SYSTEMS, METHODS, AND APPARATUS FOR IDENTIFYING AND MITIGATING POTENTIAL CHRONIC PAIN IN PATIENTS

• US 20160034662A1
• Filed: 08/01/2014
• Published: 02/04/2016
• Est. Priority Date: 08/01/2014
• Status: Abandoned Application

• Current Assignee: The Travelers Indemnity Company (The Travelers Cos., Inc.)
• Original Assignee: The Travelers Indemnity Company (The Travelers Cos., Inc.)
• Inventors: Seidner, Adam L., Shivakoti, Mikesh, Moynihan, Joanne, Chambers, Linda S., Jamgochian, Linda F., Kamienski, Kathleen M., Kirshen, Keefe I., Smyth, Glen W.
• Application Number:
  US14/450,147
• Publication Number:
  US 20160034662A1
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

Systems, apparatus, methods, and articles of manufacture provide for identifying and/or managing patients and/or claims in order to prevent the development of chronic pain conditions.

Claims

1. An apparatus comprising:

a processor; and

a computer-readable memory in communication with the processor, the computer-readable memory storing instructions that when executed by the processor direct the processor to;

determine information about a claim associated with a person;

determine at least one of;

information about a medical condition associated with the person, personal information associated with the person, and employment information associated with the person;

determine an indication of a prediction that the patient will develop chronic pain, based on at least one of;

the information about the medical condition, the personal information, the claim information, and the employment information;

after determining the indication of the prediction, receive information provided by the person;

determine, based on the information provided by the person, at least one pain driver;

based on the at least one pain driver, determine at least one preventative action for preventing the patient from developing chronic pain; and

store an indication of the at least one preventative action in association with the claim.

2. The apparatus of claim 1, wherein the information about the medical condition comprises at least one of:

an injury type,

an indication of a diagnosis code,

an indication of whether a surgery was performed on the person,

an indication of a number of procedures performed on the person,

an indication of one or more procedures performed on the person,

an indication of an initial treatment of the person, and

an indication of an injured body part.

3. The apparatus of claim 1, wherein the employment information comprises at least one of:

an industry type,

a compensation rate,

an employment status, and

a wage of the person.

4. The apparatus of claim 1, wherein the personal information comprises at least one of:

a gender of the person, and

an age of the person.

5. The apparatus of claim 1, wherein the information about the claim comprises at least one of:

a geographical jurisdiction associated with the claim, and

an industry code.

6. The apparatus of claim 1, wherein determining the indication of the prediction comprises:

generating the prediction using a chronic pain prediction model.

7. The apparatus of claim 1, wherein the instructions further direct the processor to:

present, via a user interface, the indication of the prediction.

8. The apparatus of claim 1, wherein the indication of the prediction comprises a recommendation that the claim be referred to a chronic pain prevention program.

9. The apparatus of claim 1, wherein the instructions further direct the processor to:

receive an indication that the person is accepted into a chronic pain prevention program.

10. The apparatus of claim 1, wherein receiving the information provided by the person comprises:

receiving responses of the person to a questionnaire associated with a chronic pain prevention program.

11. The apparatus of claim 1, wherein receiving the information provided by the person comprises:

receiving the information via a user interface.

12. The apparatus of claim 1, wherein each at least one pain driver corresponds to a respective contributing cause of chronic pain for the person.

13. The apparatus of claim 1, wherein determining the at least one pain driver based on the information provided by the person comprises:

determining a first score for a first pain driver based on the information provided by the person; and

determining a second score for a second pain driver based on the information provided by the person.

14. The apparatus of claim 1, wherein determining the at least one pain driver based on the information provided by the person comprises:

determining a first score for a first pain driver based on a first answer to a first question of a chronic pain prevention program questionnaire;

determining a second score for the first pain driver based on a second answer to a second question of the chronic pain prevention program questionnaire;

summing the first score and the second score to generate a total claim score for the first pain driver; and

determining that the claim score for the first pain driver is greater than a predetermined threshold value for the first pain driver.

15. The apparatus of claim 1, wherein the instructions further direct the processor to:

present an indication of the at least one pain driver via a user interface.

16. The apparatus of claim 1, wherein determining the at least one preventative action for preventing the patient from developing chronic pain, based on the at least one pain driver, comprises:

accessing at least one first preventative action associated with a first pain driver in a database.

17. The apparatus of claim 1, wherein the at least one preventative action comprises at least one of:

a consultation by an insurance professional with a medical professional,

conducting a treatment effectiveness review,

a consultation between two medical professionals,

a peer review of a physician,

a review of medical records,

replacement of a first treating physician with a second treating physician,

a diagnostics assessment,

a nerve conduction quality assessment,

a radiological quality assessment,

a medical fraud review, and

a pain management consultation.

18. The apparatus of claim 1, wherein the at least one preventative action comprises at least one of:

identifying available light duty jobs,

ergonomic review,

surveillance of the person, and

vocational rehabilitation for the person.

19. The apparatus of claim 1, wherein the at least one preventative action comprises at least one of:

review of pharmacy guidelines, and

consultation with a pharmacist.

20. The apparatus of claim 1, wherein the at least one pain driver comprises one or more of:

effectiveness of current treatment,

functional ability of the person,

pain intensity experienced by the person,

psychiatric issues,

substance abuse, and

substance addiction.

21. The apparatus of claim 1, wherein the instructions further direct the processor to:

present an indication of the at least one preventative action via a user interface.

22. A method comprising:

determining, by a computerized processing device, information about a claim associated with a person;

determining, by the computerized processing device, at least one of;

information about a medical condition associated with the person, personal information associated with the person, and employment information associated with the person;

determining, by the computerized processing device, an indication of a prediction that the patient will develop chronic pain, based on at least one of;

the information about the medical condition, the personal information, the claim information, and the employment information;

after determining the indication of the prediction, receiving information provided by the person;

determining, by the computerized processing device and based on the information provided by the person, at least one pain driver;

based on the at least one pain driver, determining at least one preventative action for preventing the patient from developing chronic pain; and

storing an indication of the at least one preventative action in association with the claim.