System for providing medical information

• US 5,918,208 A
• Filed: 04/13/1995
• Issued: 06/29/1999
• Est. Priority Date: 04/13/1995
• Status: Expired due to Term

• Current Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Original Assignee: Ingenix Incorporated (UnitedHealth Group Incorporated)
• Inventors: Javitt, Jonathan C.
• Primary Examiner(s): Thomas, Joseph
• Application Number:
  US08/422,511
• Time in Patent Office: 1,538 Days
• Field of Search: 364/401 R, 364/406, 364/401 M, 395/600, 395/202, 395/203, 395/207, 395/210, 705/1, 705/2, 705/3, 705/4, 705/7, 705/8, 705/10, 735/376
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A managed care expert system provides a graphical, interactive computer system which accepts user input relating to contract variables for a plurality of alternative contract scenarios, consults a database of national and locality-specific utilization data, performs a utilization and revenue analysis for both commercial and Medicare-age beneficiaries, and provides a synthetic fee schedule for comparing the likely revenue under capitation for a plurality of services to revenue for those services under a current reimbursement scenario. The system of the invention in its preferred embodiment enables a physician or other health care professional to use a broad array of assumptions to forecast utilization of medical procedures and estimated revenue per procedure under multiple capitation scenarios.

Claims

1. A device for aiding in managed health care decision-making, comprising:

means for selecting a plurality of medical procedures for analysis;

means for storing a first database of health care utilization data indicating levels of utilization for said plurality of procedures under a first scenario;

means for receiving user input of at least one variable affecting an amount of revenue derived from providing health care under a second scenario;

means for creating, based at least in part upon said variable affecting revenue and data in said said first database, a second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario;

means for projecting a first revenue amount relating to said first scenario, said first revenue amount being derived at least in part from said the data in said first database;

means for projecting a second revenue amount relating to said second scenario, said second revenue amount being derived at least in part from said the data in said second database; and

,

means for displaying said first and second revenue amounts.

2. The device according to claim 1, wherein said at least one variable affecting revenue derived from providing health care comprises an indication of utilization under said second scenario.

3. The device according to claim 2, wherein at said indication of utilization under said second scenario comprises a percentage of a total utilization with respect to a corresponding total utilization under said first scenario.

4. The device according to claim 1, wherein said at least one variable affecting revenue derived from providing health care comprises a capitation rate reflecting a level of compensation under said second scenario.

5. The device according to claim 1, wherein said at least one variable affecting revenue derived from providing health care comprises an amount of co-payment under said second scenario.

6. The device according to claim 1, wherein said first database of health care utilization data comprises data for a specific geographic region, and wherein said first database is selected from a larger database comprising utilization data for a plurality of geographic regions.

7. The device according to claim 1, wherein said first scenario comprises a health care indemnity insurance scenario and said second scenario comprises a managed care plan scenario.

8. The device according to claim 1, wherein said first scenario comprises a first managed care plan scenario and said second scenario comprises a second managed care plan scenario.

9. A device for aiding in managed care decision-making, comprising:

means for selecting a plurality of medical procedures for analysis;

means for storing a database of health care utilization data indicating levels of utilization for a plurality of procedures;

means for receiving user input of at least one desired revenue amount for insuring provision of said plurality of procedures to a population;

means for calculating, based at least upon said data in said database and said at least one desired revenue amount, a capitation rate reflecting a level of compensation statistically required to achieve said desired revenue amount; and

,

means for displaying said capitation rate.

10. A device for aiding in managed health care decision-making, comprising:

means for selecting a plurality of medical procedures for analysis;

means for storing a first database of health care utilization data indicating levels of utilization for said plurality of procedures under a first scenario;

means for receiving user input of at least one variable affecting revenue derived from providing health care under a second scenario;

means for creating, based at least in part upon said variable affecting revenue and data in said said first database, a second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario;

means for displaying said second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario.

11. A device for aiding in managed health care decision-making, comprising:

means for selecting a plurality of medical procedures for analysis;

means for storing a first database of health care utilization data indicating levels of utilization for said plurality of procedures under a first scenario;

means for receiving user input of at least one variable affecting revenue derived from providing health care under a second scenario;

means for creating, based at least in part upon said variable affecting revenue and data in said said first database, a second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario;

means for storing a third database of data representing relative value units for each of said plurality of medical procedures;

means for creating a fourth database of relative-value-units-per-service based at least in part upon said data in said second database and said data in said third database.