Fully Automated Health Plan Administrator

• US 20070250352A1
• Filed: 04/20/2007
• Published: 10/25/2007
• Est. Priority Date: 04/20/2006
• Status: Active Grant

• Current Assignee: Jack J. Tawil
• Original Assignee: Jack J. Tawil
• Inventors: Tawil, Jack J.
• Granted Patent: US 8,165,894 B2
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• 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 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

A system for administering a health care system, comprising up to five processing means and a database. The system accepts inputs from enrollees, insureds, providers, insurers and vendors, but requires no input from an administrator. The apparatus optionally includes devices for: measuring patient treatment outcomes, a “just-in-time” appointment rescheduler, an editable archive of prototypical treatment plans, measuring the diagnostic accuracy of diagnosing physicians and measuring the complication rate of treatment providers.

Claims

1. A method for automatically administering a health care plan using a database, comprising:

providing primary data for enrollment on-line to the database;

providing primary data from self-administered surveys on-line to the database by an insured;

providing primary data about insurance coverage on-line to the database; and

processing the primary data automatically into processed data.

2. The method as claimed in claim 1, further comprising:

providing billing and claim processing information to the database; and

processing the billing and claim information automatically into processed data.

3. The method as claimed in claim 1, wherein the primary data for enrollment is provided by an insured.

4. The method as claimed in claim 1, wherein the primary data for enrollment is provided by a diagnostic physician.

5. The method as claimed in claim 1, wherein the primary data for enrollment is provided by a treatment provider.

6. The method as claimed in claim 1, wherein the primary data for enrollment is provided by one or more of an insured, a diagnostic physician and a treatment provider.

7. The method as claimed in claim 1, wherein the primary data about insurance coverage is provided by an insurer.

8. The method as claimed in claim 1, wherein the processed data includes a confirmation of insured eligibility.

9. The method as claimed in claim 1, wherein the processed data includes a computation of an Outcomes Index, the Outcomes Index providing a measure for a predicted and an actual recovery score of a patient.

10. The method as claimed in claim 9, further comprising:

creating a set of Reference Recovery Functions (RRFs) from historical patient data;

generating a predicted recovery score for a patient using the set of RFFs;

generating an actual recovery score for the patient using a set of the patient'"'"'s data and using the set of RFFs; and

calculating an Outcomes Index by using the predicted recovery score with the actual recovery score of the patient.

11. The method as claimed in claim 9, further comprising:

providing the Outcomes Index in a comparative report.

12. The method as claimed in claim 1, further comprising:

evaluating quantitatively a Diagnostic Accuracy Index (DAI) for a Diagnostic Physician, including the steps;

providing a diagnostic code for a patient; and

assigning a probability that the diagnostic code predicts the likelihood of the illness of the patient.

13. The method as claimed in claim 12, further comprising determining an accuracy score based on the diagnostic code and the probability.

14. A method for providing a comparative report on the performance of a health care provider, comprising:

creating a set of Reference Recovery Functions (RRFs) from historical patient data;

generating a predicted recovery score for a patient using the set of RRFs;

generating an actual recovery score for the patient using a set of the patient'"'"'s data and using the set of RRFs; and

calculating an Outcomes Index by using the predicted recovery score with the actual recovery score of the patient, the Outcomes Index providing a measure for a predicted and an actual recovery score of a patient.

15. The method as claimed in claim 14, wherein the set of the patient'"'"'s data comprises self-administered surveys from the patient.

16. The method as claimed in claim 14, wherein the outcomes measure can be expressed as M*=0.1[Σ

_iRS_idp/Σ

_i years_i].

17. The method as claimed in claim 14, wherein the outcomes measure can be expressed as M⁺=Σ

_i(RS_idp/PS_idp).

18. The method as claimed in claim 14, wherein the outcomes measure can be expressed as M^#=Σ

_iAS_idp/Σ

_iPS_idp.

19. The method as claimed in claim 14, wherein the outcomes measure can be determined by using the relationship Y_idp=b₀+b₁ M*idp+b₂ M^#idp+b₃ PR_idp+b₄ ln Q_idp+u.

20. The method as claimed in claim 14, wherein the health care provider may be one or more of a hospital, a diagnostic physician, a treatment provider, an insurer, a pharmaceutical or a nurse.

21. The method as claimed in claim 14, further comprising:

providing a set of Reference Recovery Functions (RRFs) for an illness, each RRF constructed from survey scores from a plurality of patients;

estimating a personal recovery function (RF) of a patient;

determining a recovery score (RS) of the patient based on the set of RRFs; and

determining the outcomes measure of the provider comprising a plurality of Recovery Scores of a plurality of patients.

22. A method for creating a Reference Recovery Function as a benchmark for comparing survey scores of a plurality of patients, comprising:

calculating a mean for a set of survey scores, a set of survey scores being all survey scores of a patient with respect to a single injury or illness;

sorting means of a plurality of sets of survey scores of the plurality of patients;

organizing a plurality of sorted means into a group; and

creating a Reference Recovery Function by fitting a curve statistically to means of survey scores in a group.

23. A system for automatically administering a health care plan comprising:

a processor; and

a memory in communications with the processor, the memory including program code executable by the processor to perform the following steps;

providing primary data for enrollment on-line to the database;

providing primary data from self-administered surveys on-line to the database by an insured;

providing primary data about insurance coverage on-line to the database; and

processing the primary data automatically into processed data.

24. The system as claimed in claim 23, further comprising:

providing billing and claim processing information to the database; and

processing the billing information automatically into processed claim data.

25. The system as claimed in claim 23, wherein the primary data for enrollment is provided by an insured.

26. The system as claimed in claim 23, wherein the primary data for enrollment is provided by a diagnostic physician.

27. The system as claimed in claim 23, wherein the primary data for enrollment is provided by a treatment provider.

28. The system as claimed in claim 23, wherein the primary data for enrollment is provided by one or more of an insured, a diagnostic physician and a treatment provider.

29. The system as claimed in claim 23, wherein the primary data about insurance coverage is provided by an insurer.

30. The system as claimed in claim 23, wherein the processed data includes a confirmation of insured eligibility.

31. The system as claimed in claim 23, wherein the processed data includes a computation of an Outcomes Index, the Outcomes Index providing a measure for a predicted and an actual recovery score of a patient.

32. The system as claimed in claim 31, the system further enabled to perform the following steps:

creating a set of Reference Recovery Functions (RRFs) from historical patient data;

generating a predicted recovery score for a patient using the set of RFFs;

generating an actual recovery score for the patient using a set of the patient'"'"'s data and using the set of RFFs; and

calculating an Outcomes Index by using the predicted recovery score with the actual recovery score of the patient.

33. The system as claimed in claim 32, the system further enabled to perform the step of providing the Outcomes Index in a comparative report.

34. The system as claimed in claim 23, the system further enabled to perform the steps of:

evaluating quantitatively a Diagnostic Accuracy Index (DAI) for a Diagnostic Physician, including the steps;

providing a diagnostic code for a patient; and

assigning a probability that the diagnostic code predicts the likelihood of the illness of the patient.

35. The system as claimed in claim 34, the system further enabled to perform the step of determining an accuracy score based on the diagnostic code and the probability.