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Outcomes based service provider networks

  • US 8,719,058 B2
  • Filed: 12/02/2010
  • Issued: 05/06/2014
  • Est. Priority Date: 12/02/2010
  • Status: Active Grant
First Claim
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1. A system for determining a composition of a service provider network for providing services according to a workers'"'"' compensation insurance plan, the system comprising:

  • a computer-readable storage medium that stores claim information, which describes;

    workers'"'"' compensation claims; and

    medical service providers that provided medical services related to the workers'"'"' compensation claims including numerical information related to a patients'"'"' satisfaction with the medical services provided;

    at least one processor that;

    determines, for each of the medical service providers included in the stored claim information, a metric value for each of a plurality of service provider metrics based on the stored claim information, wherein the service provider metrics include;

    the information related to the patient view of the medical services provided;

    a metric that relates to an amount paid per claim; and

    a percentage of claims that involved lost time;

    adjusts the metric values based on one or more adjustment parameters;

    assigns scores to each of the medical service providers based on the adjusted metric values;

    determines an average of the assigned scores for each of the medical service providers; and

    generates results data based on the determined averages of the assigned scores, wherein the results data indicates, for each of the medical service providers, whether the medical service provider is included in the service provider network, and wherein the medical service providers with generated results below a threshold are not included in the service provider network; and

    a display device that displays the results data.

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