Method, system, and computer program product for physician efficiency measurement and patient health risk stratification utilizing variable windows for episode creation

• US 9,881,129 B1
• Filed: 05/03/2014
• Issued: 01/30/2018
• Est. Priority Date: 03/02/2004
• Status: Active Grant

• Current Assignee: Cave Consulting Group LLC
• Original Assignee: Cave Consulting Group LLC
• Inventors: Cave, Douglas G
• Primary Examiner(s): Chng, Joy
• Application Number:
  US14/269,084
• Time in Patent Office: 1,368 Days
• Field of Search: 705 2- 3
• CPC Class Codes: A61B 2505/05 Surgical care
• CPC Class Codes: G06Q 10/06398 Performance of employee with respect to a job function
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• 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 40/63 for local operation
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A method for measuring physician efficiency and patient health risk stratification is disclosed. Episodes of care are formed from medical claims data and an output process is performed. Physicians are assigned to report groups, and eligible physicians and episode assignments are determined. Condition-specific episode statistics and weighted episode statistics are calculated, from which physician efficiency scores are determined.

Claims

1. A healthcare analytics computer system for statistical analysis of medical care information for a medical care provider efficiency measurement, said healthcare analytics computer system comprising a memory device for storing data and a processor in communication with said memory device, said processor programmed to:

receive a plurality of scores defining an efficiency of care wherein each of the plurality of scores is associated with one of a plurality of physician identifiers identifying one of a plurality of physicians;

receive a plurality of episodes of care records, wherein each of the plurality of episodes of care records is associated with one of the plurality of physician identifiers identifying one of the plurality of associated physicians;

receive a plurality of patient treatment information data, wherein each of the plurality of patient treatment information data includes associated claim characteristics associated with a particular episode of care record, wherein the associated claim characteristics are a subset of a plurality of claim characteristics, wherein the plurality of claim characteristics includes a medical condition, a severity of illness classification, an average charge per episode of the medical condition at the severity of illness classification for a plurality of service categories, and an average utilization per episode of the medical condition at the severity of illness classification for the plurality of service categories, and wherein the average charge per episode and the average utilization per episode are weighted according to a predetermined relevance of the associated medical condition in a practice area associated with the plurality of physicians;

determine a relationship score between each of the plurality of claim characteristics and score calculations by performing a statistical analysis using the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data;

identify at least one of the plurality of claim characteristics for at least one of the physicians as having an associated relationship score exceeding a minimum threshold; and

report the identified at least one claim characteristic as a driver of efficiency for the at least one of the physicians.

2. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

receive a plurality of input files defining the association between each of the plurality of episodes of care records and each of the plurality of patient treatment information data; and

link each of the plurality of episodes of care records with the associated patient treatment information data based on the plurality of input files.

3. The healthcare analytics computer system of claim 2, wherein each of the plurality of input files includes a structured data relationship between each of the plurality of episodes of care records and each of the plurality of patient treatment information data.

4. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

identify a behavior adjustment associated with each of the efficiency drivers; and

recommend the plurality of behavior adjustments based on each identified efficiency driver.

5. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

receive with the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data, an associated geographic identifier; and

determine the relationship score for each of the associated geographic identifiers.

6. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

receive the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data for a plurality of physician practice areas; and

determine the relationship score for each of the associated physician practice areas.

7. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

identify a minimum threshold for episodes of care records;

filter the plurality of episodes of care records based on the identified minimum threshold; and

determine a filtered relationship score that is based on only episodes of care records that satisfy the identified minimum threshold.

8. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

determine the relationship score by performing a Pearson'"'"'s correlation analysis.

9. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

receive a plurality of input files defining the association between each of the plurality of episodes of care records and each of the plurality of patient treatment information data, each of the plurality of input files having a hierarchical structure including at least four different record types; and

flatten the hierarchical structure of the plurality of input files to generate the plurality of patient treatment information data, such that the plurality of patient treatment information data includes only one record type, wherein a CPU processing time of said processor reading the flattened plurality of patient treatment information data is significantly reduced relative to a CPU processing time for the plurality of input files.

10. The healthcare analytics computer system of claim 1, wherein said processor is further configured to:

calculate the plurality of scores defining the efficiency of care based on the plurality of episodes of care records, wherein the score for each of the physicians is calculated utilizing a subset of medical conditions clinically related to that physician'"'"'s specialty type, the subset including the medical conditions most commonly treated by that physician'"'"'s specialty type, and wherein each medical condition included in the subset of medical conditions is associated with the severity-of-illness classification, the severity of illness classification representing a severity level from a plurality of severity levels for the corresponding medical condition, each of the subset of medical conditions weighted by a factor representing a prevalence of the corresponding medical condition relative to other medical conditions included within the subset.

11. A computer-implemented method for statistical analysis of medical care information for a medical care provider efficiency measurement, said method implemented by a healthcare analytics computer system comprising a memory device for storing data and a processor in communication with the memory device, said method comprising:

receiving a plurality of scores defining an efficiency of care wherein each of the plurality of scores is associated with one of a plurality of physician identifiers identifying one of a plurality of physicians;

receiving a plurality of episodes of care records, wherein each of the plurality of episodes of care records is associated with one of the plurality of physician identifiers identifying one of the plurality of associated physicians;

receiving a plurality of patient treatment information data, wherein each of the plurality of patient treatment information data includes associated claim characteristics associated with a particular episode of care record, wherein the associated claim characteristics are a subset of a plurality of claim characteristics, wherein the plurality of claim characteristics includes a medical condition, a severity of illness classification, an average charge per episode of the medical condition at the severity of illness classification for a plurality of service categories, and an average utilization per episode of the medical condition at the severity of illness classification for the plurality of service categories, and wherein the average charge per episode and the average utilization per episode are weighted according to a predetermined relevance of the associated medical condition in a practice area associated with the plurality of physicians;

determining a relationship score between each of the plurality of claim characteristics and score calculations by performing a statistical analysis using the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data;

identifying at least one of the plurality of claim characteristics for at least one of the physicians as having an associated relationship score exceeding a minimum threshold; and

reporting the identified at least one claim characteristic as a driver of efficiency for the at least one of the physicians.

12. The method of claim 11, further comprising:

receiving a plurality of input files defining the association between each of the plurality of episodes of care records and each of the plurality of patient treatment information data; and

linking each of the plurality of episodes of care records with the associated patient treatment information data based on the plurality of input files.

13. The method of claim 12, wherein each of the plurality of input files includes a structured data relationship between each of the plurality of episodes of care records and each of the plurality of patient treatment information data.

14. The method of claim 11, further comprising:

identifying a behavior adjustment associated with each of the efficiency drivers; and

recommending the plurality of behavior adjustments based on each identified efficiency driver.

15. The method of claim 11, further comprising:

receiving with the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data, an associated geographic identifier; and

determining the relationship score for each of the associated geographic identifiers.

16. The method of claim 11, further comprising:

receiving the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data for a plurality of physician practice areas; and

determining the relationship score for each of the associated physician practice areas.

17. The method of claim 11, further comprising:

identifying a minimum threshold for episodes of care records;

filtering the plurality of episodes of care records based on the identified minimum threshold; and

determining a filtered relationship score that is based on only episodes of care records that satisfy the identified minimum threshold.

18. The method of claim 11, further comprising:

determining the relationship score by performing a Pearson'"'"'s correlation analysis.

19. A computer-readable storage device, having processor-executable instructions embodied thereon, for statistical analysis of medical care information for a medical care provider efficiency measurement using a healthcare analytics computer system, wherein the healthcare analytics computer system includes at least one processor and a memory device coupled to the processor, wherein, when executed by the healthcare analytics computer system, the processor-executable instructions cause the healthcare analytics computer system to:

receive a plurality of scores defining an efficiency of care wherein each of the plurality of scores is associated with one of a plurality of physician identifiers identifying one of a plurality of physicians;

receive a plurality of episodes of care records, wherein each of the plurality of episodes of care records is associated with one of the plurality of physician identifiers identifying one of the plurality of associated physicians;

receive a plurality of patient treatment information data, wherein each of the plurality of patient treatment information data includes associated claim characteristics associated with a particular episode of care record, wherein the associated claim characteristics are a subset of a plurality of claim characteristics, wherein the plurality of claim characteristics includes a medical condition, a severity of illness classification, an average charge per episode of the medical condition at the severity of illness classification for a plurality of service categories, and an average utilization per episode of the medical condition at the severity of illness classification for the plurality of service categories, and wherein the average charge per episode and the average utilization per episode are weighted according to a predetermined relevance of the associated medical condition in a practice area associated with the plurality of physicians;

determine a relationship score between each of the plurality of claim characteristics and score calculations by performing a statistical analysis using the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data;

identify at least one of the plurality of claim characteristics for at least one of the physicians as having an associated relationship score exceeding a minimum threshold; and

report the identified at least one claim characteristic as a driver of efficiency for the at least one of the physicians.

20. The computer-readable storage device of claim 19, wherein the processor-executable instructions cause the healthcare analytics computer system to:

receive a plurality of input files defining the association between each of the plurality of episodes of care records and each of the plurality of patient treatment information data; and

link each of the plurality of episodes of care records with the associated patient treatment information data based on the plurality of input files.

21. The computer-readable storage device of claim 20, wherein the processor-executable instructions cause the healthcare analytics computer system to:

identify a behavior adjustment associated with each of the efficiency drivers; and

recommend the plurality of behavior adjustments based on each identified efficiency driver.

22. The computer-readable storage device of claim 19, wherein the processor-executable instructions cause the healthcare analytics computer system to:

receive with the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data, an associated geographic identifier; and

determine the relationship score for each of the associated geographic identifiers.

23. The computer-readable storage device of claim 19, wherein the processor-executable instructions cause the healthcare analytics computer system to:

receive the plurality of scores, the plurality of episode of care records, and the plurality of patient treatment information data for a plurality of physician practice areas; and

determine the relationship score for each of the associated physician practice areas.

24. The computer-readable storage device of claim 19, wherein the processor-executable instructions cause the healthcare analytics computer system to:

identify a minimum threshold for episodes of care records;

filter the plurality of episodes of care records based on the identified minimum threshold; and

determine a filtered relationship score that is based on only episodes of care records that satisfy the identified minimum threshold.

25. The computer-readable storage device of claim 19, wherein the processor-executable instructions cause the healthcare analytics computer system to:

determine the relationship score by performing a Pearson'"'"'s correlation analysis.

26. The computer-readable storage device of claim 19, wherein the processor-executable instructions cause the healthcare analytics computer system to:

identify a minimum threshold for episodes of care records;

filter the plurality of episodes of care records based on the identified minimum threshold; and

determine a filtered relationship score that is based on only episodes of care records that satisfy the identified minimum threshold.