Methods for Improving the Clinical Outcome of Patient Care and for Reducing Overall Health Care Costs

• US 20120310661A1
• Filed: 06/08/2012
• Published: 12/06/2012
• Est. Priority Date: 05/06/2004
• Status: Active Grant

• Current Assignee: Medencentive LLC
• Original Assignee: Medencentive LLC
• Inventors: Greene, Jeffrey C.
• Granted Patent: US 9,171,285 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/0207 Discounts or incentives, e.g. coupons or rebates
• CPC Class Codes: G06Q 50/20 Education
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

System and method for reducing healthcare costs by improving care and encouraging healthy behaviors. A web-based or telephonic program using health plan sponsor funded financial incentives, offered to patients and providers for declaring or demonstrating adherence or providing a reason for non-adherence to performance standards. Financial incentives are contingent upon patient'"'"'s and provider'"'"'s agreement to allow the other to confirm or acknowledge the other'"'"'s declaration or demonstration of adherence or non-adherence reason. Combining financial incentives with a set of checks and balances motivates participation in the program and adherence to the performance standards. Performance standards include evidence-based treatment guidelines, information therapy, wellness and prevention solutions, care management, and other methods proven to control costs by improving behaviors and healthcare. The system and method achieves improved health and more affordable healthcare by aligning the interests of providers, patients/consumers, and health plan sponsors in a win-win-win arrangement.

Claims

1. A method for managing delivery of healthcare services, the method comprising:

receiving a diagnosed health condition of a patient and a claim for services rendered from a service provider at a computer;

transmitting, to a service provider from the computer, an offer of a performance-based financial incentive, at least one service provider performance standard and at least one patient performance standard comprising at least one patient educational material corresponding to the diagnosed condition;

querying the service provider to generate a service provider response comprising a service provider declaration of adherence or reason for non-adherence to the service provider performance standard, a prescription of at least one patient educational material, the patient performance standard, and a service provider acknowledgement the patient will confirm or rate the service provider declaration of adherence or reason for non-adherence to the service provider performance standard;

receiving the service provider response at the computer;

transmitting, to the patient, an offer of a performance-based financial incentive, the diagnosed health condition, the service provider performance standard, the prescription of at least one patient educational material, and the service provider response;

querying the patient to generate a patient response comprising a patient demonstration of knowledge of the diagnosed health condition, the at least one patient educational material, a patient declaration of adherence or reason for non-adherence to the performance standard, a patient agreement to allow the service provider to rate the patient demonstration of knowledge and the patient declaration of adherence or the patient reason for non-adherence to the performance standard, and a patient confirmation or acknowledgment of the service provider declaration of adherence or reason for non-adherence to the performance standard;

receiving the patient response at the computer;

transmitting the patient response from the computer to the service provider;

authenticating the service provider response and the patient response with the computer; and

authorizing disbursement of the performance-based financial incentive to the service provider or the performance-based financial incentive to the patient based on authentication by the computer.

2. The method of claim 1 wherein the service provider declaration of adherence comprises a demonstration of an action or physical act independently verifiable by the patient and capable of authentication by an independent intermediary and wherein the patient declaration of adherence comprises a demonstration of an action or physical act independently verifiable by the service provider and capable of authentication by an independent intermediary.

3. The method of claim 1 wherein the service provider confirmation of the patient response comprises an acknowledgment of a patient demonstrated act and wherein the patient confirmation of the service provider response comprises an acknowledgment of a service provider demonstrated act.

4. The method of claim 1 wherein transmitting the diagnosed health condition and performance standard to the patient comprises allowing the patient access to a website containing the patient'"'"'s diagnosed health condition and the performance standard and wherein querying the patient to generate a patient response comprises providing the patient with a series of questions, using a website, regarding the diagnosed health condition and the performance standard and receiving a series of responses from the patient to the series of questions.

5. The method of claim 1 wherein the performance standard comprises at least one member selected from a group comprising:

an information technology based recommended treatment guideline;

an information technology based patient health literacy and information therapy program, an information technology based drug therapy prescription system, an information technology based pre-authorization certification program, an information technology based wellness and prevention program, an information technology based health risk assessment program, information technology based readiness to improve health behavior intervention program;

an information technology based social networking therapy program;

an information technology based coordination of care program;

an information technology enabled health screening program, an information technology based personal or electronic health record system, an information technology based enabled patient health monitoring devices, an information technology based medical advancement education and acknowledgment system, an information technology based service provider continuing education system;

an information technology based medical and provider services quality and cost transparency patient education system; and

an information technology based evidence-based hospital treatment plan system.

6. The method of claim 1 wherein the service provider reason for non-adherence is adjudicated by an independent intermediary and wherein the independent intermediary authorizes payment of the claim for services rendered and disbursement of the performance-based financial incentive to the service provider if the service provider reason for non-adherence is accepted by the independent intermediary and if the service provider acknowledges to allow a patient to rate the reason for non-adherence, and wherein the independent intermediary authorizes disbursement of the performance-based incentive to the patient if the reason for patient non-adherence is accepted by the independent intermediary and if the patient agrees to allow the service provider to rate the reason for non-adherence.

7. The method of claim 1 wherein the service provider must agree to allow the patient to confirm, verify, or acknowledge the service provider response before disbursement of the performance-based financial incentive to the service provider;

wherein the patient must agree to allow the service provider to confirm, verify, or acknowledge the patient response, and wherein both the service provider and the patient further agree to allow said responses to be authenticated by a third party intermediary.

8. The method of claim 1 wherein the performance-based incentive to the patient is disbursed to the patient only upon querying the service provider to generate a service provider confirmation of the patient response.

9. The method of claim 1 wherein the performance-based incentive to the service provider is disbursed to the service provider only upon confirmation, verification or acknowledgement of the service provider response by the patient.

10. A computer-based method for managing healthcare delivery, the method comprising:

receiving a patient identification and at least one diagnosis from a service provider or a health plan sponsored wellness, prevention or care management program through an information technology interface;

transmitting an offer of a service provider performance-based financial incentive, at least one service provider performance standard and at least one patient performance standard corresponding with the diagnosis received from the service provider or a health plan sponsored wellness, prevention or care management program through the information technology based interface;

querying a service provider to generate a service provider response to a series of queries comprising a request for a service provider declaration of adherence or reason for non-adherence to the service provider performance standard, a service provider acknowledgment that the patient will to rate or confirm the service provider declaration of adherence or reason for non-adherence, a patient performance standard and information therapy prescription through the information technology based interface;

receiving the service provider response;

authenticating and adjudicating the service provider response; and

authorizing disbursement of the service provider performance-based financial incentive to the service provider based upon authentication and adjudication of the service provider response.

11. The method of claim 10 wherein authorizing disbursement of the service provider performance-based incentive to the service provider based upon authentication and adjudication of the service provider response comprises:

directing a health plan to disburse the service provider performance-based financial incentive comprising monetary compensation to the service provider.

12. The method of claim 10 further comprising receiving a patient declaration of adherence to the performance standard or a patient reason for non-adherence to the performance standard from a patient.

13. The method of claim 12 further comprising receiving a service provider confirmation of the patient declaration of adherence or a service provider confirmation of the patient reason for non-adherence before authorizing disbursement of the performance-based incentive to the service provider.

14. The method of claim 12 further comprising:

allowing the patient access to a website containing the patient'"'"'s diagnosis and the performance standard;

assessing patient knowledge of the diagnosis and the performance standard by presenting the patient with at least one question regarding the diagnosis and the performance standard on the website; and

receiving a patient response to the at least one question.

15. A web-based system for managing healthcare delivery, the system comprising:

a healthcare services provider web-based interface adapted to accept a patient identification and a diagnosis from a healthcare services provider, to transmit a performance standard and an information therapy to the healthcare services provider based upon the diagnosis, to accept a healthcare services provider response comprising a healthcare service provider declaration or demonstration of adherence or reason for non-adherence to the performance standard, to accept a rating of patient adherence to the performance standard, and the information therapy, to accept an acknowledgment that the patient will rate or confirm the healthcare service provider declaration or demonstration of adherence or reason for non-adherence to the performance standard; and

to accept healthcare service provider verification of a patient declaration of adherence to the performance standard;

a patient web-based interface adapted to provide the patient with a performance standard and the information therapy, to provide at least one query to the patient regarding the information therapy and the performance standard, to receive a patient response comprising an answer to the at least one query, the patient declaration or demonstration of adherence or reason for non-adherence to the performance, and rating or confirmation of the service provider declaration or demonstration of adherence or reason for non-adherence; and

a means for automatically adjudicating and authenticating the patient response and authorizing disbursement of a performance-based reward to the patient.

16. The system of claim 15 wherein the healthcare service provider declaration of adherence comprises an action or physical act independently verifiable by the patient and capable of authentication by the means for automatically adjudicating and authenticating and wherein the patient declaration of adherence comprises an action or physical act independently verifiable by the healthcare service provider and capable of authentication by the means for automatically adjudicating and authenticating.

17. The system of claim 16 wherein a healthcare service provider verification of the patient declaration of adherence comprises an acknowledgment of the action or physical act and wherein the patient verification of the healthcare service provider declaration of adherence comprises an acknowledgment of the action or physical act.

18. The system of claim 15 further comprising automatically selecting a patient information therapy and performance standard based on the diagnosed health condition when the service provider does not provide a service provider response;

and

transmitting, to the patient, an offer of a performance-based financial incentive, the diagnosed health condition, the service provider performance standard, and a prescription of at least one patient educational material.

19. The system of claim 15 further comprising a means for automatically adjudicating and authenticating the healthcare service provider response and authorizing disbursement of a performance-based reward to the healthcare service provider.