Methods and systems for healthcare practice management
First Claim
Patent Images
1. A method of managing a healthcare practice participating in an insurance network to enhance profitability of the healthcare practice with respect to a predetermined reimbursement amount for ancillary pharmacy costs, the method comprising:
- gathering data in a tangible computer medium from each of a plurality of physicians in the healthcare practice participating in the insurance network including pharmacy costs other than those attributed to a medical procedure performed directly by any of the plurality of physicians when the respective physician directly administers a medication to a patient to thereby define ancillary pharmacy costs;
analyzing the gathered data by a computer;
identifying responsive to the analysis by the computer, at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs from the insurance network by prescribing medications that are detrimental to receiving the predetermined reimbursement amount for the ancillary pharmacy costs;
after the step of identifying, modifying ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary pharmacy costs; and
determining that the risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs from the insurance network has been reduced to increase the profitability of the healthcare practice.
6 Assignments
0 Petitions
Accused Products
Abstract
Methods and systems are provided for optimizing profits for healthcare practices and insurance networks. The methods and systems include modifying physician'"'"'s cost management behavior to enhance profitability of healthcare practices and insurance networks by identifying physicians that are not profitable because of cost management behavior and providing intervention to change the management behavior of the physician.
39 Citations
62 Claims
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1. A method of managing a healthcare practice participating in an insurance network to enhance profitability of the healthcare practice with respect to a predetermined reimbursement amount for ancillary pharmacy costs, the method comprising:
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gathering data in a tangible computer medium from each of a plurality of physicians in the healthcare practice participating in the insurance network including pharmacy costs other than those attributed to a medical procedure performed directly by any of the plurality of physicians when the respective physician directly administers a medication to a patient to thereby define ancillary pharmacy costs; analyzing the gathered data by a computer; identifying responsive to the analysis by the computer, at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs from the insurance network by prescribing medications that are detrimental to receiving the predetermined reimbursement amount for the ancillary pharmacy costs; after the step of identifying, modifying ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary pharmacy costs; and determining that the risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs from the insurance network has been reduced to increase the profitability of the healthcare practice. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method of managing a healthcare practice participating in an insurance network to enhance profitability of the healthcare practice with respect to a predetermined reimbursement amount for medical costs other than those attributed directly to a medical procedure performed by a physician to thereby define ancillary medical costs, the method comprising:
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gathering data in a tangible computer medium from each of a plurality of physicians in the healthcare practice participating in the insurance network including ancillary medical costs; analyzing the gathered data by a computer; identifying responsive to the analysis by the computer, at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in medical procedures other than those attributed directly to a medical procedure performed by a physician and that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs; after the step of identifying, modifying management behavior of the at least one of the plurality of physicians at risk regarding the ancillary medical costs; and determining that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced to increase the profitability of the healthcare practice. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24)
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25. A method of optimizing the profitability of an insurance network having a plurality of physicians in a healthcare practice participating therein by managing ancillary medical costs, the method comprising the steps of:
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gathering data in a tangible computer medium from each of the plurality of physicians in the healthcare practice participating in the insurance network including management of medical costs other than those attributed directly to medical procedures performed by any of the plurality of physicians to thereby define ancillary medical costs; analyzing the gathered data by a computer; identifying responsive to the analysis by the computer, at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by performing activities that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs; after the step of identifying, modifying management behavior of the at least one of the plurality of physicians'"'"' physicians in the healthcare practice regarding ancillary medical costs that are not profitable for the insurance network responsive to the gathered data; and providing a financial incentive to the insurance network and the plurality of physicians in the healthcare practice participating in the insurance network to modify the plurality of physicians'"'"' ancillary medical costs management behavior of ancillary medical costs that are the plurality of physicians that is not as profitable to the insurance network. - View Dependent Claims (26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36)
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37. A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network comprising:
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a first database comprising medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures that are preferred by the insurance network; a second database comprising medical costs other than those attributed directly to medical procedures performed by any of the plurality of physicians to thereby define ancillary medical costs of each of the plurality of physicians participating in the insurance network; and computer executable program product stored on a tangible computer medium, comprising; an analyzer in communication with the first and second databases for analyzing the data in the first and second database and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify ancillary medical costs of the physicians that are not preferred by the insurance network, and managing means responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing means including an identifier for identifying responsive to the analyzer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, and a modifier responsive to the identifier for modifying ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary medical costs, the managing means further determining responsive to the modifier that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced. - View Dependent Claims (38, 39, 40, 41, 42, 43, 44)
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45. A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network comprising:
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a server having at least one database, the at least one database comprising a first and second database, the first database including the ancillary medical procedures that are more preferred by the insurance network, the second database including ancillary medical costs of each of the plurality of physicians participating in the insurance network; a communications network positioned to be in communication with the server; a plurality of computers positioned to be in communication with the communications network, each including a user interface responsive to a user; computer executable program product stored on a tangible computer medium positioned on the server, comprising; an updater responsive to the user interface updating each of the plurality of physicians in the healthcare practice of any changes in the management of medical costs other than those attributed directly to a medical procedure performed directly by any of the plurality of physicians to thereby define ancillary medical costs and that are preferred by the insurance network, recommending means responsive to the user interface for recommending to each of the plurality of physicians alternative medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures and that are preferred by the insurance network, an analyzer in communication with the first and second databases for analyzing the data in the first and second databases and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify the ancillary medical costs of the physicians that are not preferred by the insurance network, and managing means responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing means including an identifier for identifying responsive to the analyzer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, and a modifier responsive to the identifier for modifying ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary medical costs, the managing means further determining responsive to the modifier that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced. - View Dependent Claims (46, 47, 48, 49, 50, 51)
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52. A computer-assisted method of managing a healthcare practice participating in an insurance network to enhance profitability of the healthcare practice with respect to a predetermined reimbursement amount for ancillary pharmacy costs, the method comprising the steps of:
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providing a first computer associated with a tangible non-transitory computer readable medium and positioned to receive data indicating pharmacy costs other than those attributed to a medical procedure performed directly by any of the plurality of physicians when the respective physician directly administers a medication to a patient to thereby define ancillary pharmacy costs attributed to the plurality of physicians; receiving by the first computer from a second computer, the data indicating the ancillary pharmacy costs attributed to the plurality of physicians; processing, by the first computer, the received data to include comparing the ancillary pharmacy costs attributed to the plurality of physicians with costs of ancillary prescription medications preferred by the insurance network to thereby identify physicians prescribing medications not preferred by the insurance network; responsive to the step of processing, identifying by the first computer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs from the insurance network as a result of prescribing ancillary medications that are detrimental to receiving the predetermined reimbursement amount for the ancillary pharmacy costs; responsive to the step of identifying at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary pharmacy costs, generating by the first computer information identifying alternative recommended prescription medications that are preferred by the insurance network to provide to the at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary pharmacy costs to thereby modify ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary pharmacy costs; and determining by the first computer that the risk of not receiving the predetermined reimbursement amount for ancillary pharmacy costs from the insurance network has been reduced responsive to an indication of a modification of ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at a greater risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs.
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53. A computer-assisted method of managing a healthcare practice participating in an insurance network to enhance profitability of the healthcare practice with respect to a predetermined reimbursement amount for medical costs other than those attributed directly to a medical procedure performed by a physician to thereby define ancillary medical costs, the method comprising the steps of:
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providing a first computer associated with a tangible non-transitory computer readable medium and positioned to receive data indicating medical costs attributed to the plurality of physicians in the healthcare practice participating in the insurance network other than those attributed directly to medical procedures performed by a physician to thereby define ancillary medical costs; receiving by the first computer from at least one other computer, the data indicating the ancillary medical costs attributed to the plurality of physicians; processing by the first computer, the received data to include comparing the ancillary medical costs attributed to the plurality of physicians with ancillary medical costs of ancillary medical procedures preferred by the insurance network to thereby identify physicians performing ancillary medical procedures not preferred by the insurance network; responsive to the step of processing, identifying by the first computer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network as a result of engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs; responsive to the step of identifying at least one of the plurality of physicians at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network, generating by the first computer information identifying recommended alternative ancillary medical procedures that are preferred by the insurance network to provide to the at least one of the plurality of physicians at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs to thereby modify management behavior of the at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs; and determining by the first computer that the risk of not receiving the predetermined reimbursement amount for ancillary medical costs from the insurance network has been reduced to increase the profitability of the healthcare practice responsive to an indication of a modification of ancillary medical costs management behavior of the at least one of the plurality of physicians at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs.
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54. A computer-assisted method of enhancing profitability of an insurance network having a plurality of physicians in a healthcare practice participating therein by managing ancillary medical costs, the method comprising the steps of:
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providing a first computer associated with a tangible non-transitory computer readable medium and positioned to receive data indicating medical costs attributed to the plurality of physicians in the healthcare practice participating in the insurance network other than those attributed directly to medical procedures performed by any of the plurality of physicians to thereby define ancillary medical costs; receiving by the first computer from a second computer, the data indicating the ancillary medical costs attributed to the plurality of physicians; processing by the first computer, the received data to include comparing the ancillary medical costs attributed to the plurality of physicians with ancillary medical costs of ancillary medical procedures preferred by the insurance network to thereby identify physicians performing ancillary medical procedures not preferred by the insurance network; responsive to the step of processing, identifying by the first computer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network as a result of performing ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs; responsive to the step of identifying at least one of the plurality of physicians at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network, generating by the first computer information identifying recommended alternative ancillary medical procedures that are preferred by the insurance network to provide to the at least one of the plurality of physicians at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network, to thereby modify management behavior of the at least one of the plurality of physicians in the healthcare practice regarding ancillary medical costs that are not profitable for the insurance network; and determining by the first computer, an amount of a monetary financial incentive to be provided to the insurance network and the plurality of physicians in the healthcare practice participating in the insurance network responsive to an indication of a modification of management behavior of the at least one of the plurality of physicians in the healthcare practice regarding ancillary medical costs that are not profitable for the insurance network. - View Dependent Claims (55)
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56. A healthcare management optimization system to manage a healthcare practice including a plurality of physicians participating in an insurance network, the system comprising computer executable program code stored on a tangible computer medium, executable by a computer to perform the following operations:
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receiving data indicating pharmacy costs other than those attributed to a medical procedure performed directly by any of the plurality of physicians when the respective physician directly administers a medication to a patient to thereby define ancillary pharmacy costs attributed to the plurality of physicians; processing the received data to include comparing the ancillary pharmacy costs attributed to the plurality of physicians with costs of ancillary prescription medications preferred by the insurance network to thereby identify physicians prescribing medications not preferred by the insurance network; responsive to the operation of processing, identifying at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs from the insurance network as a result of prescribing ancillary medications that are detrimental to receiving the predetermined reimbursement amount for the ancillary pharmacy costs; responsive to the operation of identifying at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary pharmacy costs, generating information identifying alternative recommended prescription medications that are preferred by the insurance network to provide to the at least one of the plurality of physicians at the a greater risk of not receiving a predetermined reimbursement amount for the ancillary pharmacy costs to thereby modify ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary pharmacy costs; and determining that the risk of not receiving the predetermined reimbursement amount for ancillary pharmacy costs from the insurance network has been reduced responsive to an indication of a modification of ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at the greater risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs.
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57. A healthcare management optimization system to manage a healthcare practice including a plurality of physicians participating in an insurance network, the system comprising computer executable program code stored on a tangible computer medium, executable by a computer to perform the following operations:
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receiving data indicating medical costs attributed to the plurality of physicians in the healthcare practice participating in the insurance network other than those attributed directly to medical procedures performed by a physician to thereby define ancillary medical costs attributed to the plurality of physicians; processing the received data to include comparing the ancillary medical costs attributed to the plurality of physicians with ancillary medical costs of ancillary medical procedures preferred by the insurance network to thereby identify physicians performing ancillary medical procedures not preferred by the insurance network; responsive to the operation of processing, identifying at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network as a result of engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs; responsive to the operation of identifying at least one of the plurality of physicians at greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network, generating information identifying recommended alternative ancillary medical procedures that are preferred by the insurance network to provide to the at least one of the plurality of physicians at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs to thereby modify management behavior of the at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs; and determining that the risk of not receiving the predetermined reimbursement amount for ancillary medical costs from the insurance network has been reduced to increase the profitability of the healthcare practice responsive to an indication of a modification of ancillary medical costs management behavior of the at least one of the plurality of physicians at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs.
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58. A healthcare management optimization system to manage a healthcare practice including a plurality of physicians participating in an insurance network, the system comprising computer executable program code stored on a tangible computer medium, executable by a computer to perform the following operations:
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receiving data indicating medical costs attributed to the plurality of physicians in the healthcare practice participating in the insurance network other than those attributed directly to medical procedures performed by a physician to thereby define ancillary medical costs attributed to the plurality of physicians; processing the received data to include comparing the ancillary medical costs attributed to the plurality of physicians with ancillary medical costs of ancillary medical procedures preferred by the insurance network to thereby identify physicians performing ancillary medical procedures not preferred by the insurance network; responsive to the operation of processing, identifying at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network as a result of performing ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs; responsive to the operation of identifying at least one of the plurality of physicians at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network, generating information identifying recommended alternative ancillary medical procedures that are preferred by the insurance network to provide to the at least one of the plurality of physicians at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network, to thereby modify management behavior of the at least one of the plurality of physicians in the healthcare practice regarding ancillary medical costs that are not profitable for the insurance network; and determining an amount of a monetary financial incentive to be provided to the insurance network and the plurality of physicians in the healthcare practice participating in the insurance network responsive to an indication of a modification of management behavior of the at least one of the plurality of physicians in the healthcare practice regarding ancillary medical costs that are not profitable for the insurance network.
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59. A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network, the system comprising:
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a first database comprising medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures that are preferred by the insurance network; a second database comprising medical costs other than those attributed directly to medical procedures performed by any of the plurality of physicians to thereby define ancillary medical costs of each of the plurality of physicians participating in the insurance network; and computer executable program code stored on a tangible computer medium and executable by a computer to manage the healthcare practice participating in the insurance network, the computer executable program code comprising; an analyzer in communication with the first and the second databases for analyzing the data in the first and the second database and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify ancillary medical costs of the physicians that are not preferred by the insurance network; and managing program code responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing program code executable by the computer to perform the following operations; responsive to the analysis of the data in the first and the second databases, identifying at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, responsive to the identification of at least one of the plurality of physicians in the healthcare practice at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network, generating information identifying recommended alternative ancillary medical procedures that are preferred by the insurance network to provide to the at least one of the plurality of physicians at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network, to thereby modify ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs, and determining that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced responsive to an indication of a modification of ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs.
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60. A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network, the system comprising:
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a first database comprising medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures that are preferred by the insurance network; a second database comprising medical costs other than those attributed directly to medical procedures performed by any of the plurality of physicians to thereby define ancillary medical costs of each of the plurality of physicians participating in the insurance network; and computer executable program code stored on a tangible computer medium and executable by a computer to manage the healthcare practice participating in the insurance network, the computer executable program code comprising; an analyzer in communication with the first and the second databases for analyzing the data in the first and the second database and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify ancillary medical costs of the physicians that are not preferred by the insurance network; and managing program code responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing program code including; an identifier for identifying responsive to the analyzer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, a modifier responsive to the identifier for modifying ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary medical costs, and program code for determining responsive to the modifier that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced.
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61. A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network, the system comprising:
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a server having at least one database, the at least one database comprising a first and a second database, the first database including the ancillary medical procedures that are more preferred by the insurance network, the second database including ancillary medical costs of each of the plurality of physicians participating in the insurance network; a communications network positioned to be in communication with the server; a plurality of computers positioned to be in communication with the communications network, each including a user interface responsive to a user; and computer executable program code stored on a tangible computer medium positioned on the server and executable by the server to manage the healthcare practice participating in the insurance network, the computer executable program code comprising; an updater to update through to the user interface each of the plurality of physicians in the healthcare practice of any changes in the management of medical costs other than those attributed directly to a medical procedure performed directly by any of the plurality of physicians to thereby define ancillary medical costs and that are preferred by the insurance network, recommending program code for recommending to each of the plurality of physicians through the user interface, alternative medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures and that are preferred by the insurance network, an analyzer in communication with the first and the second databases for analyzing the data in the first and the second databases and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify the ancillary medical costs of the physicians that are not preferred by the insurance network, and managing program code responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing program code executable by the server to perform the following operations; responsive to the analysis of the data in the first and the second databases, identifying at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, responsive to identification of at least one of the plurality of physicians in the healthcare practice that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network, generating information identifying recommended alternative ancillary medical procedures that are preferred by the insurance network to provide to the at least one of the plurality of physicians at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs to thereby modify ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs, and determining that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced responsive to an indication of a modification of ancillary pharmacy costs management behavior of the at least one of the plurality of physicians at the greater risk of not receiving the predetermined reimbursement amount for the ancillary pharmacy costs.
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62. A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network, the system comprising:
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a server having at least one database, the at least one database comprising a first and a second database, the first database including the ancillary medical procedures that are more preferred by the insurance network, the second database including ancillary medical costs of each of the plurality of physicians participating in the insurance network; a communications network positioned to be in communication with the server; a plurality of computers positioned to be in communication with the communications network, each including a user interface responsive to a user; and computer executable program code stored on a tangible computer medium positioned on the server and executable by the server to manage the healthcare practice participating in the insurance network, the computer executable program code comprising; an updater to update through to the user interface each of the plurality of physicians in the healthcare practice of any changes in the management of medical costs other than those attributed directly to a medical procedure performed directly by any of the plurality of physicians to thereby define ancillary medical costs and that are preferred by the insurance network, recommending program code for recommending to each of the plurality of physicians through the user interface, alternative medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures and that are preferred by the insurance network, an analyzer in communication with the first and the second databases for analyzing the data in the first and the second databases and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify the ancillary medical costs of the physicians that are not preferred by the insurance network, and managing program code responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing program code including; an identifier for identifying responsive to the analyzer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, a modifier responsive to the identifier for modifying ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary medical costs, and program code for determining responsive to the modifier that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced.
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Specification