System and method for assessing healthcare risks

• US 20050086076A1
• Filed: 10/17/2003
• Published: 04/21/2005
• Est. Priority Date: 10/17/2003
• Status: Active Grant

• Current Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Original Assignee: Integrated Healthcare Information Services, Inc. (UnitedHealth Group Incorporated)
• Inventors: Celebi, Dogu, Dunn, Daniel L.
• Granted Patent: US 9,058,629 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

A system and method for receiving demographic data on a patient and data on at least one pharmacy service prescribed for the patient; assigning a unique drug class to each pharmacy service; using the unique drug classes for ordering the pharmacy services according to a predetermined hierarchy of classes; and providing a risk score for the patient using the ordered pharmacy services.

Claims

1. A method for assessing risk of insuring a healthcare patient, the method comprising:

receiving demographic data on a patient and data on at least one pharmacy service prescribed for the patient;

assigning a unique drug class to each pharmacy service;

using the unique drug classes for ordering the pharmacy services according to a predetermined hierarchy of classes; and

providing a risk score for the patient using the ordered pharmacy services.

2. The method of claim 1, wherein the step of assigning a unique drug class comprises using national drug codes to assign each pharmacy service to a unique class.

3. The method of claim 1, further comprising categorizing each unique drug class into one of a number of initial pharmacy risk groups.

4. The method of claim 3 further comprising defining additional member risk markers based on patient age and other characteristics known to indicate that the patient belongs to a high risk category.

5. The method of claim 3 further comprising providing a clinical and demographic risk profile for the patient based on the patient'"'"'s age, gender and a mix of clinical and demographic risk profiles.

6. The method of claim 5 further comprising providing multiple patient risk markers for patients with pharmacy services that indicate multiple medical conditions.

7. The method of claim 1 wherein the risk score comprises the sum of each patient risk marker.

8. The method of claim 7 wherein the risk score is computed using pre-determined weights and a patient'"'"'s patient risk marker profile.

9. The method of claim 3 wherein the pharmacy risk groups comprise patient risk markers.

10. An information processing system comprising computer-readable instructions for:

receiving demographic data on a patient and data on at least one pharmacy service prescribed for the patient;

assigning a unique drug class to each pharmacy service;

using the unique drug classes for ordering the pharmacy services according to a predetermined hierarchy of classes; and

providing a risk score for the patient using the ordered pharmacy services.