Impact Intelligence Oncology Management

• US 20100042431A1
• Filed: 08/14/2009
• Published: 02/18/2010
• Est. Priority Date: 08/15/2008
• Status: Abandoned Application

• Current Assignee: Ingenix Incorporated (UnitedHealth Group Incorporated)
• Original Assignee: Ingenix Incorporated (UnitedHealth Group Incorporated)
• Inventors: O'Connor, Joe, Woo, Ruby K., Khan, Janis Diring
• Application Number:
  US12/541,776
• Publication Number:
  US 20100042431A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 50/22 Social work or social welfare, e.g. community support activities or counselling services
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A system and methods for evaluating quality and cost efficiency of a healthcare service to a patient are presented. In one embodiment, the system may include a merged database comprising administrative data and clinical data, a cost-of-care efficiency engine coupled to the merged database, the cost efficiency engine configured to analyze the merged clinical data and administrative data to determine a measurement of cost efficiency, a quality engine coupled to the merged database, the quality engine configured to analyze the merged clinical data and administrative data to determine a compliance value, wherein the compliance value indicates a level of compliance with a clinical guideline, and a reporting application coupled to the cost efficiency engine and the quality engine, the reporting application configured to generate a report representing at least one of the measurement of cost efficiency and the compliance value.

Claims

1. A system for evaluating quality and cost efficiency of a healthcare service to a patient, comprising:

a merged database comprising administrative data and clinical data;

a cost-of-care efficiency engine coupled to the merged database, the cost efficiency engine configured to analyze the merged clinical data and administrative data to determine a measurement of cost efficiency;

a quality engine coupled to the merged database, the quality engine configured to analyze the merged clinical data and administrative data to determine a compliance value, wherein the compliance value indicates a level of compliance with a clinical guideline; and

a reporting application coupled to the cost efficiency engine and the quality engine, the reporting application configured to generate a report representing at least one of the measurement of cost efficiency and the compliance value.

2. The system of claim 1, wherein the clinical data is collected by a clinical exchange system and a clinical coding system.

3. The system of claim 2, wherein the clinical exchange system comprises fax or internet based data exchange forms.

4. The system of claim 2, wherein the specialty is oncology, cardiology, renal disease or orthopedics.

5. The system of claim 4, wherein the specialty is oncology.

6. The system of claim 5, wherein the clinical data include histology, tumor stage, tumor cell receptor expression or disease progression.

7. The system of claim 5, wherein the clinical coding system comprises a data dictionary.

8. The system of claim 7, wherein the data dictionary includes initial diagnosis, disease stage or treatment status.

9. The system of claim 1, wherein the system further comprises a benchmark module.

10. A method for evaluating quality of healthcare service to a patient, comprising:

merging clinical data and administrative data;

analyzing the merged clinical data and administrative data to determine a compliance value, wherein the compliance value indicates a level of concurrence with a clinical guideline; and

generating a report representing the compliance value.

11. The method of claim 10, wherein the clinical guideline comprises a treatment guideline or medication adherence.

12. The method of claim 11, wherein the clinical guidelines is an NCCN guideline.

13. The method of claim 10, further comprising aggregating clinical and administrative data to provide a benchmark.

14. The method of claim 10, wherein the provider is a physician, a hospital, a clinic or an emergency room.

15. The method of claim 10, wherein the provider is an individual or a healthcare network.

16. The method of claim 10, wherein the stakeholder is a consumer, a healthcare provider, a payer or an employer.

17. A method for evaluating cost efficiency of a healthcare service to a patient, comprising:

merging clinical data and administrative data;

analyzing the merged clinical data and administrative data to determine a measurement of cost efficiency; and

generating a report representing the measurement of cost efficiency.

18. The method of claim 17, wherein the clinical data include initial stage, disease stage, treatment status or prognostic indicators.

19. The method of claim 17, further comprising aggregating clinical and administrative data to provide a benchmark.

20. The method of claim 17, wherein the provider is a physician, a hospital, a clinic or an emergency room.

21. The method of claim 17, wherein the provider is an individual or a healthcare network.

22. The method of claim 17, wherein the stakeholder is a consumer, a healthcare provider, a payer or an employer.