Methods for collecting fees for healthcare management group

• US RE43,550 E1
• Filed: 07/15/2010
• Issued: 07/24/2012
• Est. Priority Date: 03/19/2001
• Status: Active Grant

• Current Assignee: Jasos Intellectual Property LLC
• Original Assignee: Jasos Intellectual Property LLC
• Inventors: Moore, Terrance, Lewis, Charles
• Primary Examiner(s): Gart, Matthew S.
• Assistant Examiner(s): Goyea, Olusegun
• Application Number:
  US12/837,290
• Time in Patent Office: 740 Days
• Field of Search: 705 2- 4, 705/11, 705/35, 705/53, 705/40, 707/100, 707/769, 707/776
• US Class Current: 705/2
• CPC Class Codes: G06F 19/328 Health insurance management, e.g. payments or protection against fraud
• CPC Class Codes: G06Q 10/04 Forecasting or optimisation specially adapted for administrative or management purposes, e.g. linear programming or "cutting stock problem" market predictions or forecasting for commercial activities G06Q30/0202
• CPC Class Codes: G06Q 10/0637 Strategic management or analysis, e.g. setting a goal or target of an organisation; Planning actions based on goals; Analysis or evaluation of effectiveness of goals
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/10 specially adapted for electronic funds transfer [EFT] systems; specially adapted for home banking systems
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G06Q 50/22 Social work or social welfare, e.g. community support activities or counselling services
• CPC Class Codes: G06Q 50/24 Patient record management
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Methods are provided for collecting fees for managing and optimizing the profitability of a plurality of physicians in a healthcare practice participating in an insurance network. The methods include establishing a relationship between a healthcare consultation group and the healthcare practice participating in the insurance network to increase the physician'"'"'s profitability by reducing a risk of not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network. The methods also include distributing predetermined percentages of savings attributed to the physicians'"'"' modified ancillary medical cost management behavior.

Claims

1. A method of collecting fees for managing and optimizing the profitability of a plurality of physicians in a healthcare practice participating in an insurance network, the method comprising the steps of:

establishing a relationship between a healthcare consultation group and the a healthcare practice participating in the an insurance network to increase the profitability of a plurality of physicians'"'"' profitability physicians in the healthcare practice by reducing a risk of the healthcare practice not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network;

funding an incentive pool;

gathering, by a computer, data in a tangible computer medium from on each of the plurality of physicians in the healthcare practice participating in the insurance network including ancillary medical costs respective to the physicians;

modifying behavior of at least one of the plurality of physicians in the healthcare practice for management of the ancillary medical costs responsive to the gathered data gathered in the tangible computer medium;

determining, by the computer, whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached a predetermined level within over a preselected period of time;

paying funds from the funded incentive pool to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have not decreased to the preselected level over the preselected period of time; and

distributing predetermined percentages of savings attributed to the modifying modified ancillary medical cost management behavior of the plurality of physicians ancillary medical cost management if when the ancillary medical costs of the plurality of physicians in the healthcare practice have decreased to the preselected level over the preselected period of time.

2. The method as defined in claim 1, wherein the step of distributing the predetermined percentages of the savings includes dividing the savings into selected percentages between at least two of the healthcare consultation group, the healthcare practice, and the insurance network, and distributing the savings to the at least two of the healthcare consultation group, the healthcare practice, and the insurance network, based on the selected percentages.

3. The method as defined in claim 2, further comprising the step of collecting no fee by the healthcare consultation group if the healthcare practice does not reduce the ancillary medical costs to the preselected level over the predetermined period of time.

4. The method as defined in claim 3, wherein each of the respective predetermined percentages of savings distributed to the healthcare consultation group and the healthcare practice are greater than the predetermined percentage of the savings distributed to the insurance network, and wherein the step of funding the incentive pool includes the healthcare consultation group funding the incentive pool.

5. The method as defined in claim 4, further comprising the step of providing a billing fee structure from the healthcare consultation group wherein the savings are calculated by subtracting current ancillary medical costs from predetermined baseline ancillary medical costs.

6. The method as defined in claim 5, further comprising the step of calculating the billing fee structure for the healthcare consultation group by multiplying a predetermined percentage of the savings by the number of patients participating in the healthcare practice.

7. The method as defined in claim 1, wherein the ancillary medical costs include any costs taken from the group of pharmacy, radiology, laboratory, anesthesiology, occupational therapy, physical therapy, speech therapy, therapeutic radiology, operating room, or emergency room costs.

8. A method of collecting fees for managing a plurality of physicians in a healthcare practice participating in an insurance network, the method comprising the steps of:

establishing a relationship between a healthcare consultation group and the a healthcare practice participating in the an insurance network to reduce a risk of the healthcare practice not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network;

funding an incentive pool;

establishing a plan to pay funds from the funded incentive pool to the healthcare practice participating in the insurance network, wherein the payment of funds occurs in the plan when the ancillary medical costs of the a plurality of physicians in the healthcare practice do not decrease to a preselected level over a preselected period of time;

gathering, by a computer, data in a tangible computer medium from on each of the plurality of physicians in the healthcare practice participating in the insurance network including ancillary medical costs respective to the physicians;

modifying behavior of at least one of the plurality of physicians in the healthcare practice for management of the ancillary medical costs responsive to the gathered data gathered in the tangible computer medium;

determining, by the computer, whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the preselected level within the preselected period of time; and

distributing predetermined percentages of savings attributed to the modifying modified ancillary medical cost management behavior of the plurality of physicians if the ancillary medical costs have decreased to the preselected level over the preselected period of time.

9. The method as defined in claim 8, wherein the step of funding the incentive pool includes the healthcare consultation group funding the incentive pool, wherein the modifying behavior of the plurality of physicians is responsive to recommendations of the healthcare consultation group, and the method further comprising the step of paying funds from the funded incentive pool only if the ancillary medical costs of the plurality of physicians in the healthcare practice do not decrease to the preselected level over the preselected period of time responsive to the modifying behavior.

10. The method as defined in claim 9, wherein the step of distributing the predetermined percentages of the savings includes dividing the savings into selected percentages between at least two of the healthcare consultation group, the healthcare practice, and the insurance network, and distributing the savings to the at least two of the healthcare consultation group, the healthcare practice, and the insurance network, based on the selected percentages.

11. The method as defined in claim 10, further comprising the steps of collecting no fee by the healthcare consultation group if the healthcare practice does not reduce the ancillary medical costs to the preselected level over the predetermined period of time and providing a billing fee structure from the healthcare consultation group wherein the savings are calculated by subtracting current ancillary medical costs from predetermined baseline ancillary medical costs.

12. The method as defined in claim 11, wherein each of the respective predetermined percentages of savings distributed to the healthcare consultation group and the healthcare practice are greater than the predetermined percentage of the savings distributed to the insurance network, and wherein the ancillary medical costs include any costs taken from the group of pharmacy, radiology, laboratory, anesthesiology, occupational therapy, physical therapy, speech therapy, therapeutic radiology, operating room, or emergency room costs.

13. A method of collecting fees for managing and optimizing the profitability of an insurance network having a plurality of physicians in a healthcare practice participating therein, the method comprising the steps of:

establishing a relationship between a healthcare management consultation group and the a healthcare practice participating in the an insurance network to increase the insurance network'"'"'s profitability by limiting the plurality of physicians'"'"' modifying ancillary medical cost management behavior of a plurality of physicians in the healthcare practice that is not preferred by the insurance network;

gathering, by a computer, data in a tangible computer medium from on each of the plurality of physicians in the healthcare practice participating in the insurance network regarding management of ancillary medical costs respective to the physicians;

modifying behavior of at least one of the plurality of physicians in the healthcare practice for management of the ancillary medical costs responsive to the gathered data gathered in the tangible computer medium;

determining, by the computer, whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached a preselected level within over a preselected period of time;

funding an incentive pool to be paid to the insurance network when the modified medical management practices do not decrease ancillary medical costs of the insurance network related to the ancillary medical costs of the plurality of physicians in the healthcare practice participating in the insurance network to the preselected level over the preselected period of time; and

distributing predetermined percentages of savings attributed to the modifying modified ancillary medical cost management behavior of the plurality of physicians ancillary medical cost management to at least one of to one or more of the following;

the insurance network and the healthcare management consultation group, when the ancillary medical costs have decreased to the preselected level over the preselected period of time.

14. The method as defined in claim 13, wherein the step of distributing the predetermined percentages of the savings includes dividing the savings into selected percentages between at least two of the healthcare consultation group, the healthcare practice, and the insurance network, and distributing the savings to the at least two of the healthcare consultation group, the healthcare practice, and the insurance network, based on the selected percentages.

15. The method as defined in claim 14, further comprising the steps of collecting no fee by the healthcare consultation group if the modified medical management practices do not reduce the ancillary medical costs of the insurance network to the preselected level over the predetermined period of time.

16. The method as defined in claim 14, wherein each of the respective predetermined percentages of savings distributed to the healthcare consultation group and the insurance network are greater than the predetermined percentage of the savings distributed to the healthcare practice.

17. The method as defined in claim 16, further comprising the step of providing a billing fee structure from the healthcare consultation group wherein the savings are calculated by subtracting current ancillary medical costs from predetermined ancillary medical costs.

18. The method as defined in claim 17, further comprising the step of calculating the billing fee structure for the healthcare consultation group by multiplying a predetermined percentage of the savings by the number of patients participating in the healthcare practice.

19. The method as defined in claim 13, wherein the ancillary medical costs include any costs taken from the group of pharmacy, radiology, laboratory, anesthesiology, occupational therapy, physical therapy, speech therapy, therapeutic radiology, operating room, or emergency room costs.

20. A computer-assisted method of collecting fees for managing and enhancing profitability of a plurality of physicians in a healthcare practice participating in an insurance network, the method comprising the steps of:

providing a first computer associated with a tangible non-transitory computer readable medium and positioned to receive data indicating management of ancillary medical costs by a plurality of physicians in a healthcare practice participating in an insurance network;

establishing an electronic communications network between a healthcare management consultation group and the healthcare practice participating in the insurance network;

receiving data by the first computer from at least one other computer associated with the plurality of physicians in the healthcare practice participating in the insurance network, the received data including ancillary medical costs attributed to the plurality of physicians;

identifying by the first computer one or more the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level to thereby identify one or more of the plurality of physicians in the healthcare practice for behavior modification with respect to ancillary medical costs to increase profitability of the plurality of physicians by reducing a risk of the healthcare practice not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network;

generating information by the first computer identifying recommended alternative ancillary medical procedures to modify the behavior of the plurality of physicians in the healthcare practice with respect to management of the ancillary medical costs;

determining by the first computer whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached a predetermined level over a preselected period of time;

funding an incentive pool by the healthcare consultation group to provide for paying funds to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have not decreased to the predetermined level over the preselected period of time;

performing the step of paying funds from the funded incentive pool to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have not decreased to the predetermined level over the preselected period of time;

calculating a predetermined percentage of savings attributed to modified ancillary medical cost management behavior of the plurality of physicians with respect to ancillary medical costs; and

distributing the predetermined percentage of savings to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have decreased to the predetermined level over the preselected period of time.

21. A computer-assisted method of collecting fees for managing a plurality of physicians in a healthcare practice participating in an insurance network, the method comprising the steps of:

providing a first computer associated with a tangible non-transitory computer readable medium and positioned to receive data indicating management of ancillary medical costs of a plurality of physicians in a healthcare practice participating in an insurance network;

establishing an electronic communications network between a healthcare management consultation group and the healthcare practice participating in the insurance network to thereby facilitate communications between the healthcare management consultation group and the healthcare practice;

funding an incentive pool to provide for payment of funds under certain conditions;

establishing a plan to pay funds from the funded incentive pool to the healthcare practice participating in the insurance network, whereby the payment of funds occurs in the plan when the ancillary medical costs of the plurality of physicians in the healthcare practice do not decrease to a preselected level over a preselected period of time;

receiving data by the first computer for each of the plurality of physicians in the healthcare practice participating in the insurance network, the received data including ancillary medical costs attributed to the respective physicians;

identifying by the first computer one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level to thereby identify one or more of the plurality of physicians in the healthcare practice for behavior modification with respect to management of ancillary medical costs;

generating information identifying recommended alternative ancillary medical procedures by the first computer to modify behavior of the plurality of physicians in the healthcare practice with respect to management of the ancillary medical costs to thereby reduce a risk of the healthcare practice not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network;

determining by the first computer whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the preselected level over the preselected period of time;

calculating a predetermined percentage of savings attributed to modified ancillary medical cost management behavior of the plurality of physicians; and

distributing the predetermined percentage of savings when the ancillary medical costs have decreased to the preselected level over the preselected period of time.

22. A computer-assisted method of collecting fees for managing and enhancing profitability of an insurance network including a plurality of physicians in a healthcare practice participating in the insurance network, the method comprising the steps of:

providing a first computer associated with a tangible non-transitory computer readable medium and positioned to receive data indicating management of ancillary medical costs of a plurality of physicians in a healthcare practice participating in an insurance network;

establishing an electronic communications network between a healthcare management consultation group and the healthcare practice participating in the insurance network;

responsive to establishment of the electronic communications network between a healthcare management consultation group and the healthcare practice, receiving data by the first computer from at least one other computer associated with the plurality of physicians, the received data indicating ancillary medical costs attributed to each of the plurality of physicians in the healthcare practice participating in the insurance network;

responsive to the received data, identifying by the first computer one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level to thereby identify one or more of the plurality of physicians in the healthcare practice for behavior modification;

responsive to identifying one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level, generating information identifying alternative recommended ancillary medical practices by the first computer to modify the behavior of the plurality of physicians in the healthcare practice with respect to management of the ancillary medical costs that is not preferred by the insurance network to thereby reduce ancillary medical costs attributed to the plurality of physicians to increase the insurance network'"'"'s profitability;

determining by the first computer whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached a preselected level over a preselected period of time;

funding an incentive pool by the healthcare consultation group to provide for paying funds to the insurance network when the modified ancillary medical costs management behavior does not decrease ancillary medical costs of the insurance network to the preselected level over the preselected period of time;

responsive to the first computer determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the predetermined level over the preselected period of time, performing the step of paying funds from the funded incentive pool to the insurance network when the modified ancillary medical costs management behavior does not decrease ancillary medical costs of the insurance network to the preselected level over the preselected period of time;

responsive to the first computer determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the predetermined level over the preselected period of time, calculating a predetermined percentage of savings attributed to modified ancillary medical costs management behavior of the plurality of physicians; and

distributing the predetermined percentage of savings to one or more of the following;

the insurance network and the healthcare management consultation group, when the ancillary medical costs have decreased to the preselected level over the preselected period of time.

23. A computer-assisted method of collecting fees for managing and enhancing profitability of a plurality of physicians in a healthcare practice participating in an insurance network, the method comprising the steps of:

providing a first computer associated with a tangible non-transitory computer readable medium and positioned to receive data indicating management of ancillary medical costs by a plurality of physicians in a healthcare practice participating in an insurance network;

establishing an electronic communications network between a healthcare management consultation group and the healthcare practice participating in the insurance network;

responsive to establishment of the electronic communications network between the healthcare management consultation group and the healthcare practice, receiving data by the first computer from at least one other computer associated with the plurality of physicians in the healthcare practice participating in the insurance network, the received data including ancillary medical costs attributed to the plurality of physicians,

responsive to the received data, identifying by the first computer one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level to thereby identify one or more of the plurality of physicians in the healthcare practice for behavior modification with respect to ancillary medical costs to increase profitability of the plurality of physicians by reducing a risk of the healthcare practice not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network;

responsive to identifying one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level, generating information by the first computer identifying recommended alternative ancillary medical procedures to modify the behavior of the plurality of physicians in the healthcare practice with respect to management of the ancillary medical costs;

determining by the first computer whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached a predetermined level over a preselected period of time;

responsive to a result of the determination of whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the predetermined level over the preselected period of time, performing the step of paying funds from a funded incentive pool to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have not decreased to the predetermined level over the preselected period of time; and

responsive to the result of the determination of whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the predetermined level over the preselected period of time, calculating a predetermined percentage of savings attributed to modified ancillary medical cost management behavior of the plurality of physicians with respect to ancillary medical costs; and

distributing the predetermined percentage of savings to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have decreased to the predetermined level over the preselected period of time.

24. A healthcare management system for collecting fees for managing and enhancing profitability of a plurality of physicians in a healthcare practice participating in an insurance network, the system comprising:

a computer to facilitate management of a healthcare practice participating in an insurance network, the computer having a tangible storage medium for storing computer executable program code; and

computer executable program code to facilitate modifying ancillary medical cost management behavior of a plurality of physicians in the healthcare practice and to facilitate paying a percentage of savings attributed to modified ancillary medical cost management behavior of the plurality of physicians, the computer executable program code stored in the storage medium of the computer and executable by the computer to perform the following operations;

establishing communications between the healthcare management consultation group and the healthcare practice participating in the insurance network,

responsive to establishment of communications between the healthcare management consultation group and the healthcare practice participating in the insurance network, receiving data from at least one other computer associated with the plurality of physicians in the healthcare practice participating in the insurance network, the received data including data indicating ancillary medical costs attributed to the plurality of physicians,

responsive to the received data, identifying one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level to thereby identify one or more of the plurality of physicians in the healthcare practice for behavior modification with respect to ancillary medical costs to increase profitability of the plurality of physicians by reducing a risk of the healthcare practice not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network,

responsive to identifying one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level, generating information identifying recommended alternative ancillary medical procedures to modify the behavior of the plurality of physicians in the healthcare practice with respect to management of the ancillary medical costs,

determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached a predetermined level over a preselected period of time,

responsive to determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the predetermined level over the preselected period of time, calculating for distribution to the healthcare practice, a predetermined percentage of savings attributed to the modified ancillary medical cost management behavior of the plurality of physicians, and

distributing the predetermined percentage of savings attributed to the modified ancillary medical cost management behavior of the plurality of physicians when the ancillary medical costs of the plurality of physicians in the healthcare practice have decreased to the predetermined level over the preselected period of time; and

a funded incentive pool funded by the healthcare consultation group and configured to provide for paying funds to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have not decreased to the predetermined level over the preselected period of time.

25. A healthcare management system for collecting fees for managing and enhancing profitability of a plurality of physicians in a healthcare practice participating in an insurance network, the system comprising:

a computer to facilitate management of a healthcare practice participating in an insurance network, the computer having a tangible storage medium for storing computer executable program code; and

computer executable program code to facilitate modifying ancillary medical cost management behavior of a plurality of physicians in the healthcare practice and to facilitate paying a percentage of savings attributed to modified ancillary medical cost management behavior of the plurality of physicians, the computer executable program code stored in the storage medium of the computer and executable by the computer to perform the following operations;

establishing communications between a healthcare management consultation group and the healthcare practice participating in the insurance network to thereby facilitate a relationship between the healthcare management consultation group and the healthcare practice,

responsive to establishment of communications between the healthcare management consultation group and the healthcare practice participating in the insurance network, receiving data for each of the plurality of physicians in the healthcare practice participating in the insurance network, the received data including data indicating ancillary medical costs attributed to the plurality of physicians,

responsive to the received data, identifying by the first computer one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level to thereby identify one or more of the plurality of physicians in the healthcare practice for behavior modification with respect to management of ancillary medical costs,

responsive to identifying one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level, generating information identifying recommended alternative ancillary medical procedures to modify behavior of the plurality of physicians in the healthcare practice with respect to management of the ancillary medical costs to thereby reduce a risk of the healthcare practice not receiving a predetermined reimbursement amount for ancillary medical costs from the insurance network,

determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the preselected level over the preselected period of time,

responsive to determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the predetermined level over the preselected period of time, calculating for distribution a predetermined percentage of savings attributed to modified ancillary medical cost management behavior of the plurality of physicians, and

distributing the predetermined percentage of savings attributed to the modified ancillary medical cost management behavior of the plurality of physicians when the ancillary medical costs have decreased to the preselected level over the preselected period of time; and

a funded incentive pool funded by the healthcare consultation group and configured to provide for paying funds to the healthcare practice participating in the insurance network when the ancillary medical costs of the plurality of physicians in the healthcare practice have not decreased to the predetermined level over the preselected period of time.

26. A healthcare management system for collecting fees for managing and enhancing profitability of a plurality of physicians in a healthcare practice participating in an insurance network, the system comprising:

a computer to facilitate management of a healthcare practice participating in an insurance network, the computer having a tangible storage medium for storing computer executable program code; and

computer executable program code to facilitate modifying ancillary medical cost management behavior of a plurality of physicians in the healthcare practice and to facilitate paying a percentage of savings attributed to modified ancillary medical cost management behavior of the plurality of physicians, the computer executable program code stored in the storage medium of the computer and executable by the computer to perform the following operations;

establishing communications between the healthcare management consultation group and the healthcare practice participating in the insurance network,

responsive to establishment of communications between the healthcare management consultation group and the healthcare practice participating in the insurance network, receiving data from at least one other computer associated with the plurality of physicians, the received data indicating the ancillary medical costs attributed to each of the plurality of physicians in the healthcare practice participating in the insurance network,

responsive to the received data, identifying by the first computer one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level to thereby identify one or more of the plurality of physicians in the healthcare practice for behavior modification,

responsive to identifying one or more of the plurality of physicians in the healthcare practice participating in the insurance network having ancillary medical costs that exceed a certain level, generating information identifying alternative recommended ancillary medical practices to modify the behavior of the plurality of physicians in the healthcare practice with respect to management of the ancillary medical costs that is not preferred by the insurance network to thereby reduce ancillary medical costs attributed to the plurality of physicians to increase the insurance network'"'"'s profitability,

determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached a preselected level over a preselected period of time,

responsive to determining whether the ancillary medical costs of the plurality of physicians in the healthcare practice have reached the predetermined level within the preselected period of time, calculating for distribution to one or more of the following;

the insurance network and the healthcare management consultation group, a predetermined percentage of savings attributed to modified ancillary medical costs management behavior of the plurality of physicians, and

distributing the predetermined percentage of savings attributed to the modified ancillary medical cost management behavior of the plurality of physicians when the ancillary medical costs have decreased to the preselected level over the preselected period of time; and

a funded incentive pool funded by the healthcare consultation group and configured to provide for paying funds to the insurance network when the modified ancillary medical costs management behavior does not decrease ancillary medical costs of the insurance network to the preselected level over the preselected period of time.