3. The method of claim 1, wherein the geographic area comprises a metropolitan statistical area.

4. The method of claim 1, wherein the patient-diagnosis code comprises an administrative claim submitted by the health-care provider.

5. The method of claim 1, wherein the diagnosis comprises at least one International Classification of Diseases (ICD) code.

6. The method of claim 1, wherein the severity-factor is dependent on whether a particular patient-diagnosis code is chronic or non-chronic.

7. The method of claim 1, wherein a patient-volume for the medical-specialization is calculated based on one or more patient-volumes corresponding to one or more condition-groups within the medical-specialization.

8. The method of claim 7, wherein a patient-volume for the medical-specialization comprises a weighted average of the one or more patient-volumes.

9. The method of claim 1, wherein the relative number of cases is weighted by the time elapsed since each patient-visit corresponding to each patient-diagnosis code.

10. The method of claim 9, wherein the relative number of cases is weighted by the severity-factor corresponding to each patient-diagnosis code.

11. The method of claim 9, wherein a patient-diagnosis code corresponding to a chronic diagnosis is weighted more than a patient-diagnosis code corresponding to a non-chronic diagnosis.

12. The method of claim 1, wherein calculating a variety-score comprises:

selecting a condition-group within the medical-specialization;

determining a number of distinct patient-diagnosis code-types within the condition-group;

determining a number of patient-diagnosis code-types corresponding to each health-care provider;

determining a number of patient-diagnosis code-types corresponding to a plurality of health-care providers within the medical-specialization; and

dividing the number of patient-diagnosis code-types for each health-care provider by the number of patient-diagnosis code-types for the plurality of health-care providers.

13. The method of claim 1, wherein calculating a variety-score comprises:

determining a number of distinct condition-groups within the medical-specialization;

determining a number of condition-groups corresponding to each health-care provider;

determining a number of condition-groups corresponding to a plurality of health-care providers within the medical-specialization; and

dividing the number of condition-groups for each health-care provider by the number of condition-groups for the plurality of health-care providers.

14. The method of claim 1, wherein the experience-score comprises a product of the patient-volume and the variety-score.

15. The method of claim 1, wherein the experience-score comprises a weighted sum or weighted average of the patient-volume and the variety-score.

16. The method of claim 1, wherein a health-care provider associated with two or more specializations is also associated with distinct experience-scores for each of the specializations.

17. The method of claim 1, wherein a health-care provider is determined to be unqualified for a particular condition-group if a corresponding experience-score is below a threshold experience-score.

18. One or more non-transitory, computer-readable storage media embodying software that is operable when executed to:

identify one or more health-care-providers associated with one or more medical-specializations, each medical-specialization associated with a specialty class and at least one geographic area;

receive a plurality of patient-diagnosis codes corresponding to the one or more health-care-providers, wherein each patient-diagnosis code represents a patient visit to the health-care-provider and comprises;

at least one diagnosis given for the patient visit, the diagnosis being associated with a condition-group; and

a severity-factor associated with the diagnosis;

determine all patient-diagnosis codes corresponding to the one or more health-care-providers;

for a particular health-care-provider from the one or more health-care-providers, calculate a patient-volume for each condition-group, wherein the patient-volume is calculated based on a relative number of cases within a particular condition-group for the particular health-care-provider compared to the total number of cases within the particular condition-group for all health-care-providers in the medical-specialization, the patient-volume being based on a number of the patient-diagnosis codes corresponding to the health-care-provider, wherein the number of the patient-diagnosis codes is further weighted by the severity-factor for each patient-diagnosis code corresponding to the health-care provider;

for each health-care-provider, calculate a variety-score based at least in part on the patient-diagnosis codes corresponding to the health-care-provider;

for each health-care-provider, calculate an experience-score based on the patient-volume and variety-score; and

send the one or more experience-scores for the one or more health-care-providers to a matching engine system, wherein the one or more experience-scores are used with a physician performance-score to determine whether a reference to a health-care-provider of the one or more health-care-providers should be sent to a client computing device of a user in response to a request for information about health-care-providers.

19. A system comprising:

one or more processors; and

a memory coupled to the processors comprising instructions executable by the processors, the processors being operable when executing the instructions to;

identify one or more health-care-providers associated with one or more medical-specializations, each medical-specialization associated with a specialty class and at least one geographic area;

receive a plurality of patient-diagnosis codes corresponding to the one or more health-care-providers, wherein each patient-diagnosis code represents a patient visit to the health-care-provider and comprises;

at least one diagnosis given for the patient visit, the diagnosis being associated with a condition-group; and

a severity-factor associated with the diagnosis;

determine all patient-diagnosis codes corresponding to the one or more health-care-providers;

for a particular health-care-provider from the one or more health-care-providers, calculate a patient-volume for each condition-group, wherein the patient-volume is calculated based on a relative number of cases within a particular condition-group for the particular health-care-provider compared to the total number of cases within the particular condition-group for all health-care-providers in the medical-specialization, the patient-volume being based on a number of the patient-diagnosis codes corresponding to the health-care-provider, wherein the number of the patient-diagnosis codes is further weighted by the severity-factor for each patient-diagnosis code corresponding to the health-care provider;

for each health-care-provider, calculate a variety-score based at least in part on the patient-diagnosis codes corresponding to the health-care-provider;

for each health-care-provider, calculate an experience-score based on the patient-volume and variety-score; and

send the one or more experience-scores for the one or more health-care-providers to a matching engine system, wherein the one or more experience-scores are used with a physician performance-score to determine whether a reference to a health-care-provider of the one or more health-care-providers should be sent to a client computing device of a user in response to a request for information about health-care-providers.