HEALTHCARE INCENTIVE SYSTEM AND METHOD

• US 20100145736A1
• Filed: 12/01/2009
• Published: 06/10/2010
• Est. Priority Date: 12/03/2008
• Status: Abandoned Application

• Current Assignee: Michael Rohwer
• Original Assignee: Michael Rohwer
• Inventors: Rohwer, Michael
• Application Number:
  US12/628,888
• Publication Number:
  US 20100145736A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A method for rewarding providers who are parts of virtual teams may permit a payer to establish practice goals, clinical goals, cost containment goals, or other goals by rewarding outcomes deemed to be beneficial by the payer, providers, or both. Providers may participate in one or more member management objects, which may be software that define provider and patient goals and a set of rewards for achieving the provider and patient goals. Subscribing to a member management object may reward providers with bonus payments when a provider goal is met, which may be met by achieving patient goals. The patient goals may be defined in the member management object, and may relate to medical practices, including procedures performed, procedures not performed, clinical results, lab and other test results, diagnoses, referrals, and cost objectives. By subscribing to member management objects, providers may become parts of virtual teams of providers, each virtual team rendering services for one patient. Provider team members may be able to view the other virtual team members, the past services rendered by the other virtual team members, and the results of the services provided by the other virtual team members.

Claims

1. A computer program product, comprising a computer usable medium having a computer readable program code embodied therein, said computer readable program code adapted to be executed to implement a method for facilitating healthcare services, said program code comprising:

computer readable instructions that enable a computer to receive at least a portion of an electronic provider payment request, the portion of the provider payment request including a provider identifier, a patient identifier, and a service identifier representing a current service rendered by the provider, the service identifier related to a medical condition;

computer readable instructions that enable the computer to identify a patient record in a database, the patient record associated with the patient identifier;

computer readable instructions that enable the computer to identify a provider record in a database, the provider record associated with the provider identifier;

computer readable instructions that enable the computer to create a current unbounded virtual team including other providers with unique provider identifiers that are associated with both the patient identifier in a database and with a past service identifier that is related to the medical condition;

computer readable instructions that enable the computer to associate the provider identifier with both the patient identifier and the service identifier in a database to update the current unbounded virtual team associated with the patient identifier by including the provider identifier with the current unbounded virtual team;

computer readable instructions that grant the provider associated with the provider identifier information access to a medical record for the patient, the medical record related to the medical condition and the medical record including clinical data from the other providers who are members of the current unbounded virtual team; and

computer readable instructions that permit the provider to access the medical record for the patient and base further treatment for the medical condition at least in part on the medical record.

2. A computer program product according to claim 1, said program code further comprising:

computer readable instructions that enable the computer to determine whether the provider associated with the provider identifier qualifies for a reward using the service identifier, the provider identifier, and the patient identifier;

computer readable instructions that enable the computer to retrieve at least one unbounded virtual team of which the provider is a member, including the current unbounded virtual team, where the provider identifier is associated with a past service identifier related to the medical condition;

computer readable instructions that enable the computer to determine a patient goal achievement indicator for each retrieved unbounded virtual team, where the patient goal achievement indicator relates to an aspect of the medical condition exhibited by a patient associated with the patient identifier;

computer readable instructions that enable the computer to determine a provider goal achievement indicator using the patient goal achievement indicator for each retrieved unbounded virtual team and the determination of whether the provider associated with the provider identifier qualifies for a reward; and

computer readable instructions that enable the computer to create a reward for the provider associated with the provider identifier based on the provider goal achievement indicator.

3. A computer program product according to claim 2, wherein retrieving at least one unbounded virtual team is further based on the provider identifier being associated with a past service identifier related to the medical condition within a predetermined time.

4. A computer program product according to claim 2, wherein the reward includes a bonus payment.

5. A computer program product according to claim 1, said program code further comprising computer readable instructions that enable the computer to write the provider goal achievement indicator to a database.

6. A computer program product according to claim 1, said program code further comprising:

computer readable instructions that enable the computer to receive an information request from the provider regarding past service identifiers associated with the patient identifier, the past service identifiers related to the medical condition; and

computer readable instructions that enable the computer to respond with at least a portion of the patient'"'"'s medical record, the medical record portion related to the medical condition and including clinical data related to the medical condition.

7. A computer program product according to claim 1, said program code further comprising:

computer readable instructions that enable the computer to receive an information request regarding provider identifiers related to the medical condition; and

computer readable instructions that enable the computer to respond with providers associated with the provider identifiers related to the medical condition, the providers categorized by role and by provider goal achievement.

8. A computer program product according to claim 1, said program code further comprising:

computer readable instructions that enable the computer to receive an information request regarding provider identifiers related to the medical condition; and

computer readable instructions that enable the computer to respond with unbounded virtual teams associated with the provider identifiers related to the medical condition and with patient goal achievement indicators associated with each unbounded virtual team.

9. An incentive system comprising:

a general purpose computer; and

one or more databases operatively connected to the general purpose computer;

the one or more databases including encounter records, clinical records, patient records, and provider records;

the general purpose computer programmed to;

receive at least a portion of a provider payment request, the provider payment request including a provider identifier, a patient identifier, medical codes, and clinical information, the clinical information and the medical codes related to a medical condition;

verify that the provider identifier is associated with a provider record;

verify that the patient identifier is associated with a patient record;

update an encounter record associated with the patient identifier with the provider identifier and the medical codes;

update a clinical record associated with the patient identifier with the clinical information; and

grant a provider associated with the provider identifier access to the patient record associated with the patient identifier, access to clinical records associated with the patient identifier and the medical condition, and access to encounter records associated with the patient identifier and the medical condition.

10. An incentive system according to claim 9, wherein the general purpose computer is further programmed to:

retrieve encounter records associated with the provider identifier and the medical condition, the encounter records including patient identifiers;

retrieve clinical records based on the patient identifiers retrieved from the encounter records;

determine a patient goal achievement indicator for each patient identifier retrieved from the encounter records based on the retrieved clinical records;

determine a provider goal achievement indicator based on the determined patient goal achievement indicators; and

determine a reward based on the provider goal achievement indicator.

11. A method for facilitating healthcare services comprising:

receiving at a computer at least a portion of an electronic provider payment request, the portion of the provider payment request including a provider identifier, a patient identifier, and a service identifier representing a current service rendered by the provider, the service identifier related to a medical condition;

identifying by the computer a patient record in a database, the patient record associated with the patient identifier;

identifying by the computer a provider record in a database, the provider record associated with the provider identifier;

associating by the computer the provider identifier with both the patient identifier and with the service identifier in a database to update a current unbounded virtual team associated with the patient identifier, the current unbounded virtual team including other providers with unique provider identifiers that are associated with the patient identifier and with a past service identifier related to the medical condition; and

granting information access to a medical record for the patient by the computer to the provider associated with the provider identifier, the medical record related to the medical condition and the medical record including clinical data from the other providers who are members of the current unbounded virtual team; and

accessing through the computer the medical record for the patient, and basing further treatment for the medical condition at least in part on the medical record.

12. A method for facilitating healthcare services comprising:

receiving at a computer at least a portion of an electronic provider payment request from a provider, the portion of the provider payment request relating to a current service rendered for a patient;

determining by the computer whether the request for payment should be paid;

determining by the computer whether the current service rendered qualifies the provider for a bonus;

creating by the computer a virtual unbounded team of healthcare providers, the team including healthcare providers who rendered past services for the patient within a predetermined period of time, and each rendered past service qualified the healthcare provider who rendered the past service for a bonus;

adding the provider to the virtual unbounded team by the computer based on whether the current service qualifies the provider for a bonus; and

granting access to medical records for the patient by the computer to each provider on the virtual unbounded team.

13. A method for facilitating healthcare services according to claim 12, wherein the current service is related to a medical condition, each past service is related to the medical condition, and the medical records are related to the medical condition.