System and method of predicting high utilizers of healthcare services
First Claim
1. A method of improving health and reducing healthcare encounter trends, comprising the steps of:
- presenting an individual with a questionnaire designed to elicit said individual'"'"'s response to each distinct predictive factor of a predetermined set of predictive factors, said predetermined set of predictive factors including domains of functional ability, adherence with current medical treatment, numbers of uses of various healthcare services over past time periods, beliefs in the safety and value of healthcare services, healthcare partnering preferences and information-seeking preferences;
collecting self-reported information from said individual about their perceived health wherein said self-reported information comprises said individual'"'"'s response to each said distinct predictive factor of said predetermined set of predictive factors;
assigning, based upon said individual'"'"'s response, a dichotomous value to each said distinct predictive factor of said predetermined set of predictive factors;
calculating, based upon a predetermined predictive model and said dichotomous values assigned to said predetermined set of predictive factors, a probability value of said individual becoming a high-encounter user of healthcare services for any reason within a prospective time span, wherein a high-encounter user makes high use of inpatient, outpatient, emergency room, or physician office healthcare services, and wherein said calculating is accomplished using a computing device having a processor;
and identifying said individual as a probable high-encounter user of healthcare services within said prospective time span if said probability value of said individual exceeds a predetermined threshold.
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Accused Products
Abstract
A healthcare management system and method identify individuals at risk of high near-term healthcare use. On step of the method includes collecting information from an individual for a predetermined set of predictive factors. Another step of the method includes assigning, based upon the information from the individual, a separate value to each predictive factor of the predetermined set of predictive factors. The method further includes the step of generating, based upon a predetermined predictive model and the separate values assigned to the predetermined set of predictive factors, a risk level of the individual utilizing healthcare services at a predetermined level within a prospective time span.
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Citations
19 Claims
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1. A method of improving health and reducing healthcare encounter trends, comprising the steps of:
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presenting an individual with a questionnaire designed to elicit said individual'"'"'s response to each distinct predictive factor of a predetermined set of predictive factors, said predetermined set of predictive factors including domains of functional ability, adherence with current medical treatment, numbers of uses of various healthcare services over past time periods, beliefs in the safety and value of healthcare services, healthcare partnering preferences and information-seeking preferences; collecting self-reported information from said individual about their perceived health wherein said self-reported information comprises said individual'"'"'s response to each said distinct predictive factor of said predetermined set of predictive factors; assigning, based upon said individual'"'"'s response, a dichotomous value to each said distinct predictive factor of said predetermined set of predictive factors; calculating, based upon a predetermined predictive model and said dichotomous values assigned to said predetermined set of predictive factors, a probability value of said individual becoming a high-encounter user of healthcare services for any reason within a prospective time span, wherein a high-encounter user makes high use of inpatient, outpatient, emergency room, or physician office healthcare services, and wherein said calculating is accomplished using a computing device having a processor; and identifying said individual as a probable high-encounter user of healthcare services within said prospective time span if said probability value of said individual exceeds a predetermined threshold. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A method of improving health and reducing healthcare encounter trends, the method comprising:
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designing a self-assessment questionnaire comprising a plurality of questions designed to elicit self-reported information from an individual about their perceived health; presenting each of a plurality of sample subjects with the self-assessment questionnaire; collecting a plurality of answers from each of the plurality of sample subjects answering the plurality of questions of the self-assessment questionnaire; collecting from healthcare claims data, a total number of healthcare encounters for each of the plurality of sample subjects during a predetermined time span, the total number of healthcare encounters being the sum of all uses of inpatient, outpatient, emergency room, and physician office healthcare services by the sample subject within the predetermined time span; determining a dependent variable based on the total number of healthcare encounters for each of the plurality of sample subjects during the predetermined time span; determining a set of independent predictor variables based upon the plurality of answers from the self-assessment questionnaire from each of the plurality of sample subjects; associating each predictor variable of the set of independent predictor variables to at least one of the plurality of questions of the self-assessment questionnaire; deriving a predictive modeling formula from the dependent variable and the set of independent predictor variables for each of the plurality of sample subjects, the predictive modeling formula being designed to determine a probability value for each individual of a plurality of individuals becoming a high-encounter user of healthcare services for any reason within a prospective time span, and wherein said deriving is accomplished using a computing device having a processor; determining a threshold value such that the individual will be classified as a probable high-encounter user of healthcare services within the prospective time span if the probability value computed by the predictive modeling formula for the individual exceeds the threshold value; programming a computing device having a processor with the predictive modeling formula and the threshold value for the purpose of using said computing device and said predictive modeling formula to identify individuals as probable high-encounter users of healthcare services within a prospective time span if said probability value of said individuals exceeds a predetermined threshold. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16, 17, 18, 19)
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Specification