FACILITATING CLINICALLY INFORMED FINANCIAL DECISIONS THAT IMPROVE HEALTHCARE PERFORMANCE

• US 20160092641A1
• Filed: 11/30/2015
• Published: 03/31/2016
• Est. Priority Date: 02/17/2011
• Status: Active Application

• Current Assignee: Socrates Analytics, Inc., University Hospitals of Cleveland (University Hospitals Health System Incorporated)
• Original Assignee: Socrates Analytics, Inc., University Hospitals of Cleveland (University Hospitals Health System Incorporated)
• Inventors: Delaney, Conor, Evans, James
• Application Number:
  US14/954,449
• Publication Number:
  US 20160092641A1
• Time in Patent Office: Days
• US Class Current: 1/1
• 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 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

Systems, methods and computer readable media that facilitate providing clinically informed financial decisions that improve healthcare performance are provided. In an aspect, a system includes a performance evaluation component configured to identify groups of patients having received healthcare service by a healthcare organization and associated with a common healthcare service parameter and uncommon healthcare service parameters. The system further includes a scoring component configured to determine performance scores for respective groups of patients, wherein the performance scores reflect clinical and financial performance of the healthcare organization in association with provision of the healthcare service to the respective groups of patients. A comparison component further compare the respective groups of patients based on the performances scores respectively associated therewith to facilitate identifying one or more of the uncommon healthcare service parameters that are responsible for variance between at least a subset of performance scores.

Claims

1. A system, comprising:

a memory that stores computer executable components;

a processor that executes at least the following computer executable components stored in the memory;

a performance evaluation component configured to identify groups of patients having received healthcare service by a healthcare organization and associated with a common healthcare service parameter and an uncommon healthcare service parameters;

a scoring component configured to determine performance scores for respective groups of patients, wherein the performance scores reflect clinical and financial performance of the healthcare organization in association with provision of the healthcare service to the respective groups of patients; and

a comparison component configured to compare the respective groups of patients based on the performances scores respectively associated therewith to facilitate identifying one or more of the uncommon healthcare service parameters that are responsible for variance between at least a subset of performance scores.

2. The system of claim 1, wherein scoring component is configured to determine the respective performance scores based on:

cost of care delivery to the respective patients of the groups of patients, length of stay (LOS) of the respective patients of the groups of patients, readmission rate of the respective patients of the groups of patients, complication rate of the respective patients of the groups of, financial variance of the respective patients of the groups of patients, and case complexity of the respective patients of the groups of patients.

3. The system of claim 1, wherein the comparison component is configured to select a subset of the respective groups of patients for comparison based on association with performance scores that differ beyond a threshold deviation value, and wherein the comparison component is configured to identify one or more of the uncommon healthcare service parameters that are responsible for variance between the performance scores of the respective groups included in the subset.

4. The system of claim 3, further comprising:

an opportunity assessment component configured to determine an amount of unnecessary cost associated with provision of healthcare service to respective groups of patients included in the subset based on the one or more uncommon healthcare service parameters.

5. The system of claim 3, further comprising:

an opportunity assessment component configured to determine an amount of unnecessary days associated with provision of healthcare service to respective groups of patients included in the subset based on the one or more uncommon healthcare service parameters.

6. The system of claim 3, further comprising:

a recommendation component configured to determine a mechanism to improve the clinical or financial performance of the healthcare organization in association with provision of future healthcare service to new patients associated with the common healthcare service parameter based on the one or more of the uncommon healthcare service parameters.

7. The system of claim 1, further comprising, a ranking component configured to rank the respective groups of patients based on the performance scores respectively associated therewith;

and

an improvement evaluation component configured to select a subset of the respective groups of patients for improvement evaluation based on their ranking being below a threshold value.

8. The system of claim 1, wherein the common healthcare service parameter comprises a common diagnosis.

9. The system of claim 1, wherein the common healthcare service parameter comprises a common medical procedure.

10. The system of claim 1, wherein the uncommon healthcare service parameters comprise one or more of:

a diagnosis, a procedure, a risk score, a medical caregiver, a facility or place of service, a supply type, a supply manufacturer, an avoidable complication, activities included in a course of care, or an order of care activities included in the course of care.

11. A method comprising:

using a processor to execute the following computer executable instructions stored in a memory to perform the following acts;

identifying groups of patients having received healthcare service by a healthcare organization and associated with a common healthcare service parameter and uncommon healthcare service parameters;

determining performance scores for respective groups of patients, wherein the performance scores reflect clinical and financial performance of the healthcare organization in association with provision of the healthcare service to the respective groups of patients; and

comparing the respective groups of patients based on the performances scores respectively associated therewith to facilitate identifying one or more of the uncommon healthcare service parameters that are responsible for variance between at least a subset of performance scores.

12. The method of claim 11, wherein determining comprises determining the respective performance scores based on:

cost of care delivery to the respective patients of the groups of patients, length of stay (LOS) of the respective patients of the groups of patients, readmission rate of the respective patients of the groups of patients, complication rate of the respective patients of the groups of, financial variance of the respective patients of the groups of patients, and case complexity of the respective patients of the groups of patients.

13. The method of claim 11, further comprising:

selecting a subset of the respective groups of patients for comparison based on association with performance scores that differ beyond a threshold deviation value; and

identifying one or more of the uncommon healthcare service parameters that are responsible for variance between the performance scores of the respective groups included in the subset.

14. The method of claim 13, further comprising:

determining an amount of unnecessary cost associated with provision of healthcare service to respective groups of patients included in the subset based on the one or more uncommon healthcare service parameters.

15. The method of claim 13, further comprising:

determining an amount of unnecessary days associated with provision of healthcare service to respective groups of patients included in the subset based on the one or more uncommon healthcare service parameters.

16. The method of claim 13, further comprising:

determining a mechanism to improve the clinical or financial performance of the healthcare organization in association with provision of future healthcare service to new patients associated with the common healthcare service parameter based on the one or more of the uncommon healthcare service parameters.

17. The method of claim 11, further comprising:

ranking the respective groups of patients based on the performance scores respectively associated therewith; and

selecting a subset of the respective groups of patients for improvement evaluation based on their ranking being below a threshold value.

18. A tangible computer-readable storage medium comprising computer-readable instructions that, in response to execution, cause a computing system to perform operations, comprising:

identifying groups of patients with a common diagnosis having received healthcare service from a healthcare organization;

determining performance scores for respective groups of patients, wherein the performance scores reflect clinical and financial performance of the healthcare organization in association with provision of the healthcare service to the respective groups of patients; and

comparing the respective groups of patients based on the performances scores respectively associated therewith to facilitate identifying one or more healthcare service parameters that are responsible for variance between at least a subset of performance scores.

19. The tangible computer-readable storage medium of claim 18, wherein determining comprises determining the respective performance scores based on:

cost of care delivery to the respective patients of the groups of patients, length of stay (LOS) of the respective patients of the groups of patients, readmission rate of the respective patients of the groups of patients, complication rate of the respective patients of the groups of, financial variance of the respective patients of the groups of patients, and case complexity of the respective patients of the groups of patients.

20. The tangible computer-readable storage medium of claim 18, the operations further comprising:

selecting a subset of the respective groups of patients for comparison based on association with performance scores that differ beyond a threshold deviation value; and

identifying one or more of the healthcare service parameters that are responsible for variance between the performance scores of the respective groups included in the subset, wherein the healthcare service parameters include;

a procedure, a risk score, a medical caregiver, a facility or place of service, a supply type, a supply manufacturer, an avoidable complication, activities included in a course of care, and an order of care activities included in the course of care.