ANALYZING ADMINISTRATIVE HEALTHCARE CLAIMS DATA AND OTHER DATA SOURCES

• US 20110231422A1
• Filed: 03/28/2011
• Published: 09/22/2011
• Est. Priority Date: 12/06/2005
• Status: Active Grant

• Current Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Original Assignee: Ingenix Incorporated (UnitedHealth Group Incorporated)
• Inventors: Rawlings, Jean, Paris, Andrew, Anderson, David, Kraus, Carl
• Granted Patent: US 8,700,649 B2
• Time in Patent Office: Days
• US Class Current: 707/758
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation
• CPC Class Codes: Y10S 707/941 Human sciences

Abstract

Techniques suitable for identifying potential subjects for a clinical trial and other applications are disclosed. One or more exclusion or inclusion criteria are defined for the clinical trial. One or more specialized searching tables are pre-generated using administrative healthcare claims data and the one or more exclusion or inclusion criteria. The specialized searching tables are searched. Through the searching step, subjects are identified within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria. Through the searching step, a geographical area is identified corresponding to the subjects who match the one or more exclusion or inclusion criteria. A customized report is generated using the identified subjects and geographical area.

Claims

1-34. -34. (canceled)

35. A method for identifying potential subjects for a clinical trial, comprising:

defining one or more exclusion or inclusion criteria for the clinical trial;

pre-generating one or more specialized searching tables using administrative healthcare claims data and the one or more exclusion or inclusion criteria;

searching with a computing device the specialized searching tables;

identifying with the computing device, through the searching step, subjects within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria;

identifying with the computing device, through the searching step, a geographical area corresponding to the subjects who match the one or more exclusion or inclusion criteria; and

generating a customized report using the identified subjects and geographical area.

36. The method of claim 35, where defining one or more exclusion or inclusion criteria comprises selecting criteria using a Venn diagram.

37. The method of claim 35, where defining one or more exclusion or inclusion criteria comprises selecting one or more medical diagnosis codes.

38. The method of claim 35, where identifying the geographical area comprises identifying a zip code.

39. The method of claim 35, where the customized report comprises a map illustrating subjects according to location.

40. The method of claim 35, further comprising identifying potential clinical investigators for the clinical trial through searching of the specialized searching tables and generating a customized report using identified investigators and a corresponding geographical area.

41. The method of claim 40, further comprising using one or more investigator databases to identify the investigators.

42. The method of claim 35, further comprising, prior to the generating of the customized report, defining a minimum subject participation and modifying the one or more exclusion or inclusion criteria if the number of subjects within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria does not meet the minimum subject participation.

43. The method of claim 42, where modifying is done automatically.

44. The method of claim 43, where modifying is done automatically and iteratively until the minimum subject participation is met.

45. A method for recruiting a medical professional, comprising:

defining one or more exclusion or inclusion criteria for the medical professional;

pre-generating one or more specialized searching tables using administrative healthcare claims data and the one or more exclusion or inclusion criteria;

searching with a computing device the specialized searching tables;

identifying with the computing device, through the searching step, medical professionals within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria;

identifying with the computing device, through the searching step, a geographical area corresponding to the medical professionals who match the one or more exclusion or inclusion criteria; and

generating a customized report using the identified medical professionals and geographical area.

46. The method of claim 45, where defining one or more exclusion or inclusion criteria comprises selecting criteria using a Venn diagram.

47. The method of claim 45, where defining one or more exclusion or inclusion criteria comprises selecting one or more medical diagnosis codes.

48. The method of claim 45, where the medical professionals comprise physicians being recruited as an expert witness for litigation.

49. The method of claim 48, further comprising determining if one or more of the physicians have previous experience as an expert witness, through correlation with one or more expert databases.

50. A computer readable medium comprising computer executable instructions that, when executed, carry out the method of claim 45.

51. A method for statistical calculations based on administrative healthcare claims data, comprising:

searching with a computing device administrative healthcare claims data; and

comparing with the computing device one subset of the administrative healthcare claims data against a plurality of other subsets of the administrative healthcare claims data; and

calculating with the computing device a hypergeometric statistical result based on the comparing step using one or more pre-generated factorial tables, the factorial tables comprising logarithmic entries.

52. The method of claim 51, where calculating comprises one or more calculations using the logarithmic entries followed by one or more exponential operations.

53. The method of claim 51, further comprising using the hypergeometric statistical result to detect medical-related fraud.

54. The method of claim 53, where the one subset comprises medical coding data associated with a first physician and the plurality of other subsets comprises medical coding data associated with a plurality of other physicians.

55. The method of claim 54, where the plurality of other physicians are selected to be within the same specialty as the first physician.

56. The method of claim 55, further comprising generating a customized report comparing the first physician versus the plurality of other physicians.

57. The method of claim 56, the customized report comprising a graph of utilization percentage versus medical code for the first physician and the plurality of other physicians.

58. The method of claim 51, further comprising using the hypergeometric statistical result to rate one physician versus other physicians.

59. The method of claim 51, further comprising using the hypergeometric statistical result to identify potential subjects for a clinical trial.

60. The method of claim 51, further comprising using the hypergeometric statistical result to recruit a medical professional for use as an expert witness for litigation.

61. A method, comprising:

pre-generating one or more specialized searching tables using administrative healthcare claims data;

pre-generating one or more factorial tables, the factorial tables comprising logarithmic entries;

searching the specialized searching tables;

identifying with a computing device through the searching step, one or more records within the administrative healthcare claims data that matches one or more search criteria;

comparing with the computing device the one or more records against a plurality of other records of the administrative healthcare claims data;

calculating with the computing device a hypergeometric statistical result based on the comparing step using the one or more factorial tables; and

generating a customized report using the one or more records and the statistical result.

62. The method of claim 61, where the one or more search criteria comprise one or more exclusion or inclusion criteria selected using a Venn diagram.

63. The method of claim 61, where calculating comprises one or more calculations using the logarithmic entries followed by one or more exponential operations.