IDENTIFICATION, STRATIFICATION, AND PRIORITIZATION OF PATIENTS WHO QUALIFY FOR CARE MANAGEMENT SERVICES
First Claim
1. One or more computer-readable media having computer executable instructions embodied thereon that, when executed by a computing device, perform a method of identifying and stratifying a population of patients eligible for care management services, the method comprising:
- receiving data associated with the population of patients from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data;
for each patient within the population of patients, using the data to determine;
(1) a disease burden associated with the each patient, (2) an amount of health system utilization by the each patient, and (3) an amount of money spent on healthcare services for the each patient;
determining that a first patient within the population of patients exceeds a predetermined threshold value associated with one or more of the disease burden, the amount of health system utilization, or the amount of money spent on healthcare services;
subsequent to determining that the first patient exceeds the predetermined threshold value, categorizing the first patient into one of the following categories;
(1) high-risk senior, (2) high-risk adult, (3) high-risk pediatrics, or (4) high-risk maternity; and
generating a notification that the first patient is eligible for care management services.
1 Assignment
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Accused Products
Abstract
Methods, systems, and computer-readable media are provided for identifying, stratifying, and prioritizing patients who are eligible for care management services. For each patient, patient health data is used to determine one or more of a disease burden associated with the patient, an amount of health system utilization by the patient, and an amount of money spent on healthcare services for the patient. It is further determined if the patient exceeds a respective threshold value associated with each of these criteria. If the patient exceeds the respective threshold value, the patient is stratified into a category comprising one of high-risk senior, high-risk adult, high-risk pediatrics, or high-risk maternity. The patient may also be prioritized based on one or more factors, and a notification may be sent to the patient informing the patient of his/her eligibility for care management services.
16 Citations
20 Claims
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1. One or more computer-readable media having computer executable instructions embodied thereon that, when executed by a computing device, perform a method of identifying and stratifying a population of patients eligible for care management services, the method comprising:
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receiving data associated with the population of patients from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data; for each patient within the population of patients, using the data to determine;
(1) a disease burden associated with the each patient, (2) an amount of health system utilization by the each patient, and (3) an amount of money spent on healthcare services for the each patient;determining that a first patient within the population of patients exceeds a predetermined threshold value associated with one or more of the disease burden, the amount of health system utilization, or the amount of money spent on healthcare services; subsequent to determining that the first patient exceeds the predetermined threshold value, categorizing the first patient into one of the following categories;
(1) high-risk senior, (2) high-risk adult, (3) high-risk pediatrics, or (4) high-risk maternity; andgenerating a notification that the first patient is eligible for care management services. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A computerized method carried out by at least one server having at least one processor for identifying and stratifying a population of patients who are eligible for care management services, the method comprising:
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receiving data associated with the population of patients from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data; using the data to stratify each patient within the population of patients into one of the following categories;
(1) senior, (2) adult, (3) pediatrics, or (4) maternity;for the each patient within the each category, using the data to determine;
(1) a disease burden associated with the each patient, (2) an amount of health system utilization by the each patient, and (3) an amount of money spent on healthcare services for the each patient;determining, using the at least one processor, that at least a first patient within a respective category exceeds a predetermined threshold value associated with one or more of the disease burden, the amount of health system utilization, or the amount of money spent on healthcare services; and generating a notification that the first patient is eligible for care management services. - View Dependent Claims (12, 13, 14, 15, 16, 17)
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18. One or more computer-readable media having computer-executable instructions embodied thereon that, when executed by a computing device, perform a method of enabling a healthcare organization to identify and stratify patients within a patient population cared for by the healthcare organization who are eligible for care management services, the method comprising:
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receiving from the healthcare organization a selection of one or more criteria used to identify patients who are eligible for care management services, the one or more criteria comprising;
(1) a disease burden associated with each patient, (2) an amount of health system utilization by the each patient, and (3) an amount of money spent on healthcare services for the each patient;receiving from the healthcare organization a threshold value for each of the selected one or more criteria; receiving data associated with the patient population from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data; determining that at least a first patient within the patient population exceeds the respective threshold value for the each of the selected criteria specified by the healthcare organization; categorizing the first patient into one of the following categories;
(1) high-risk senior, (2) high-risk adult, (3) high-risk pediatrics, or (4) high-risk maternity; andgenerating a notification that the first patient is eligible for care management services. - View Dependent Claims (19, 20)
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Specification