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CNA-guided care for improving clinical outcomes and decreasing total cost of care

  • US 9,734,291 B2
  • Filed: 11/14/2016
  • Issued: 08/15/2017
  • Est. Priority Date: 10/08/2013
  • Status: Active Grant
First Claim
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1. A method for improving clinical outcomes at a specific patient level and for decreasing total cost of care at a population level comprising:

  • a computer containing a processor comprising a first clinical outcome tracking and analysis module executing on the processor comprising the first clinical outcome tracking and analysis module steps comprising;

    (a) accounting for biological variance upfront by grouping patients in a patient population, thereby effectively removing biological variance as a factor in value of care, and leaving treatment variance as a predominant factor in treatment outcome by;

    (i) receiving, collecting and recording in a database personal health information from each patient in the patient population, the personal health information comprising each parameter that characterizes each patient in the patient population and information that impacts survival, prognosis, or treatment based on the latest scientific knowledge or medical guidelines;

    (ii) sorting the personal health information for each patient in the patient population using a sorting filter to provide a sorted set of personal health information for that population, and to identify patients satisfying each parameter in the patient population;

    (iii) classifying like personal health information, and grouping types of patients in the patient population based on the personal health information associated with the patient population by generating and assigning a plurality of Clinical outcome tracking and analysis Nodal Addresses (CNAs) within the first clinical outcome tracking and analysis module, wherein said generating and assigning said plurality of nodal addresses comprises;

    (1) representing each CNA as a discrete punctuated string of digits comprising a prefix, a middle and a suffix that represent a set of preselected variables that partition the sorted and classified information into a clinically relevant set of health information;

    (2) reducing trillions of possible permutations to a reduced number of clinically meaningful permutations based on the discrete punctuated string of digits representing each CNA that enable analysis of first behavioral and then consequent clinical and cost outcome variance from an ideal value, expressed as best clinical outcome at lowest possible cost, in a requisite time needed to alert for necessary care and avoidance of unnecessary care, thereby increasing the value of care, meaning better clinical outcomes at a lowest possible cost;

    (3) reducing processing requirements and time for processing to make real-time monitoring of medical provider performance efficient based on the discrete punctuated string of digits representing each CNA and based on the reduction in permutations; and

    (4) enabling prediction of key points in time at which behavioral variance is likely to occur and interrupting treatment flow to avoid over-/under-utilization of care to prevent the behavioral variance;

    (iv) measuring clinical outcome for each CNA by;

    analyzing the clinically relevant set of personal health information for the subset of the patient population for one or more patients in the subset of the patient population; and

    (v) measuring behavioral variance for each medical care provider of each patient in the patient population assigned to each CNA by comparing differences between one medical care provider and another medical care provider in treating, testing, following up, complying with prescribed medicines, and cost for each patient in the patient population assigned to each CNA;

    (b) upon receiving communications from a payer via a first client device comprising a second clinical outcome tracking and analysis module, identifying a health care service under consideration for a patient whose health plan benefits cover the medical service and variables selected by the payer, the first clinical outcome tracking and analysis module transmitting to the second clinical outcome tracking and analysis module information comprising,(1′

    ) the clinical outcome data for each CNA in (iv),(2′

    ) the behavioral variance data for each medical provider at each CNA in (v);

    (3′

    ) a cost report comprising cost data in real time for treating each patient in the patient population assigned to the CNA in (iii); and

    (4′

    ) one or more graphic analyses correlating cost of care to clinical outcome;

    wherein the information is sufficientfor the payer to establish at the key points in time,(a′

    ) that the medical service is an appropriate delivery or level of service, considering potential benefits and harms to the patient;

    (b′

    ) that the medical service is effective in improving health outcome by improving clinical outcomes and reducing total cost of care;

    (c′

    ) that the service is cost-effective for the medical condition being treated and the clinical outcome, compared to alternative health interventions or no intervention; and

    (d′

    ) that the service follows generally accepted medical practice, andfor the payer to approve payment to the medical care provider for the medical service;

    (c) upon exchanging a series of communications with the patient via a second client device comprising a third clinical outcome tracking and analysis module, the first clinical outcome tracking and analysis moduleproviding information sufficient for a complete medical evaluation of the patient and for assigning a CNA to the patient, andusing the CNA to determine an optimal level of care with a reduced risk of adverse variance; and

    to select a health care provider and a desired level of CNA-guided care,the series of communications comprising;

    (i″

    ) in response to a first communication from the patient reporting a health concern to the processor of the computer server comprising the first clinical outcome tracking and analysis module,sending to the second client device comprising the third clinical outcome tracking and analysis module in reply a second communication containing list of tests needed to diagnose the health concern as a medical condition;

    (ii″

    ) in response to a third communication from the patient containing results of the tests needed to diagnose the health concern in (i″

    ),sending to the second client device comprising the third clinical outcome and analysis module in reply a fourth communication containing a diagnosis of the medical condition and a list of additional tests needed for further classifying the medical condition;

    (iii″

    ) in response to a fifth communication from the patient containing the results of the additional tests in (i″

    ), based on the results of the tests, the diagnosis in (ii″

    ), and the list of additional tests in (ii″

    ),(a″

    ) assigning, a CNA to the patient from the plurality of CNAs available in a(iii), the assigned CNA containing the clinically relevant set of health information for the patient; and

    (b″

    ) transmitting to the second client device comprising the third clinical outcome tracking module a sixth communication comprising;



    (1″

    ) the assigned CNA; and



    (2″

    ) a geographically organized list of medical professionals treating patients within the assigned CNA, wherein the list of medical professionals is classified by one or more of geography, clinical outcome or cost;

    (iv″

    ) in response to a seventh communication from the patient selecting an optimal care plan comprising a reduced risk of adverse variance and a medical professional that meets at least one or more of geographical, cost, and outcome needs of the patient,communicatively linking to a computing device comprising a third clinical outcome tracking and analysis module at the selected medical professional'"'"'s office to facilitate scheduling of an appointment of the patient with the selected medical professionalwherein the processor comprising the first clinical outcome tracking and analysis module, the first client device comprising a second clinical outcome tracking and analysis module, the second client device comprising a second clinical outcome tracking and analysis module, and the computing device comprising the third clinical outcome tracking and analysis module are communicatively linked via a network.

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