SYSTEM AND METHOD FOR SCORING THE PERFORMANCE OF HEALTHCARE ORGANIZATIONS
First Claim
1. A computer system configured to perform a method of evaluating managed care organizations (MCOs), the system comprising:
- a memory storing a computer program; and
a processor configured to execute the computer program, wherein the computer program is configured to;
acquire medical data associated with patients'"'"' healthcare encounters with the MCOs, wherein the medical data comprises encounter data indicating a relation between services provided by the MCOs and the patients'"'"' healthcare encounters, and patient characteristic data indicating characteristics of the patients;
calculate a health risk score of a subpopulation using the patient characteristic data;
provide the encounter data and the health risk score as input to analytic modules existing in a library of analytic modules that track the services provided by the MCOs;
generate a risk-adjusted performance metric of the MCOs by each of the analytic modules, wherein each of the risk-adjusted performance metrics relates to a category of concern, and the risk-adjusted performance metrics are calculated using the encounter data and the health risk score;
generate a standardized score for each of the risk-adjusted performance metrics based on a comparison of the subpopulation with an entire population;
assign a weight to each of the standardized scores based on an importance level of each category of concern; and
generate a final score corresponding to a performance category for each of the MCOs based on the standardized scores.
2 Assignments
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Accused Products
Abstract
A method of evaluating managed care organizations (MCOs) includes acquiring medical data associated with patients'"'"' healthcare encounters with the MCOs, calculating a health risk score of a subpopulation using patient characteristic data included in the medical data, providing encounter data included in the medical data and the health risk score as input to analytic processes that track services provided by the MCOs, and generating a risk-adjusted performance metric of the MCOs by the analytic processes. The risk-adjusted performance metrics relate to categories of concern. The method further includes generating a standardized score for each of the risk-adjusted performance metrics based on a comparison of the subpopulation with an entire population, assigning a weight to each of the standardized scores based on an importance level of each category of concern, and generating a final score corresponding to a performance category for each of the MCOs based on the standardized scores.
22 Citations
20 Claims
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1. A computer system configured to perform a method of evaluating managed care organizations (MCOs), the system comprising:
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a memory storing a computer program; and a processor configured to execute the computer program, wherein the computer program is configured to; acquire medical data associated with patients'"'"' healthcare encounters with the MCOs, wherein the medical data comprises encounter data indicating a relation between services provided by the MCOs and the patients'"'"' healthcare encounters, and patient characteristic data indicating characteristics of the patients; calculate a health risk score of a subpopulation using the patient characteristic data; provide the encounter data and the health risk score as input to analytic modules existing in a library of analytic modules that track the services provided by the MCOs; generate a risk-adjusted performance metric of the MCOs by each of the analytic modules, wherein each of the risk-adjusted performance metrics relates to a category of concern, and the risk-adjusted performance metrics are calculated using the encounter data and the health risk score; generate a standardized score for each of the risk-adjusted performance metrics based on a comparison of the subpopulation with an entire population; assign a weight to each of the standardized scores based on an importance level of each category of concern; and generate a final score corresponding to a performance category for each of the MCOs based on the standardized scores. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A method of evaluating managed care organizations (MCOs), comprising:
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acquiring medical data associated with patients'"'"' healthcare encounters with the MCOs, wherein the medical data comprises encounter data indicating a relation between services provided by the MCOs and the patients'"'"' healthcare encounters, and patient characteristic data indicating characteristics of the patients; calculating a health risk score of a subpopulation using the patient characteristic data; providing the encounter data and the health risk score as input to analytic modules existing in a library of analytic modules that track the services provided by the MCOs; generating a risk-adjusted performance metric of the MCOs by each of the analytic modules, wherein each of the risk-adjusted performance metrics relates to a category of concern, and the risk-adjusted performance metrics are calculated using the encounter data and the health risk score; generating a standardized score for each of the risk-adjusted performance metrics based on a comparison of the subpopulation with an entire population; assigning a weight to each of the standardized scores based on an importance level of each category of concern; and generating a final score corresponding to a performance category for each of the MCOs based on the standardized scores. - View Dependent Claims (16, 17)
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18. A computer program product for evaluating managed care organizations (MCOs), the computer program product comprising a computer readable storage medium having program instructions embodied therewith, the program instructions executable by a processor to cause the processor to:
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acquire medical data associated with patients'"'"' healthcare encounters with the MCOs, wherein the medical data comprises encounter data indicating a relation between services provided by the MCOs and the patients'"'"' healthcare encounters, and patient characteristic data indicating characteristics of the patients; calculate a health risk score of a subpopulation using the patient characteristic data; provide the encounter data and the health risk score as input to analytic modules existing in a library of analytic modules that track the services provided by the MCOs; generate a risk-adjusted performance metric of the MCOs by each of the analytic modules, wherein each of the risk-adjusted performance metrics relates to a category of concern, and the risk-adjusted performance metrics are calculated using the encounter data and the health risk score; generate a standardized score for each of the risk-adjusted performance metrics based on a comparison of the subpopulation with an entire population; assign a weight to each of the standardized scores based on an importance level of each category of concern; and generate a final score corresponding to a performance category for each of the MCOs based on the standardized scores. - View Dependent Claims (19, 20)
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Specification