Methods for improving the clinical outcome of patient care and for reducing overall health care costs

• US 9,977,867 B2
• Filed: 10/26/2015
• Issued: 05/22/2018
• Est. Priority Date: 05/06/2004
• Status: Active Grant

• Current Assignee: Medencentive LLC
• Original Assignee: Medencentive LLC
• Inventors: Greene, Jeffrey C.
• Primary Examiner(s): Le, Linh Giang
• Application Number:
  US14/923,043
• Publication Number:
  US 20160042132A1
• Time in Patent Office: 939 Days
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• 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 50/20 Education
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

System and method for reducing healthcare costs by improving care and encouraging healthy behaviors. A web-based or telephonic program using health plan sponsor funded financial incentives, offered to patients and providers for declaring or demonstrating adherence or providing a reason for non-adherence to performance standards. Financial incentives are contingent upon patient'"'"'s and provider'"'"'s agreement to allow the other to confirm or acknowledge the other'"'"'s declaration or demonstration of adherence or non-adherence reason. Combining financial incentives with a set of checks and balances motivates participation in the program and adherence to the performance standards. Performance standards include evidence-based treatment guidelines, information therapy, wellness and prevention solutions, care management, and other methods proven to control costs by improving behaviors and healthcare. The system and method achieves improved health and more affordable healthcare by aligning the interests of providers, patients/consumers, and health plan sponsors in a win-win-win arrangement.

Claims

1. A method for managing a patient'"'"'s health and healthcare costs, the method comprising:

authenticating an electronic device to a computer that stores a patient account record corresponding to a patient identification;

commanding the computer to generate and transmit a unique patient webpage for display on the electronic device using data from the patient account record;

wherein the patient webpage comprises an opportunity to earn a financial reward associated with a medical service that is unique to the patient account record, the opportunity comprising a healthcare provider name and a patient diagnosis associated with a date of service, an expiration date assigned to the opportunity by the computer, and a patient session link to instruct the computer to generate and display an information therapy prescription, a patient knowledge exam, a patient declaration link, a patient agreement link, and a patient rating link;

displaying the information therapy prescription at the electronic device;

displaying the patient knowledge exam on the electronic device, the knowledge exam comprising a plurality of questions related to the information therapy prescription and selected by the computer from a question database;

receiving input signals from the electronic device, the signals comprising answers to the plurality of questions;

creating and displaying a new webpage when an incorrect answer is received directing the patient to a question with the incorrect answer and a portion of the information therapy prescription containing a correct answer;

activating the patient declaration link to transmit a signal from the electronic device to indicate a patient declaration of adherence or reason for non-adherence to the information therapy prescription;

receiving the signal from the patient declaration link, the signal comprising an answer to the patient declaration of adherence or reason for non-adherence to the information therapy prescription;

amending the patient account record to indicate a patient declaration of adherence or reason for non-adherence to the information therapy prescription;

activating the patient agreement link to transmit a signal used to amend the patient account record to indicate a patient agreement to release the patient'"'"'s answers to the plurality of questions and the declaration of adherence or reason for non-adherence to the information therapy prescription and to the healthcare provider;

activating the patient rating link to transmit a signal indicative of the patient'"'"'s answers to the rating of the healthcare provider; and

thereafter, the computer authorizes disbursement of the financial reward to the patient.

2. The method of claim 1 wherein the electronic device comprises an Internet or application enabled device.

3. The method of claim 1 wherein authenticating the electronic device to the computer comprises receiving the patient identification and an authentication factor both corresponding to the patient account record at the computer.

4. The method of claim 1 wherein the electronic device and the computer communicate via the Internet.

5. The method of claim 1 wherein the patient web page comprises a plurality of opportunities to earn financial rewards each comprising an entry on the patient account record comprising the healthcare provider name and the patient diagnosis associated with a date of service, the expiration date of the opportunity assigned by the computer, and the patient session link.

6. The method of claim 1 further comprising before displaying the information therapy prescription and the knowledge exam on the electronic device, the computer automatically processes the patient account record to determine if the expiration date assigned by the computer has passed, thereafter the computer does not authorize disbursement of the financial reward to the patient if the computer determines the expiration date has passed.

7. The method of claim 1 further comprising creating and sending an electronic mail message or postal notice to the patient of the opportunity to earn a financial reward associated with a medical service before displaying the unique patient webpage.

8. The method of claim 7 wherein the electronic mail message comprises an active link to the unique patient webpage.

9. The method of claim 1 further comprising the computer establishing a threshold dwell time for the electronic device to display the information therapy prescription and measuring the dwell time, authorizing disbursement of the financial reward if the measured dwell time meets or exceeds the threshold dwell time.

10. The method of claim 1 wherein the information therapy prescription comprises an educational material selected by the computer based on the patient diagnosis.

11. The method of claim 1 wherein the patient'"'"'s rating of the healthcare provider is aggregated with ratings from a plurality of patients and transmitted by the computer to the healthcare provider as a composite performance rating.

12. The method of claim 11 wherein the computer uses the composite performance rating to determine a level of compensation to the healthcare provider.

13. The method of claim 1 further comprising instructing a health plan to disburse the financial reward to the patient.

14. The method of claim 12 further comprising instructing a health plan to disburse the financial reward to the healthcare provider.

15. A computer implemented method for managing health and healthcare costs, comprising executing on a processor the steps of:

creating a financial reward opportunity record for a patient based on a patient identifier and a medical diagnosis code associated with a medical service rendered by a healthcare provider to the patient received in a first electronic message;

assigning a time limit to the financial reward opportunity record;

linking an information therapy selected from an information therapy database to the financial reward opportunity record;

linking a randomly selected query related to the information therapy from a plurality of queries stored in a query database to the financial reward opportunity record;

receiving a second electronic message comprising the patient identifier and requesting access to the financial reward opportunity;

in response to the second electronic message, accessing the financial reward opportunity record to create and transmit a patient session webpage comprising the medical diagnosis code, the selected information therapy, the query, and an active link to generate a third electronic message comprising a patient declaration of adherence or reason for non-adherence to the information therapy, a patient answer to the query, and a patient agreement to release the patient answer and the patient declaration of adherence or reason for non-adherence transmitted to the healthcare provider;

receiving and processing the third electronic message to write the patient declaration of adherence or reason for non-adherence, the patient answer, and the patient agreement to release to a patient record and to confirm receipt of the third electronic message prior to the time limit; and

thereafter authorizing disbursement of the financial reward to the patient.

16. The method of claim 15 further comprising processing the patient answer to the query and creating and displaying a new webpage when the patient answer is incorrect, the new webpage comprising the query for which the patient answer was given and at least a portion of the information therapy containing a correct answer to the query.

17. The method of claim 15 further comprising:

receiving a healthcare provider identification at the computer from a provider electronic device;

processing the healthcare provider identification to create and transmit a healthcare provider webpage for display on the provider electronic device, the healthcare provider webpage comprising a plurality of fields to receive data from a healthcare provider containing the patient identifier and the medical diagnosis code;

wherein the computer receives the patient identification and the medical diagnosis code and generates a healthcare provider prescription page for display on the provider electronic device, the prescription page comprising plurality of active links for the healthcare provider to select an offer of a healthcare provider financial compensation, a healthcare provider performance standard, a patient performance standard and information therapy corresponding with the medical diagnosis code, and an expiration date assigned to the offer by the computer;

the computer processes the data received from the prescription page and generates a unique declaration page corresponding to the patient identification and the medical diagnosis code comprising a plurality of active links to receive and transmit data from the provider electronic device to the computer comprising a healthcare provider declaration of adherence or reason for non-adherence to the healthcare provider performance standard, a healthcare provider acknowledgment that the patient will rate or confirm the healthcare provider declaration of adherence or reason for non-adherence, a patient performance standard and information therapy prescription, and an agreement to confirm and acknowledge the patient declaration of adherence or reason for non-adherence;

the computer receives the data from the declaration page and automatically processes the data to determine if the healthcare provider has declared adherence to the healthcare provider performance standard or provided a reason for non-adherence that corresponds to at least one reason for non-adherence from plurality of preselected reasons for non-adherence stored in a database at the computer; and

the computer issues a command signal to order disbursement of the healthcare provider financial incentive to the healthcare provider based upon authentication of the data received from the prescription page and the healthcare provider declaration of adherence or authorized reason for non-adherence, if the expiration date has not passed.

18. The method of claim 17 further comprising processing data received from the prescription page to generate the patient session webpage.

19. The methods of claim 17 wherein the command signal is transmitted to a health plan computer, and comprises an order to disburse the service provider financial incentive comprising monetary compensation to the service provider.

20. The method of claim 15 further comprising before transmitting the patient session webpage, the computer automatically processes the financial opportunity reward record to determine if the time limit has passed, thereafter the computer does not authorize disbursement of the financial reward to the patient if the computer determines the time limit has passed.