Rating system, process and predictive algorithmic based medium for treatment of medical conditions in cost effective fashion and utilizing management pathways for customizing or modifying of a base algorithm by an accountable care organization or other payor in order to establish best treatment protocols and financial assessment tools for incentivizing care providers and for achieving improved clinical/functional outcomes

• US 9,734,478 B2
• Filed: 06/11/2015
• Issued: 08/15/2017
• Est. Priority Date: 09/26/2013
• Status: Active Grant

• Current Assignee: Ali Alhimiri
• Original Assignee: Ali Alhimiri
• Inventors: Alhimiri, Ali
• Primary Examiner(s): Boveja, Namrata
• Assistant Examiner(s): Ezewoko, Michael
• Application Number:
  US14/737,212
• Publication Number:
  US 20150356486A1
• Time in Patent Office: 796 Days
• Field of Search: 705 1419
• CPC Class Codes: B01F 23/191 characterised by the construction of the controlling means
• CPC Class Codes: B01F 25/3141 with additional mixing means other than injector mixers
• CPC Class Codes: B01F 25/4336 Mixers with a diverging cross-section
• CPC Class Codes: B01F 35/2113 Pressure
• CPC Class Codes: B01F 35/2211 Amount of delivered fluid during a period
• CPC Class Codes: B01F 35/715 Feeding the components in several steps, e.g. successive steps
• CPC Class Codes: B01F 35/833 Flow control by valves, e.g. opening intermittently
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/06393 Score-carding, benchmarking or key performance indicator [KPI] analysis
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/0207 Discounts or incentives, e.g. coupons or rebates
• CPC Class Codes: G06Q 30/0217 involving input on products or services in exchange for incentives or rewards
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

The present invention discloses a system, method and non-transitory software based computer writeable medium usable with a processor driven device for incentivizing service providers. A predictive algorithm which includes a series of protocols including a first protocol or subroutine for establishing a risk profile through stratifying a designated ACO population. A second subroutine operates by training the ACO doctors or other care providers in one or more of a series of medical related diagnosis and treatment programs. A third successive subroutine establishes one or more management pathways which are customizable by the ACO leadership and through establishing a questioning protocol for modifying/customizing the base algorithm for any one or more of a variety of treatment sub-species. A fourth subroutine provides care provider (e.g. doctor) feedback on the desired best practices for the given diagnosis and treatment sub-species resulting from the question and answer protocol achieved in the third subroutine. A fifth subroutine results in the creation (again by the ACO or other provider) of a scorecard for each individual care provider (doctor, therapist, etc.), such based primarily upon patient outcome assessment and accounting for patient complexities.

Claims

1. A non-transitory computer readable medium comprising instructions for incentivizing care providers that, upon execution by a processor, cause the processor to:

execute a first subroutine for establishing a risk profile through stratifying a designated population covered by an Accountable Care Organization (ACO);

execute a second subroutine for training the care providers in one or more of a series of medical related diagnosis and treatment programs;

execute a third subroutine for establishing one or more management pathways which are customizable by ACO leadership and through establishing a question and answer protocol for modifying or customizing a base algorithm for any one or more of a variety of treatment sub-species;

execute a fourth subroutine for assembling a best practices model in the form of a best practices database interfacing with the processor and which presents series of treatment options ranging from desirable to undesirable associated with a given type of service;

execute a fifth subroutine for providing feedback to the care provider on desired best practices for a given diagnosis and treatment sub-species resulting from the question and answer protocol achieved in the third subroutine;

execute a sixth subroutine for creation of a scorecard for each individual care provider based primarily upon patient outcome assessment and accounting for patient complexities, thus incentivizing adherence by the care providers to the best practices model by tying desirable performance metrics to financial incentives;

execute a seventh subroutine for designating a sum of funds representative of an operating budget for the service provider and for disbursement on a percentage basis to each of any number of subset service providers based upon adherence to the best practices model; and

execute an eighth subroutine for subdividing said sum between different practice groups and sub-specialties associated with a given class of service providers.

2. The non-transitory computer readable medium of claim 1, further comprising an additional subroutine for providing and incentivizing patient input to the processor driven device as medical data input, biographical data input, commentary regarding a service provider, or a rating regarding a service provider.

3. The non-transitory computer readable medium of claim 1, further comprising a management module having at least one additional subroutine interfacing with the processor driven device for monitoring and tracking adherence to the best practices model.

4. The non-transitory computer readable medium of claim 1, the second subroutine for training the care providers in one or more of a series of medical related diagnosis and treatment programs further comprising training in one or more of joint care, spinal care, cardiac care, acute care, post-acute care, wound care, vascular care, cancer care, diabetes care, kidney care, urology care, pulmonary care and vision care.

5. The non-transitory computer readable medium of claim 1, wherein the treatment sub-species associated with the third protocol further comprises at least one or more of emergency care, immediate care, systemic complications, disability risk, psycho-social issues, preventive care and maintenance care.

6. The non-transitory computer readable medium of claim 1, further comprising a comparison metric for providers to measure their performance versus other providers within a group and providers in other groups.

7. The non-transitory computer readable medium of claim 1, further comprising creation and management of an editable specialty physicians providers network.

8. The non-transitory computer readable medium of claim 1, further comprising distribution of shared savings and other financial incentives between patients, providers and payers.

9. The non-transitory computer readable medium of claim 1, further comprising real-time feedback for providers compliance with best practice on every patient enrolled in a program.