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System and method for generating patient health management information

  • US 8,775,200 B1
  • Filed: 08/21/2008
  • Issued: 07/08/2014
  • Est. Priority Date: 08/21/2008
  • Status: Active Grant
First Claim
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1. A computer-implemented method for generating health management data for one or more patients relating to a disease, health condition or pre-condition, comprising a computer system performing the following:

  • storing, using a computer database, a plurality of health management groups, each relating to a disease, health condition or pre-condition and comprising one or more medical codes associated with the disease, health condition, or pre-condition, a health management group definition related to self-report survey data associated with the disease, health condition, or pre-condition, and an associated severity level;

    storing mapping data that enables mapping of self-report survey data obtained from a patient to one or more of the stored health management groups based on health management group definitions related to self-report survey data using the computer database;

    receiving, at a computer processor, medical claim data and self-report survey data associated with the patient, the received self-report survey data obtained from the patient and having no defined medical code;

    determining whether the medical claim data for the patient contains one or more of the stored medical codes associated with the disease, health condition or pre-condition using the computer processor;

    assigning the patient to a first health management group having a first associated severity level using at least the medical codes in the patient'"'"'s medical claim data using the computer processor;

    assigning the patient to a second health management group having a second severity level using the received self-report survey data and the stored mapping data using the computer processor;

    reconciling the first and second health management groups using predefined reconciliation rules to generate a final health management group having an associated severity level for the patient for the disease, health condition or pre-condition using the computer processor; and

    storing the final health management group generated for the patient in the computer database.

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