METHODS AND SYSTEMS FOR ANALYZING HEALTH RISK SCORE AND MANAGING HEALTHCARE COST

• US 20140108044A1
• Filed: 10/12/2012
• Published: 04/17/2014
• Est. Priority Date: 10/12/2012
• Status: Abandoned Application

• Current Assignee: Jayaram Reddy, Kirit Pandit
• Original Assignee: Jayaram Reddy, Kirit Pandit
• Inventors: Reddy, Jayaram, Pandit, Kirit
• Application Number:
  US13/651,133
• Publication Number:
  US 20140108044A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment

Abstract

Various disclosed embodiments include methods and systems for determining a plurality of patients'"'"' risk of hospitalization and for forecasting healthcare cost. The method includes receiving a plurality of patients'"'"' clinical data from encounters over a predetermined time period and mapping disease codes in the clinical data of the plurality of patients to respective chronic diseases. The method includes determining, for the plurality of patients, health risk scores for the respective chronic diseases by applying disease models for the respective chronic diseases to the clinical data. The method includes determining, for the plurality of patients, weighted health risk scores and determining respective healthcare costs. The method includes determining an impact of the weighted health risk scores on the healthcare costs.

Claims

1. A method of determining a plurality of patients'"'"' health risk scores and managing healthcare cost, comprising:

receiving a plurality of patient'"'"'s clinical data from encounters over a predetermined time period;

mapping disease codes in the clinical data to respective chronic diseases;

determining, for the plurality of patients, health risk scores for the respective chronic diseases by applying disease models for the respective chronic diseases to the clinical data;

determining, for the plurality of patients, average health risk scores of the respective chronic diseases; and

determining, for the plurality of patients, weighted health risk scores of the respective chronic diseases, wherein the weighted health risk score is determined from the average health risk score of the chronic disease and the average cost of hospitalization due to the chronic disease;

determining healthcare costs for the patients;

determining an impact of the weighted health risk scores on the healthcare costs;

storing weighted health risk scores in a memory.

2. The method of claim 1, further comprising classifying the patients into a plurality of risk categories based on the respective health risk scores and number of hospitalizations.

3. The method of claim 1, further comprising generating, for the plurality of patients, plots illustrating health risk scores versus number of hospitalizations.

4. The method of claim 1, wherein the disease code is based on International Classification of Diseases.

5. The method of claim 1, wherein the clinical data comprises patient vitals, number of hospitalizations, laboratory results, prescribed medications and charges.

6. The method of claim 1, wherein the encounter occurs when a patient visits a healthcare provider.

7. The method of claim 1, wherein the health risk score indicates the risk of hospitalization due to the chronic disease.

8. The method of claim 1, wherein the weighted health risk score is a forecast of the future healthcare cost.

9. A data processing system for determining a plurality of patients'"'"' health risk scores and managing healthcare cost, comprising:

at least one processor;

a memory connected to the processor, wherein the data processing system is configured to;

receive a plurality of patient'"'"'s clinical data from encounters over a predetermined time period;

map disease codes in the clinical data to respective chronic diseases;

determine, for the plurality of patients, health risk scores for the respective chronic diseases by applying disease models for the respective chronic diseases to the clinical data;

determine, for the plurality of patients, average health risk scores of the respective chronic diseases; and

determine, for the plurality of patients, weighted health risk scores of the respective chronic diseases, wherein the weighted health risk score is determined from the average health risk score of the chronic disease and the average cost of hospitalization due to the chronic disease;

determine healthcare costs for the patients;

determine an impact of the weighted health risk scores on the healthcare costs; and

store the weighted health risk scores in the memory.

10. The data processing system of claim 9, wherein the disease code is based on International Classification of Diseases.

11. The data processing system of claim 9, wherein the clinical data comprises patient vitals, number of hospitalizations, laboratory results, prescribed medications and charges.

12. The data processing system of claim 9, wherein the encounter occurs when a patient visits a healthcare provider.

13. The data processing system of claim 9, wherein the risk score indicates the risk of hospitalization due to the chronic disease.

14. The data processing system of claim 9, wherein the weighted average risk score is a forecast of the future healthcare cost.