Systems and Methods of Analyzing Healthcare Data

• US 20080288286A1
• Filed: 05/16/2008
• Published: 11/20/2008
• Est. Priority Date: 05/17/2007
• Status: Abandoned Application

• Current Assignee: United HealthCare Services Incorporated (UnitedHealth Group Incorporated)
• Original Assignee: United HealthCare Services Incorporated (UnitedHealth Group Incorporated)
• Inventors: Noreen, Rebecca, Peel, Chad
• Application Number:
  US12/122,386
• Publication Number:
  US 20080288286A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

The present invention provides systems and methods of analyzing healthcare data. In one embodiment, a Medical National Operations Center application (MNOC) displays clear, concise and actionable information, with visual indicators, to help Line of Service (LOS) teams to manage their operations by providing a dashboard of information. For example, the application may present selected summaries of data, baseline targets, customized metrics and interactive alerts that will be used to monitor, analyze and measure LOS performance. In one embodiment, the systems and methods of the present invention may be implemented in a health insurance provider system. As such, the present invention may provide access to additional, real-time data to evaluate initiatives allowing the LOS to react quickly to variances and expected results. Further, the present invention may provide tools to evaluate the effectiveness and performance of initiatives and programs, such as, for example, member steerage tools.

Claims

1. A method of identifying and contacting a candidate for a disease management program, the method comprising:

reviewing data for admissions to a health care facility for a plurality of health care plan members;

identifying a condition for the admissions of the plurality of health care plan members;

identifying a disease management program addressing the condition;

reviewing an enrollment status in the disease management program for the plurality of health care plan members;

identifying a non-enrolled portion of the plurality of health care plan members that are not engaged in the disease management program;

contacting a member the non-enrolled portion while the member of the non-enrolled portion is admitted to the health care facility or shortly thereafter; and

requesting that the member of the non-enrolled portion become engaged with the disease management program.

2. The method of claim 1, wherein the data for admissions to a health care facility for a plurality of health care plan members is displayed on a graphical user interface.

3. The method of claim 2, wherein the graphical user interface can be manipulated to display data relating to an individual health care plan member.

4. The method of claim 2, wherein the graphical user interface can be manipulated to display data relating to a particular geographic region.

5. The method of claim 2, wherein the graphical user interface can be manipulated to display data based on the type of contractual agreements between the health care facility and a manager of the health care plan.

6. The method of claim 2, wherein the graphical user interface can be manipulated to display data relating to an individual physician.

7. The method of claim 1, further comprising categorizing the plurality of health care plan members into groups based on the amount of time since the health care plan member has been contacted regarding the disease management program.

8. The method of claim 1, further comprising categorizing the plurality of health care plan members into groups based on the amount of time that the health care plan member has been admitted to the health care facility.

9. The method of claim 1, wherein the condition is selected from the group consisting of:

a cardiac condition, asthma, diabetes, an oncological condition, or a neo-natal condition.

10. The method of claim 1, wherein the enrollment status comprises members who have been identified but not contacted regarding the disease management program, members who have been contacted regarding the disease management program, members who are enrolled in the disease management program, members who are actively engaged in the disease management program, and members who are disenrolled in the disease management program.

11. A computer readable medium comprising a computer program recorded thereon that causes a computer to perform the steps of:

providing a graphical user interface;

displaying data for admissions to a health care facility for a plurality of health care plan members;

identifying a condition for the admissions of the plurality of health care plan members;

identifying a disease management program addressing the condition;

displaying an enrollment status in the disease management program for the plurality of health care plan members; and

identifying a non-enrolled portion of the plurality of health care plan members that are not engaged in the disease management program.

12. The computer readable medium of claim 11, wherein the graphical user interface can be manipulated to display data relating to an individual health care plan member.

13. The computer readable medium of claim 11, wherein the graphical user interface can be manipulated to display data relating to a particular geographic region.

14. The computer readable medium of claim 11, wherein the graphical user interface can be manipulated to display data based on the type of contractual agreements between the health care facility and a manager of the health care plan.

15. The computer readable medium of claim 11, wherein the graphical user interface can be manipulated to display data relating to an individual physician.

16. The computer readable medium of claim 11, wherein the graphical user interface is configured to categorize the plurality of health care plan members into groups based on the amount of time since the health care plan member has been contacted regarding the disease management program.

17. A method of evaluating data for utilization rates for health care providers, the method comprising:

obtaining data for utilization rates for a plurality of health care providers;

determining a normal range of utilization;

identifying a subset of the health care providers with utilization rates that are within the normal range of utilization; and

identifying a subset of the health care providers with utilization rates that are outside of the normal range of utilization.

18. The method of claim 17, further comprising:

contacting a health care provider that is in the subset of the health care providers with utilization rates that are outside of the normal range of utilization; and

notifying the health care provider of the normal range of utilization and the utilization rate for the health care provider.

19. The method of claim 17, further comprising:

directing members of a health care plan to receive treatment from health care providers that are within the subset of the health care provider with utilization rates that are within the normal range of utilization.

20. The method of claim 17, wherein the utilization rate comprises a ratio of a cardiac procedure per number of office visits.

21. The method of claim 20, wherein the utilization cardiac procedure is chosen from the list consisting of:

an angiogram, a perfusion, an echocardiogram, an EKG, a stress test, a cardiac computed tomography, and a cardiac magnetic resonance imaging.

22. The method of claim 17, further comprising categorizing the data for utilization rates for a plurality of health care providers by geographic region.

23. The method of claim 17, further comprising categorizing the data for utilization rates for a plurality of health care providers by the quality and efficiency of the health care provider.

24. A computer readable medium comprising a computer program recorded thereon that causes a computer to perform the steps of:

providing a graphical user interface;

displaying data for utilization rates for a procedure for a plurality of health care providers;

displaying a normal range of utilization; and

identifying a subset of the health care providers with utilization rates that are outside of the normal range of utilization.

25. The computer readable medium of claim 24, wherein the utilization rates are categorized based on the quality and efficiency of the health care provider.

26. The method of claim 24, wherein the utilization rate comprises a ratio of a cardiac procedure per number of office visits.

27. The method of claim 26, wherein the cardiac procedure is chosen from the list consisting of:

an angiogram, a perfusion, an echocardiogram, an EKG, a stress test, a cardiac computed tomography, and a cardiac magnetic resonance imaging.

28. The computer readable medium of claim 24, wherein the graphical user interface can be manipulated to display data for utilization rates for a plurality of health care providers categorized by geographic region.

29. The method of claim 24, wherein the graphical user interface can be manipulated to display data for utilization rates for a plurality of health care providers categorized by the quality and efficiency of the health care provider.

30. A method of identifying an opportunity for an improvement in a health care plan member'"'"'s quality of health coupled with a medical cost reduction, the method comprising:

reviewing real-time data for admissions to a health care facility for a plurality of members of a health care plan of a client;

identifying a subset of the plurality of members of the health care plan, wherein members of the subset were admitted to the health care facility with one or more conditions;

identifying a disease management program addressing the one or more conditions, wherein the disease management program is not currently purchased by the client;

notifying the client of the subset of the plurality of members of the health care plan that were admitted to the health care facility with the one or more conditions; and

notifying the client of availability of the disease management program.

31. The method of claim 30, wherein the disease management program is configured to address a condition selected from the group consisting of:

coronary artery disease, heart failure, diabetes, asthma, chronic obstructive pulmonary disease, and low back pain.