CARE MANAGEMENT ASSIGNMENT AND ALIGNMENT

• US 20160125168A1
• Filed: 12/30/2014
• Published: 05/05/2016
• Est. Priority Date: 10/31/2014
• Status: Active Grant

• Current Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Original Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Inventors: Aagesen, Jaclynne L., Sutariya, Bharat B., Boswell, Sara J., Flores, Jeremy A.
• Granted Patent: US 10,978,185 B2
• 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 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
• 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
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

Methods, systems, and computer-readable media are provided for aligning a patient who is determined to be eligible for care management services with a care manager. Patient health data is received and is used to generate a patient profile for the patient. The patient profile comprises, for example, demographic information, geographic location, clinical characteristics, patient preferences, a patient need level, a category to which the patient is assigned, and a priority level associated with the patient. A set of characteristics associated with a group of care managers is accessed where the set of characteristics include clinical expertise of the care manager, geographic location of the care manager, workload capacity of the care manager, and the like. Using the patient profile and the set of characteristics associated with the group of care managers, the patient is aligned with a care manager well-suited to help the patient achieve care management goals.

Claims

1. One or more computer-readable media having computer-executable instructions embodied thereon that, when executed by a computing device, perform a method of aligning a patient who is eligible for care management services with an appropriate care manager, the method comprising:

receiving data associated with the patient from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data;

determining from the data one or more of the following;

a physician or healthcare facility caring for the patient, a priority level associated with the patient, a category to which the patient is assigned, a geographic location of the patient, clinical characteristics of the patient, patient preferences, a patient need level, patient socioeconomic status, or a support system associated with the patient;

accessing from a data store a set of criteria associated with a plurality of care managers, the set of criteria comprising one or more of the following;

clinical expertise of the care manager, a physician or healthcare facility with whom the care manager is affiliated, geographical location of the care manager, workload capacity of the care manager, or previous care management outcome data associated with the care manager;

using the data associated with the patient and the set of criteria associated with the one or more care managers, assigning the patient to a care manager of the plurality of care managers; and

generating a notification notifying both the patient and the care manager of the assignment.

2. The media of claim 1, further comprising communicating the notification to both the patient and the care manager.

3. The media of claim 1, wherein the data is received at a central processing location.

4. The media of claim 3, wherein the central processing location process the patient electronic medical record data into a longitudinal medical record for the patient.

5. The media of claim 4, wherein the disparate data sources comprise disparate healthcare facilities that have cared for the patient.

6. The media of claim 5, wherein the disparate healthcare facilities do not share patient electronic medical record data with each other.

7. The media of claim 1, wherein the clinical characteristics of the patient comprise disease conditions associated with the patient.

8. The media of claim 1, wherein the patient preferences comprise at least a language preferred to be spoken by the patient, and a gender preference for a care manager.

9. The media of claim 1, wherein the clinical expertise of the care manager comprises either a generalist or a condition-specific care manager.

10. The media of claim 1, wherein the workload capacity of the care manager is dependent upon a level of contact determined to be needed for patients currently assigned to the care manager.

11. The media of claim 10, wherein the workload capacity of the care manager is further dependent upon a number of patients currently assigned to the care manager.

12. A computerized method carried out by at least one server having at least one processor for aligning a patient who is eligible for care management services with an appropriate care manager, the method comprising:

accessing a first set of characteristics associated with a group of patients determined to be eligible for care management services, the first set of characteristics for each patient in the group of patients comprising at least a provider caring for the patient, a priority level associated with the patient, a category to which the patient was assigned, a geographic location of the patient, clinical characteristics of the patient, patient preferences, a patient need level, patient socioeconomic status, or a support system associated with the patient;

accessing a second set of characteristics associated with a group of care managers, the second set of characteristics for each care manager in the group of care managers comprising at least clinical expertise of the care manager, a provider with whom the care manager is affiliated, geographical location of the care manager, work load capacity of the care manager, and previous care management outcome data associated with the care manager;

for each patient in the group of patients determining, using the at least one processor, a degree of similarity between the first set of characteristics associated with the each patient and the second set of characteristics associated with the each care manager; and

aligning the each patient with a respective care manager in the group of care managers when the degree of similarity between the first and second sets of characteristics exceeds a predetermined threshold.

13. The method of claim 12, wherein the first set of characteristics further comprises a behavioral health profile of the patient and an ambulation status of the patient.

14. The method of claim 12, wherein the category to which the patient is assigned comprises one of high-risk senior, high-risk adult, high-risk pediatric, or high-risk maternity.

15. The method of claim 12, wherein the patient need level indicates a level of contact by the care manager determined to be needed for the patient

16. One or more computer-readable media having computer-executable instructions embodied thereon that, when executed by a computing device, perform a method of aligning a patient who is eligible for care management services with a care manager, the method comprising:

receiving data associated with the patient from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data;

determining from the data a first set of characteristics associated with the patient, the first set of characteristics comprising a provider caring for the patient, a priority level associated with the patient, a category to which the patient was assigned, a geographic location of the patient, clinical characteristics of the patient, patient preferences, a patient need level, patient socioeconomic status, and a support system associated with the patient;

accessing a second set characteristics associated with a plurality of care managers, the second set of characteristics comprising clinical expertise of the care manager, a provider with whom the care manager is affiliated, geographical location of the care manager, work load capacity of the care manager, and previous care management outcome data associated with the care manager;

based on a first portion of the first set of characteristics and a first portion of the second set of characteristics, creating a first assignment of the patient to a set of care managers;

based on a second portion of the first set of characteristics and a second portion of the second set of characteristics, creating a second assignment of the patient to a particular care manager in the set of care managers; and

generating a notification notifying the patient and the particular care manager of the second assignment.

17. The media of claim 16, wherein the category to which the patient was assigned comprises one of high-risk senior, high-risk adult, high-risk pediatric, or high-risk maternity.

18. The media of claim 16, wherein the disparate data sources comprise at least a plurality of healthcare facilities who have cared for the patient.

19. The media of claim 18, wherein the plurality of healthcare facilities do not share the patient electronic medical record data with each other.

20. The media of claim 16, wherein the patient electronic medical record data is compiled into a longitudinal medical record for the patient.