Method for selecting a high risk patient for participation in a care management program for patients having poor prognoses

• US 20090240529A1
• Filed: 05/27/2009
• Published: 09/24/2009
• Est. Priority Date: 12/27/2003
• Status: Abandoned Application

• Current Assignee: Enhanced Care Initiatives, Inc.
• Original Assignee: Enhanced Care Initiatives, Inc.
• Inventors: Chess, David Mark, Krentzman, Mary
• Application Number:
  US12/454,952
• Publication Number:
  US 20090240529A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/06375 Prediction of business process outcome or impact based on a proposed change
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 40/12 Accounting
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 70/20 relating to practices or guidelines
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

The method of the present invention is used to select high risk or co-morbid patients for participation in a care management program. An acuity score determines which patients are selected for care management.

Claims

1. ) A method for selecting a high risk patient for participation in a care management program for patients having poor prognoses, wherein said care management program is provided by a care management entity not responsible for said high risk patient'"'"'s diagnosis or prescribed medical treatment, wherein selection of said high risk patient for participation in said care management program is determined by said high risk patient'"'"'s acuity score, wherein said acuity score is calculated by said care management entity'"'"'s computer system utilizing a proprietary computer program capable of generating data enterable and viewable electronic templates for use with a multi-component calculation of said acuity score, and wherein said acuity score comprises:

i) an objective acuity rating component based on a care management entity'"'"'s representative'"'"'s verification of a potential patient'"'"'s current and past medical conditions with one or more of said potential patient, said potential patient'"'"'s representative or said potential patient'"'"'s treatment plan health care provider, wherein each medical condition is assigned a predetermined numerical value established by said care management entity, and wherein said objective acuity rating component is a summation of said predetermined numerical values;

ii) an annualized medical treatment cost acuity rating component based on said care management entity'"'"'s representative'"'"'s verification of said potential patient'"'"'s prior annualized treatment costs for up to three preceding years, wherein each yearly cost of treatment of said prior annualized treatment costs has a specific acuity rating assigned by said care management entity, wherein said annualized medical treatment cost acuity rating component is a summation of said specific acuity ratings, and wherein, by predefined parameters implemented by said proprietary program, said summation of said specific acuity ratings does not exceed a fixed limit established by said care management entity; and

iii) a subjective acuity rating component, wherein subjective responses from said potential patient regarding said patient'"'"'s cognition of said potential patient'"'"'s daily living status and medical conditions are solicited by said care management entity'"'"'s representative, wherein each of said potential patient'"'"'s responses has a predetermined numerical significance assigned by said care management entity, and wherein said subjective acuity rating component is a summation of said predetermined numerical significances;

said method for selecting said high risk patient for participation in said care management program for patients having poor prognoses, comprising the steps of;

a) having said care management entity'"'"'s representative enter said potential patient'"'"'s verified current and past medical conditions into an objective acuity rating component electronic template viewable on said computer system and authorizing said computer system to calculate said objective acuity rating component;

b) having said care management entity'"'"'s representative enter said potential patient'"'"'s verified prior annualized treatment costs into an annualized medical treatment cost acuity rating electronic template and authorizing said computer system to calculate said annualized medical treatment cost acuity rating component;

c) having said computer system generate an electronic questionnaire for utilization by said care management entity'"'"'s representative in conducting a remote telephonic or an in-personal interview of said potential patient to solicit said subjective responses from said potential patient regarding said patient'"'"'s cognition of said potential patient'"'"'s daily living status and medical conditions, wherein said care management entity'"'"'s representative subjectively evaluates said potential patient'"'"'s subjective responses in conjunction with entering said potential patient'"'"'s evaluated responses into said electronic questionnaire, wherein said care management entity'"'"'s representative'"'"'s subjective evaluation of said potential patient'"'"'s subjective responses and subsequent entry of said evaluated responses into said electronic questionnaire can alter said predetermined significance of any said potential patient'"'"'s subjective responses allowing said care management entity to better determine which potential patient is more suitable for management by said care management program;

d) having said computer system calculate said subjective acuity rating component,

e) having said computer program weigh said objective acuity rating component, said annualized medical treatment cost acuity rating component and said subjective acuity rating component according to parameters assigned by said care management entity; and

f) having said computer system calculate said high risk patient'"'"'s acuity score from said weighted objective acuity rating component, said weighted annualized medical treatment cost acuity rating component and said weighted subjective acuity rating component, wherein, as a result of said high risk patient'"'"'s acuity score, said high risk patient is accepted or rejected for participation in said care management program.

2. ) The method of claim 1 further comprising the steps of:

a) having said care management entity'"'"'s computer system mine third party databases for mortality, morbidity, medical care and treatment expenditure data associated with high risk patients other than patients managed by said care management entity; and

b) utilizing said computer program to analyze said mined data according to parameters assigned by said care management entity.

3. ) The method of claim 2 further comprising the step of utilizing a compilation of said analyzed mined data and data stored in said care management entity'"'"'s computer system for modifying weighting of said objective acuity rating component, said annualized medical treatment cost acuity rating component and said subjective acuity rating component.

4. ) The method of claim 3, wherein said care management entity'"'"'s computer system mines one or more of Medicare, Medicaid, mortality, health insurers, Center for Disease Control and health maintenance organization databases.

5. ) A method for selecting a high risk patient for participation in a care management program for patients having poor prognoses, wherein said care management program is provided by a care management entity not responsible for said high risk patient'"'"'s diagnosis or prescribed medical treatment, wherein selection of said high risk patient for participation in said care management program is determined by said high risk patient'"'"'s acuity score, wherein said acuity score is calculated by said care management entity'"'"'s computer system utilizing a proprietary computer program capable of generating data enterable and viewable electronic templates for use with a multi-component calculation of said acuity score;

said method for selecting a high risk patient comprising the steps of;

a) having a representative of said care management entity verify current and past medical conditions for a potential patient of said care management program;

b) having said representative enter said potential patient'"'"'s verified current and past medical conditions into an objective acuity rating component electronic template of said multi-component calculation;

c) having said computer system calculate said objective acuity rating component, wherein said objective acuity rating component is a summation of assigned values for each medical condition, and wherein said values are assigned by said proprietary computer program;

d) having said representative verify prior annualized treatment costs of said potential patient;

e) having said representative enter said potential patient'"'"'s verified prior annualized treatment costs into an annualized medical treatment cost acuity rating electronic template of said multi-component calculation;

f) having said computer system calculate said annualized medical treatment cost acuity rating component, wherein said annualized medical treatment cost acuity rating component is a summation of assigned specific acuity ratings associated with each yearly cost of treatment for as many as three preceding years, wherein said specific acuity ratings are assigned by said proprietary computer program, and wherein, by predefined parameters implemented by said proprietary program, said summation of said specific acuity ratings does not exceed a fixed limit established by said care management entity;

g) having said computer system generate an electronic questionnaire, associated with a subjective acuity rating component of said multi-component calculation, for utilization by said representative in conducting a remote telephonic or in-person interview of said potential patient to solicit subjective responses from said potential patient regarding said potential patient'"'"'s cognition of said potential patient'"'"'s daily living status and medical conditions, wherein each of said potential patient'"'"'s responses has a predetermined numerical significance assigned by said proprietary computer program, and wherein said subjective acuity rating component is a summation of said predetermined numerical significances;

h) in conjunction with entering said potential patient'"'"'s subjective responses into said electronic questionnaire, having said representative subjectively evaluate said potential patient'"'"'s subjective responses such that said representative'"'"'s subjective evaluation of said potential patient'"'"'s subjective responses and subsequent entry by said representative of an evaluated response into said electronic questionnaire alters said predetermined significance attributed to one or more of said potential patient'"'"'s subjective responses initially calculated by said proprietary computer program, thereby allowing said care management entity to better determine if said potential patient is more suitable for management by said care management program;

i) having said computer system calculate said subjective acuity rating component;

j) having said proprietary computer program weigh said objective acuity rating component, said annualized medical treatment cost acuity rating component and said subjective acuity rating component according to parameters assigned by said care management entity; and

k) having said computer system calculate said high risk patient'"'"'s acuity score from said weighted objective acuity rating component, said weighted annualized medical treatment cost acuity rating component and said weighted subjective acuity rating component, wherein, as a result of said high risk patient'"'"'s acuity score, said high risk patient is accepted or rejected for participation in said care management program.

6. ) The method of claim 5 further comprising the steps of:

a) having said care management entity'"'"'s computer system mine third party databases for mortality, morbidity, medical care and treatment expenditure data associated with high risk patients other than patients managed by said care management entity; and

b) utilizing said computer program to analyze said mined data according to parameters assigned by said care management entity.

7. ) The method of claim 6 further comprising the step of utilizing a compilation of said analyzed mined data and data stored in said care management entity'"'"'s computer system for modifying weighting of said objective acuity rating component, said annualized medical treatment cost acuity rating component and said subjective acuity rating component.

8. ) The method of claim 7, wherein said care management entity'"'"'s computer system mines one or more of Medicare, Medicaid, mortality, health insurers, Center for Disease Control and health maintenance organization databases.

9. ) A method for selecting a high risk patient for participation in a care management program for patients having poor prognoses, wherein said care management program is provided by a care management entity not responsible for said high risk patient'"'"'s diagnosis or prescribed medical treatment, wherein selection of said high risk patient for participation in said care management program is determined by said high risk patient'"'"'s acuity score, wherein said acuity score is calculated by said care management entity'"'"'s computer system utilizing a proprietary computer program capable of generating data enterable and viewable electronic templates for use with a multi-component calculation of said acuity score;

said method for selecting a high risk patient comprising the steps of;

a) verifying and entering a potential patient'"'"'s current and past medical conditions into an objective acuity rating component electronic template of said multi-component calculation and having said computer system calculate said objective acuity rating component, wherein said objective acuity rating component is a summation of assigned values for each medical condition, and wherein said values are assigned by said proprietary computer program;

b) verifying and entering said potential patient'"'"'s prior annualized treatment costs into an annualized medical treatment cost acuity rating electronic template of said multi-component calculation and having said computer system calculate said annualized medical treatment cost acuity rating component, wherein said annualized medical treatment cost acuity rating component is a summation of assigned specific acuity ratings associated with each yearly cost of treatment for up to three preceding years, and wherein said specific acuity ratings are assigned by said proprietary computer program;

c) having said computer system generate an electronic questionnaire, associated with a subjective acuity rating component of said multi-component calculation, for utilization by a representative in conducting a telephonic or in-person interview of said potential patient to solicit subjective responses from said potential patient regarding said potential patient'"'"'s cognition of said potential patient'"'"'s daily living status and medical conditions, wherein each of said potential patient'"'"'s responses has a predetermined numerical significance assigned by said proprietary computer program, and wherein said subjective acuity rating component is a summation of said predetermined numerical significances;

d) in conjunction with entering said potential patient'"'"'s subjective responses into said electronic questionnaire, having said representative subjectively evaluate said potential patient'"'"'s subjective responses such that said representative'"'"'s subjective evaluation of said potential patient'"'"'s subjective responses and subsequent entry by said representative of an evaluated response into said electronic questionnaire alters said predetermined significance attributed to one or more of said potential patient'"'"'s subjective responses initially calculated by said proprietary computer program, thereby allowing said care management entity to better determine if said potential patient is more suitable for management by said care management program, and having said computer system calculate said subjective acuity rating component; and

e) having said computer system calculate said high risk patient'"'"'s acuity score from said objective acuity rating component, said annualized medical treatment cost acuity rating component and said acuity rating component, wherein, as a result of said high risk patient'"'"'s acuity score, said high risk patient is accepted or rejected for participation in said care management program.

10. ) The method of claim 9, wherein said summation of said assigned specific acuity ratings does not exceed a fixed limit established by said care management entity.

11. ) The method of claim 10 further comprising the step of having said proprietary computer program weigh said objective acuity rating component, said annualized medical treatment cost acuity rating component and said subjective acuity rating component according to parameters assigned by said care management entity

12. ) The method of claim 11 further comprising the steps of:

a) having said care management entity'"'"'s computer system mine third party databases for mortality, morbidity, medical care and treatment expenditure data associated with high risk patients other than patients managed by said care management entity; and

b) utilizing said computer program to analyze said mined data according to parameters assigned by said care management entity.

13. ) The method of claim 12 further comprising the step of utilizing a compilation of said analyzed mined data and data stored in said care management entity'"'"'s computer system for modifying weighting of said objective acuity rating component, said annualized medical treatment cost acuity rating component and said subjective acuity rating component.

14. ) The method of claim 13, wherein said care management entity'"'"'s computer system mines one or more of Medicare, Medicaid, mortality, health insurers, Center for Disease Control and health maintenance organization databases.