Health cost avoidance system

• US 20060241969A1
• Filed: 04/20/2005
• Published: 10/26/2006
• Est. Priority Date: 04/20/2005
• Status: Abandoned Application

• Current Assignee: Futurehealth Corp. (Nationwide Mutual Insurance Company)
• Original Assignee: Futurehealth Corp. (Nationwide Mutual Insurance Company)
• Inventors: Rosse, Claire B., Wilhide, Calvin Christian
• Application Number:
  US11/110,469
• Publication Number:
  US 20060241969A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 50/50 for simulation or modelling of medical disorders
• CPC Class Codes: G16H 70/60 relating to pathologies

Abstract

Complications of various diseases have ascertainable direct costs and indirect costs. A method of projecting direct and indirect cost savings which may be realized from targeted interventions for achieving desired clinical outcomes which may result in the avoidance or mitigation of the complication is provided. Further, a comprehensive patient care management program is provided whereby the targeted intervention strategy of the present invention provides a list of behavioral influencers which assist in achieving desired clinical outcomes. From the achievement of the desired clinical outcomes direct and indirect cost savings from the avoidance or mitigation of a complication provides a projected overall cost savings which may be realized for an employer sponsored health plan.

Claims

1. A method of projecting health care cost savings for a complication associated with a disease, comprising:

determining an indirect cost associated with the complication;

determining a mitigating factor associated with complication; and

calculating a projected indirect cost savings based on the indirect cost and mitigating factor.

2. The method of claim 1, wherein the mitigating factor is a percent mitigable associated with the complication of the disease.

3. The method of claim 1, further comprising the steps of determining a direct cost associated with the complication.

4. The method of claim 1, further comprising the step of calculating a total cost savings based on the indirect cost, direct cost and mitigating factor.

5. The method of claim 1, further comprising the step of determining a second mitigating factor for the direct costs.

6. The method of claim 1, wherein the disease may be selected from the group consisting of diabetes, asthma, back pain, coronary artery disease, or chronic (congestive) heart failure.

7. The method of claim 1, wherein the method may be implemented as a computer readable set of instructions executable upon a computing system.

8. A method of projecting health care cost savings for a complication associated with a disease, comprising:

determining an indirect cost associated with the complication;

determining a direct cost associated with the complication;

determining a mitigating factor associated with the indirect and direct costs;

calculating a projected total cost savings based on the indirect cost, direct cost and mitigating factor.

9. The method of claim 8, further comprising the step of determining a second mitigating factor for the direct costs.

10. The method of claim 8, wherein the disease may be selected from the group consisting of diabetes, asthma, back pain, coronary artery disease, or chronic (congestive) heart failure.

11. The method of claim 8, wherein the mitigating factor is a percent mitigable associated with the complication of the disease.

12. The method of claim 8, wherein the mitigating factor is based on attainment of a desired clinical outcome selected from the group consisting of a HbA1c level, blood pressure, cholesterol level.

13. The method of claim 12, wherein the attainment of a desired clinical outcome is through execution of a targeted intervention selected from the group consisting of medication management, diet, exercise, periodicity or smoking cessation.

14. The method of claim 8, wherein the method may be implemented as a computer readable set of instructions executable upon a computing system.

15. A computer readable set of instructions allowing for the projection of health care cost savings for a complication associated with a disease, comprising:

a first instruction determines a direct cost savings associated with at least one complication;

a second instruction determines an indirect cost savings associated with the at lest one complication; and

a third instruction for the calculation of a projected total cost savings based on the direct and indirect costs associated with the complication.

16. The computer readable set of instructions of claim 15, further comprising an instruction allowing for the identification of the disease.

17. The computer readable set of instructions of claim 15, further comprising an instruction for constructing a list of a plurality of complications associated with the identified disease.

18. The computer readable set of instructions of claim 15, further comprising an instruction for calculating only one of a projected direct cost savings or a projected indirect cost savings.

19. The computer readable set of instructions of claim 15, wherein the projected total cost savings may include projected direct and indirect costs for two or more complications.

20. The computer readable set of instructions of claim 15, further comprising an instruction for indicating specific interventions for the attainment of a desired clinical outcome.

21. A method for providing a patient care program, comprising:

identifying a medical condition of the patient;

identifying a complication associated with the progression of the medical condition;

identifying and grouping a clinical outcome to the complication, the clinical outcome having an impact upon the complication;

identifying a targeted intervention for attaining the clinical outcome;

determining the direct and indirect projected cost savings which may be realized based on the complication;

wherein the patient care program is determined from the identification and determination of the disease, the complication and the projected cost savings, and the targeted interventions for achieving the desired clinical outcome.

22. The method of claim 21, wherein the identified medical condition may be selected from the group consisting of diabetes, asthma, back pain, coronary artery disease, or chronic (congestive) heart failure.

23. The method of claim 21, wherein the disease is a plurality of medical conditions.

24. The method of claim 21, wherein the complication is a plurality of complications.

25. The method of claim 21, wherein the clinical outcome is a plurality of clinical outcomes.

26. The method of claim 21, wherein the targeted intervention is a plurality of targeted interventions.