SYSTEM AND METHOD FOR AN INTEGRATED DISEASE MANAGEMENT SYSTEM

• US 20080103814A1
• Filed: 11/01/2006
• Published: 05/01/2008
• Est. Priority Date: 11/01/2006
• Status: Active Grant

• Current Assignee: Walgreen Co. (Walgreens Boots Alliance Incorporated)
• Original Assignee: Walgreen Co. (Walgreens Boots Alliance Incorporated)
• Inventors: Frazee, Sharon G., Fabius, Raymond, Kirkpatrick, Patricia
• Granted Patent: US 8,666,761 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 70/20 relating to practices or guidelines
• 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

An apparatus, method, and system for the design, administration and implementation of integrated disease management. The integrated disease management (“IDM”) system maximizes contact and enrollment rates of traditional remote disease management alone. This is accomplished through the creation of a system that combines telephonic-delivered disease management (i.e. traditional disease management) with work-site based health center clinician (“trusted clinician”). The IDM program is characterized by the involvement of a trusted clinician who actively participates in the disease management program by being involved in the stratification process, the contact step and the process of creating and updating the patient'"'"'s individualized care plan. Therefore, the IDM program also allows the clinician to be involved in both contact and enrollment phases of the program. The IDM program further increases the efficiency of the disease management program by allowing employers to realize higher returns on their investment into such programs.

Claims

1. A method for coordinated healthcare delivery, comprising:

generating a first population of patients;

contacting the patients from said first population of patients, wherein said contact is made by a trusted clinician;

generating a second population of patients from said first population, wherein said second population comprises those patients from said first population of patients contacted by a trusted clinician who have agreed to enroll in a coordinated healthcare delivery program;

contacting the patients from said second population of patients for enrollment in a coordinated healthcare delivery program;

enrolling at least one patient from said list of second population of patients in a coordinated healthcare delivery program; and

generating a care plan for each enrolled patient wherein, said care plan is developed based upon interaction between one or more of the enrolled patient, the trusted clinician and a nurse coach.

2. The method of claim 1, wherein generating said first population of patients further comprises:

selecting an eligible population of patients from a group of patients having at least one of a group of diseases requiring coordinated healthcare delivery and wherein the patients are eligible to enroll for coordinated healthcare delivery;

selecting a base target population from said eligible population of patients, wherein each base target population patient is determined based on predictive modeling of at least one of improved health-benefits or avoidable health costs; and

selecting a final target population from a base target population, wherein each final target population patient is determined based on a review of patient claim data by at least one of a primary care physician, registered nurse, nurse'"'"'s assistant, pharmacist, pharmacy assistant or any other work-site based clinician.

3. The method of claim 2, wherein the review of claim data further comprises a predictive probability analysis of at least one of clinical data, cost data or administrative data.

4. The method of claim 1, wherein said trusted clinician is part of an on-site health clinic or pharmacy.

5. The method of claim 1, further comprises transmitting said first population of patients by at least one of:

(i) a central facility to a remote terminal within a peer-to-peer network or any data communication network capable of transmitting and receiving data from a central facility to a remote terminal;

or

(ii) an email, fax, secure message, phone call or other standard communication method.

6. The method of claim 1, further comprises transmitting said second population of patients by at least one of:

(i) a central facility to a remote terminal within a peer-to-peer network or any data communication network capable of transmitting and receiving data from a central facility to a remote terminal;

or

(ii) an email, fax, secure message, phone call or other standard communication method.

7. The method of claim 6, wherein said case manager is at least one of a registered nurse, a health service representative or a coordinated healthcare delivery representative.

8. The method of claim 1, wherein a patient from said first population of patients is contacted by at least one of:

(i) a trusted clinician during a patient'"'"'s regularly scheduled visit to the health clinic;

(ii) a trusted clinician during a patient'"'"'s visit to the pharmacy to pick up prescribed medication;

or

(iii) a trusted clinician outside of a patient'"'"'s visit to the health clinic and via any one of an email, a fax, a secure message, a phone call or other standard communication method.

9. The method of claim 1, wherein said trusted clinician is any one of a primary care physician, a registered nurse, a nurse'"'"'s assistant, a pharmacist, a pharmacy assistant or any other work-site based clinician with whom a patient has a preexisting medical relationship.

10. The method of claim 1, further comprising rendering individualized patient care to each of said enrolled patients from said list of second population of patients is in accordance with said generated care plan.

11. The method of claim 1, wherein patient information for each of said list of first population of patients and said list of second population of patients is stored in a central facility that can be accessed from a remote terminal connected to the central facility means via a network.

19. The method of claim 1, further comprising:

generating a population of patients wherein, the patients in said population have at least one of a group of diseases requiring coordinated healthcare delivery;

the patients are eligible to enroll for coordinated healthcare delivery; and

the patients are eligible for re-enrollment;

transmitting said list of population of patients to a nurse coach;

contacting the patients from said list of population of patients, wherein said contact is made by a nurse coach;

completing assessment of each of at least one of said contacted patient;

re-enrolling at least one of said contacted patient in a coordinated healthcare delivery program; and

generating a care plan for each re-enrolled patient wherein, said care plan is developed based upon interaction between one or more of the enrolled patient, the trusted clinician and a nurse coach.

20. The method of claim 19 wherein the patients eligible for re-enrollment are at least one of:

a patient who is currently not enrolled in a coordinated health delivery program;

a patient who declined enrollment during a previous contact by the trusted clinician or case manager;

a patient who has contacted a health clinic or a trusted clinician to enroll into a coordinated health delivery program;

a patient who was previously enrolled in a coordinated health delivery program which has since expired;

or

a patient who is a new employee or is newly diagnosed with one of the eligible conditions.

12. A method for coordinated healthcare delivery, comprising:

receiving a first population of patients;

contacting the patients from said first population of patients, wherein said contact is made by a trusted clinician;

receiving a second population of patients generated from said first population, wherein said second population comprises those patients from said first population of patients contacted by a trusted clinician who have agreed to enroll in a coordinated healthcare delivery program; and

rendering individualized patient care by a trusted clinician to the patients enrolled in a coordinated healthcare delivery program wherein, each enrolled patient is at least one of a member of a second population of patients transmitted to a case manager, a patient contacted by a case manager, or a patient enrolled in a coordinated healthcare delivery program, said second population of patients comprising those patients from the first population of patients who agreed to enroll in a coordinated healthcare delivery program, and wherein an individualized care plan for each of said enrolled patient is developed based upon interaction between the enrolled patient and at least one of a trusted clinician or nurse coach.

13. The method of claim 12, wherein said first population of patients further comprises:

an eligible population of patients, wherein the patients have at least one of a group of diseases requiring coordinated healthcare delivery and wherein the patients are eligible to enroll for coordinated healthcare delivery;

a base target population from said eligible population of patients, wherein each of said base target population patient is determined based on predictive modeling of at least one of improved health-benefits or avoidable health costs; and

a final target population from a base target population, wherein each final target population patient is determined based on a review of patient claim data by at least one of a primary care physician, registered nurse, nurse'"'"'s assistant, pharmacist, pharmacy assistant or any other work-site based clinician.

14. The method of claim 13, wherein the review of claim data further comprises a predictive probability analysis of at least one of clinical data, cost data or administrative data.

15. The method of claim 12, further comprises receiving said first population of patients by at least one of:

(i) a central facility means to a remote terminal within a peer-to-peer network or any data communication network capable of transmitting and receiving data from a central facility means to a remote terminal;

or

(ii) an email, fax, secure message, phone call or other standard communication method.

16. The method of claim 12, further comprises receiving said second population of patients by at least one of:

(i) a central facility means to a remote terminal within a peer-to-peer network or any data communication network capable of transmitting and receiving data from a central facility means to a remote terminal;

or

(ii) an email, fax, secure message, phone call or other standard communication method.

17. The method of claim 12, wherein the patients from said first population of patients are contacted by at least one of:

(i) a trusted clinician during a patient'"'"'s regularly scheduled visit to the health clinic;

(ii) a trusted clinician during a patient'"'"'s visit to the pharmacy to pick up prescribed medication;

or

(iii) a trusted clinician outside of a patient'"'"'s visit to the health clinic and via any one of an email, a fax, a secure message, a phone call or other standard communication method.

18. The method of claim 12, wherein said trusted clinician is any one of primary care physician, registered nurse, nurse'"'"'s assistant, pharmacist, pharmacy assistant or any other work-site based clinician.

21. A method for coordinated healthcare delivery, comprising:

generating a first population of patients;

contacting the patients from said first population of patients, wherein said contact is made by a trusted clinician;

generating a second population of patients from said first population, wherein said second population comprises those patients from said first population of patients contacted by a trusted clinician who have agreed to enroll in a coordinated healthcare delivery program;

contacting the patients from said second population of patients for enrollment in a coordinated healthcare delivery program;

enrolling at least one patient from said list of second population of patients in a coordinated healthcare delivery program; and

generating a care plan for each enrolled patient.