Predictive modeling system and method for disease management
First Claim
1. A method of disease management embodied in a computer program product for execution on an instruction processing system, comprising a tangible storage medium readable by the instruction processing system and storing instructions for execution by the instruction processing system for performing the method comprising:
- filtering claims data of program participants to define a population;
conducting a multi-condition risk assessment of substantially all participants within the defined population;
combining data gathered from said multi-condition risk assessment with claims data for participants within the defined population;
classifying future healthcare risk of participants based on the combination of claims data and data gathered from said multi-condition risk assessment; and
determining an appropriate level of disease management intervention and support for program participants based on the future healthcare risk classification that ranges from patient education for lower risk individuals, passive monitoring and reporting of progress and program compliance for middle risk individuals, to more active intervention and close one-on-one case management for higher risk individuals.
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Accused Products
Abstract
A method and system for administering a disease management program to improve healthcare quality, reduce healthcare costs, and optimize delivery of healthcare services. A multi-condition risk assessment is conducted for all or a substantial portion of a population of program participants, and collected multi-condition risk assessment data are combined with claims data for predictive modeling of future healthcare risk and expense. Participants are risk-stratified into one or more classifications of future healthcare cost risk, and appropriate intervention or delivery of healthcare services is made based on the risk classification.
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Citations
17 Claims
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1. A method of disease management embodied in a computer program product for execution on an instruction processing system, comprising a tangible storage medium readable by the instruction processing system and storing instructions for execution by the instruction processing system for performing the method comprising:
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filtering claims data of program participants to define a population; conducting a multi-condition risk assessment of substantially all participants within the defined population; combining data gathered from said multi-condition risk assessment with claims data for participants within the defined population; classifying future healthcare risk of participants based on the combination of claims data and data gathered from said multi-condition risk assessment; and determining an appropriate level of disease management intervention and support for program participants based on the future healthcare risk classification that ranges from patient education for lower risk individuals, passive monitoring and reporting of progress and program compliance for middle risk individuals, to more active intervention and close one-on-one case management for higher risk individuals. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method of disease management embodied in a computer program product for execution on an instruction processing system, comprising a tangible storage medium readable by the instruction processing system and storing instructions for execution by the instruction processing system for performing the method comprising:
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conducting a multi-condition risk assessment of at least a substantial portion of program participants within a defined population; generating a patient record based on the multi-condition risk assessment; and providing differing degrees of healthcare intervention for program participants based on their patient record, wherein the degrees range from patient education for lower risk individuals, passive monitoring and reporting of progress and program compliance for middle risk individuals, to more active intervention and close one-on-one case management for higher risk individuals. - View Dependent Claims (15)
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16. A method of optimizing delivery of healthcare services to participants in a disease management program, embodied in a computer program product for execution on an instruction processing system, comprising a tangible storage medium readable by the instruction processing system and storing instructions for execution by the instruction processing system for performing said method comprising:
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conducting a multi-condition risk assessment of at least a substantial portion of a population; categorizing individual program participants selected from the population into at least a higher-risk category and a lower-risk category; and providing more intensive healthcare intervention to program participants categorized in the higher-risk category and less intensive healthcare intervention to program participants categorized in the lower-risk category, wherein the program participants categorized in the lower-risk category receive patient education and close one-on-one case management for higher-risk category. - View Dependent Claims (17)
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Specification