Systems and methods for determining prescribing physician activity levels

• US 8,386,276 B1
• Filed: 02/11/2010
• Issued: 02/26/2013
• Est. Priority Date: 02/11/2010
• Status: Active Grant

• Current Assignee: McKesson Corp.
• Original Assignee: Mckesson Financial Holdings Limited (McKesson Corp.)
• Inventors: Liu, David, Reisz, Sean Daniel, Picard, Thomas A.
• Primary Examiner(s): Le, Michelle
• Application Number:
  US12/704,209
• Time in Patent Office: 1,111 Days
• Field of Search: 221/13, 235/85, 707/999.1
• US Class Current: 705/2
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• 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

Systems and methods may determine prescribing physician activity levels. Information associated with a plurality of healthcare transaction requests that are received during a designated time period from at least one healthcare provider computer for communication to one or more claims processor computers may be collected. A respective prescribing physician for each of the plurality of received healthcare transaction requests may be identified. For each identified physician, a respective activity measure for the designated time period may be calculated based upon a respective number of the healthcare transaction requests identifying the physician.

Claims

1. A computer-implemented method, comprising:

collecting information associated with a plurality of healthcare transaction requests that are received during a designated time period from at least one healthcare provider computer for communication to at least one healthcare transaction processor computer;

identifying a respective prescribing physician and a pharmacy for one or more of the plurality of received healthcare transaction requests; and

calculating, for each identified physician and based upon a respective number of the healthcare transaction requests identifying the physician and the pharmacy, a respective activity measure based at least in part on a number of identified pharmacies for the identified physician for the designated time period, wherein calculating the respective activity measure of each identified physician comprises multiplying the number of the healthcare transaction requests identifying the physician by a value of two minus one over the number of pharmacies;

wherein the above operations are performed by one or more computers associated with a service provider.

2. The method of claim 1, further comprising:

ranking the identified physicians relative to one another based upon the calculated activity measures for the identified physicians; and

determining, based upon the ranking, a respective activity level for each identified physician.

3. The method of claim 1, wherein the identifying of the respective prescribing physician comprises identifying a physician by a subscriber identifier included in a healthcare transaction requests.

4. The method of claim 1, wherein the plurality of healthcare transaction requests comprise at least one of (i) a healthcare claim transaction or (ii) an electronic prescription request.

5. The method of claim 1, wherein the designated time period comprises a first designated time period and a second designated time period different than the first designated time period, and

wherein calculating a respective activity measure for the designated time period comprises calculating a first respective activity measure for the first designated time period and calculating a second respective activity measure for the second designated time period.

6. The method of claim 1, further comprising:

utilizing a calculated activity measure for an identified physician to facilitate one of (i) detecting whether the identified physician is a new physician, (ii) determining whether the identified physician is violating applicable sanctions, (iii) detecting fraud associated with the identified physician, (iv) determining a relative practice size for the identified physician, or (v) determining a prescribing trend associated with the identified physician.

7. The method of claim 1, further comprising:

utilizing the plurality of respective activity measures to determine that a physician that is not one of the identified physicians has become inactive.

8. The method of claim 1, further comprising:

utilizing a calculated activity measure for an identified physician to update a status associated with the identified physician.

9. A system, comprising:

at least one memory operable to store computer-executable instructions; and

at least one processor configured to access the at least one memory and execute the computer-executable instructions to;

collect information associated with a plurality of healthcare transaction requests that are received during a designated time period from at least one healthcare provider computer for communication to one or more healthcare transaction processor computers;

identify a respective prescribing physician and a pharmacy for one or more of the plurality of received healthcare transaction requests; and

calculate, for each identified physician and based upon a respective number of the healthcare transaction requests identifying the physician and the pharmacy, a respective activity measure based at least in part on a number of identified pharmacies for the identified physician for the designated time period, wherein the respective activity measure for an identified physician is calculated by multiplying the number of the healthcare transaction requests identifying the physician by a value of two minus one over the number of pharmacies.

10. The system of claim 9, wherein the at least one processor is further configured to execute the computer-executable instructions to:

rank the identified physicians relative to one another based upon the calculated activity measures for the identified physicians; and

determine, based upon the ranking, a respective activity level for each identified physician.

11. The system of claim 9, wherein a respective prescribing physician is identified by a subscriber identifier included in a healthcare transaction request.

12. The system of claim 9, wherein the plurality of healthcare transaction requests comprise at least one of (i) a healthcare claim transaction or (ii) an electronic prescription request.

13. The system of claim 9, wherein the designated time period comprises a first designated time period and a second designated time period different than the first designated time period, and

wherein the at least one processor is further configured to execute the computer-executable instructions to calculate a first respective activity measure for the first designated time period and a second respective activity measure for the second designated time period.

14. The system of claim 9, wherein the at least one processor is further configured to execute the computer-executable instructions to:

utilize a calculated activity measure for an identified physician to facilitate one of (i) detecting whether the identified physician is a new physician, (ii) determining whether the identified physician is violating applicable sanctions, (iii) detecting fraud associated with the identified physician, (iv) determining a relative practice size for the identified physician, or (v) determining a prescribing trend associated with the identified physician.

15. The system of claim 9, wherein the at least one processor is further configured to execute the computer-executable instructions to:

utilize the plurality of respective activity measures to determine that a physician that is not one of the identified physicians has become inactive.

16. The system of claim 9, wherein the at least one processor is further configured to execute the computer-executable instructions to:

utilize a calculated activity measure for an identified physician to update a status associated with the identified physician.