All care health management system
DC CAFCFirst Claim
Patent Images
1. A comprehensive health care management system comprising:
- (a) input means for entering data identifying each of a predetermined plurality of persons;
(b) a data bank memory interconnected with said input means, said data bank memory including an identification of predetermined procedures requiring utilization review;
(c) payment means; and
(d) means in communication with said input means responsive to input of data through said input means symbolic of symptoms of one of said predetermined plurality of persons for tentatively identifying a proposed mode of treatment for said one of said predetermined plurality of persons and, when said proposed mode of treatment includes one of said predetermined procedures requiring utilization review, for producing indicia indicative thereof and for preventing payment therefor by said payment means until said utilization review has been obtained and data indicative thereof has been entered in said system.
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Abstract
A fully integrated and comprehensive health care system that includes the integrated interconnection and interaction of the patient, health care provider, bank or other financial institution, insurance company, utilization reviewer and employer so as to include within a single system each of the essential participants to provide patients with complete and comprehensive pre-treatment, treatment and post-treatment health care and predetermined financial support therefor.
1230 Citations
102 Claims
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1. A comprehensive health care management system comprising:
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(a) input means for entering data identifying each of a predetermined plurality of persons; (b) a data bank memory interconnected with said input means, said data bank memory including an identification of predetermined procedures requiring utilization review; (c) payment means; and (d) means in communication with said input means responsive to input of data through said input means symbolic of symptoms of one of said predetermined plurality of persons for tentatively identifying a proposed mode of treatment for said one of said predetermined plurality of persons and, when said proposed mode of treatment includes one of said predetermined procedures requiring utilization review, for producing indicia indicative thereof and for preventing payment therefor by said payment means until said utilization review has been obtained and data indicative thereof has been entered in said system. - View Dependent Claims (2, 3, 13, 14, 15)
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4. A comprehensive health care management system comprising:
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(a) input means for entering data identifying each of a predetermined plurality of persons and for entering data symbolic of patient symptoms; (b) a first data bank memory interconnected with said input means, said first data bank memory containing predetermined items of medical history for said predetermined plurality of persons; (c) another data bank memory interconnected with said first data bank memory, said another data bank memory including an identification of predetermined procedures requiring utilization review; (d) payment means; and (e) means interconnected with said payment means responsive to input to said system of said data symbolic of patient symptoms for tentatively identifying a proposed mode of treatment and, when said proposed mode of treatment includes one of said predetermined procedures requiring utilization review, for producing indicia indicative thereof and for preventing payment therefor by said payment means until said utilization review has been obtained and data indicative thereof has been entered in said system. - View Dependent Claims (5, 6, 7, 8, 9, 10, 11, 12)
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16. A comprehensive health care management system comprising:
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(a) input means for entering data identifying each of a predetermined plurality of persons; (b) a data bank memory interconnected with said input means, said data bank memory including an identification of predetermined procedures requiring second options; (c) payment means; and (d) means in communication with said input means responsive to input of data through said input means symbolic of symptoms of one of said predetermined plurality of persons for tentatively identifying a proposed mode of treatment for said one of said predetermined plurality of persons and, when said proposed mode of treatment includes one of said predetermined procedures requiring a second opinion, for producing indicia indicative thereof and for preventing payment therefor by said payment means until a second opinion has been obtained. - View Dependent Claims (17, 18, 28, 29, 30)
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19. A comprehensive health care management system comprising:
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(a) input means for entering data identifying each of a predetermined plurality of persons and for entering data symbolic of patient symptoms; (b) a first data bank memory interconnected with said input means, said data bank memory containing predetermined items of medical history for said predetermined plurality of persons; (c) another data bank memory interconnecting with said first data bank memory, said another data bank memory including an identification of predetermined procedures requiring second opinions; (d) payment means; and (e) means interconnected with said payment means responsive to the input to said system of said data symbolic of patient symptoms for tentatively identifying a proposed mode of treatment and, when said proposed mode of treatment includes one of said predetermined procedures requiring a second opinion, for producing indicia indicative thereof and for preventing payment therefor by said payment means until a second opinion has been obtained. - View Dependent Claims (20, 21, 22, 23, 24, 25, 26, 27)
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31. A comprehensive health care management system comprising:
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(a) a data input terminal for entering data identifying each of a predetermined plurality of persons being on a payroll of an organization; (b) a data bank memory containing predetermined items of medical history for said predetermined plurality of persons; (c) payroll deduction means for providing payment for said predetermined plurality of persons; (d) another data bank memory including an identification of predetermined medical procedures and pre-approved levels of payments for said predetermined medical procedures; and (e) means responsive to input of data indicative of performance of one of said predetermined medical procedures for one of said predetermined plurality of persons for examining a level of charge made by a provider of medical services for the performed procedure and, if said level of charge exceeds the pre-approved level of payment for said procedure, for causing said payroll deduction means to pay the exceeded amount by payroll deduction.
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32. A comprehensive health care management system comprising:
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(a) a first data input terminal at the location of a medical services provider for entering data identifying each of a predetermined plurality of persons being on a payroll of an organization; (b) a second data terminal at the location of said organization; (c) a first data bank memory containing predetermined items of medical history for said predetermined plurality of persons; (d) another data bank memory including an identification of predetermined medical procedures and pre-approved levels of payments for said predetermined medical procedures; and (e) means responsive to input of data indicative of performance of one of said predetermined medical procedures for one of said predetermined plurality of persons and for examining a level of charge made by a provider of medical services for the performed procedure and, if said level of charge exceeds the pre-approved level of payment, for producing at the location of said second data terminal indicia indicative thereof and for permitting authorization for the excess to be made by said organization.
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33. A comprehensive health care management system comprising:
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(a) a data input terminal for entering data identifying each of a predetermined plurality of persons being subject to workmen'"'"'s compensation; (b) a data bank memory including an identification of predetermined medical procedures and pre-approved levels of workmen'"'"'s compensation payments for said predetermined medical procedures; and (c) means responsive to the input of data to said system indicative of the desirability of performance of one of said predetermined medical procedures for one of said predetermined plurality of persons for examining a level of charge made by a provider of medical services for the performed procedure and, if said level of charge exceeds the pre-approved
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34. A comprehensive health care management system comprising:
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(a) input means for entering data identifying each of a predetermined plurality of persons and for entering data symbolic of patient symptoms; (b) a first data bank memory interconnected with said input means, said first data bank memory containing predetermined items of medical history for each of said predetermined plurality of persons; (c) another data bank memory interconnected with said first data bank memory, said another data bank memory including an identification of predetermined procedures requiring ancillary services; and (d) means interconnected with said another data bank memory and responsive to the input to said system of said data symbolic of patient symptoms for tentatively identifying a proposed mode of treatment and, when said proposed mode of treatment includes one of said ancillary services, for producing indicia indicative thereof and for providing said one of said ancillary services. - View Dependent Claims (35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46)
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47. An integrated health care management system comprising:
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(a) a data input terminal for entering data identifying each of a predetermined plurality of persons; (b) a data bank memory containing predetermined items of medical history including physical profile data for said predetermined plurality of persons; (c) health regimen recommendation means responsive to said physical profile data for said predetermined plurality of persons for generating individualized preventive health regimen recommendations for said predetermined plurality of persons including diet and exercise; (d) symptom recording means including said data bank memory for recording symptoms associated with each of a predetermined plurality of health problems; (e) recommend treatment means including said data bank memory for recording recommended treatment for each of said predetermined plurality of health problems; (f) utilization review means including said data bank memory for selecting and recording identification of treatments selected for utilization review; (g) symptom input means for inputting descriptions of patients'"'"' symptoms into said system; (h) means responsive to input of said patients'"'"' symptoms for displaying recommended treatments, for identifying recommended treatments which are selected for utilization review and for displaying indicia identifying said recommended treatments which are selected for utilization review, said means responsive to input of said patients'"'"' symptoms being further effective to identify recommended treatments for which ancillary services are indicated; (i) means responsive to identification of said recommended treatments for identifying payor-approved charges for said treatments; (j) means for comparing said payor-approved charges for said treatments with corresponding actual charges assessed by a proposed health care provider and for identifying any insufficiency of payor-approved charges compared to said actual charges; (k) means for supplying said insufficiency by payroll deduction for patients that are paid on organization payrolls; (l) means including said utilization review means for providing medical care quality control; (m) means for providing both in-patient and out-patient care; and (n) means including said data bank memory for preparing recommended post-treatment routines. - View Dependent Claims (48, 49, 50, 51)
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52. A method of managing a comprehensive health care management system utilizing a data processor, data bank memories, input means and payment means comprising:
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(a) entering into said data processor data identifying each of a predetermined plurality of persons; (b) entering into one of said data bank memories an identification of predetermined procedures requiring utilization review; (c) entering through said input means into said data processor data symbolic of patient symptoms for tentatively identifying a proposed mode of treatment and, when said proposed mode of treatment includes one of said predetermined procedures requiring utilization review, producing indicia indicative thereof; and (d) preventing payment therefor by said payment means until said utilization review has been obtained and data indicative thereof has been entered in said system. - View Dependent Claims (53, 54)
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55. A method of managing a health care management system utilizing a data processor, data bank memories, input means and payment means comprising:
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(a) entering into said input means data identifying each of a predetermined plurality of persons; (b) entering into one of said data bank memories an identification of predetermined items of medical history for said predetermined plurality of persons; (c) entering into another of said data bank memories an identification of predetermined procedures requiring utilization review; and (d) entering through said input means into said data processor data symbolic of patient symptoms for tentatively identifying a proposed mode of treatment and, when said proposed mode of treatment includes one of said predetermined procedures requiring utilization review, producing indicia indicative thereof; and (e) preventing payment therefor until said utilization review has been obtained and data indicative thereof has been entered in said system. - View Dependent Claims (56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66)
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67. A method of managing a comprehensive health care management system comprising:
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(a) providing a data input terminal for said system for entering into said system data identifying each of a predetermined plurality of persons; (b) establishing a data bank memory operatively connected to said system for including an identification of predetermined procedures requiring second options; (c) entering in said data input terminal data symbolic of patient symptoms; (d) establishing payment means; (e) accessing said data symbolic of patient symptoms for tentatively identifying a proposed mode of treatment and, (f) when said proposed mode of treatment includes one of said predetermined procedures requiring a second opinion, producing indicia indicative thereof and preventing payment therefor by said payment means until a second opinion has been obtained. - View Dependent Claims (68, 69)
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70. A method of managing a comprehensive health care management system utilizing a data processor, data bank memories, input means and payment means comprising:
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(a) providing a data input terminal for entering into said system data identifying each of a predetermined plurality of persons; (b) establishing a first system data bank memory and entering into said first data bank memory predetermined items of medical history for said predetermined plurality of persons; (c) establishing another system data bank memory and entering into said another data bank memory information including an identification of predetermined procedures requiring second opinions; (d) entering into said data processor information symbolic of patient symptoms; (e) establishing payment means; (f) accessing one of said data bank memories for tentatively identifying a proposed mode of treatment; and
,(g) when said proposed mode of treatment includes one of said predetermined procedures requiring a second opinion, for producing indicia indicative thereof and for preventing payment therefor by said payment means until a second opinion has been obtained. - View Dependent Claims (71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81)
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82. A method of managing a health care management system having a data processor comprising:
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(a) providing a data input terminal for entering data identifying each of a predetermined plurality of persons being on a payroll of an organization; (b) providing a data bank memory containing predetermined items of medical history for said predetermined plurality of persons; (c) providing another data bank memory including an identification of predetermined medical procedures and pre-approved levels of payments for said predetermined medical procedures; (d) entering into said system data indicative of performance of one of said predetermined medical procedures; and (e) examining a level of charge made by a provider of medical services for the performed procedure and, if said level of charge exceeds the pre-approved level of payment for said procedure, for causing payment of the exceeded amount by payroll deduction.
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83. A method of managing a health care management system having a data processor comprising:
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(a) providing a first data input terminal at the location of a medical services provider; (b) entering into said system through said first data input terminal data identifying each of a predetermined plurality of persons being on a payroll of an organization; (c) providing a second data terminal at the location of said organization; (d) providing a data bank memory containing predetermined items of medical history for said predetermined plurality of persons; (e) providing another data bank memory including an identification of predetermined medical procedures and pre-approved levels of payments for said predetermined medical procedures; and (f) entering into said system data indicative of performance of one of said predetermined medical procedures; (g) examining a level of charge made by a provider of medical services for the performed procedure and, if said level of charge exceeds the pre-approved level of payment for producing at the location of said second data terminal indicia indicative thereof and for permitting authorization for excess payment by said organization.
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84. A method of managing a health care management system comprising:
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(a) providing a data input terminal; (b) entering into said system through said data input terminal data identifying each of a predetermined plurality of persons being subject to workmen'"'"'s compensation; (c) providing in said system a data bank memory; (d) entering into said system an identification of predetermined medical procedures and pre-approved levels of workmen'"'"'s compensation payments for said predetermined medical procedures; and (e) examining a level of charge made by a provider of medical services for a predetermined procedure performed on one of said predetermined plurality of persons and, if said level of charge exceeds said pre-approved level of payment for said procedure, for identifying the exceeded amount and for permitting the payment of the exceeded amount by said one of said predetermined plurality of persons.
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85. A method of managing a health care management system comprising:
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(a) providing a data input terminal; (b) entering data into said system for identifying each of a predetermined plurality of persons; (c) providing a data bank memory containing predetermined items of medical history for each of said predetermined plurality of persons; (d) providing in said data bank memory an identification of predetermined procedures requiring ancillary services; and (e) tentatively identifying a proposed mode of treatment and, when said proposed mode of treatment includes one of said ancillary services, for producing indicia indicative thereof and for providing said one of said ancillary services. - View Dependent Claims (86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96)
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97. A method of managing a health care management system comprising:
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(a) providing a data input terminal for entering data identifying each of a predetermined plurality of persons; (b) providing a data bank memory containing predetermined items of medical history including physical profile data for said predetermined plurality of persons; (c) including in said data bank memory health regimen recommendation data for each of a predetermined plurality of physical profiles; (d) generating individualized preventive health regimen recommendations for each of said predetermined plurality of persons including diet and exercise; (e) recording in said data bank memory symptoms associated with each of a predetermined plurality of health problems; (f) recording in said data bank memory recommended treatment protocols for each of said predetermined plurality of health problems; (g) selecting treatments for utilization review; (h) inputting into said system data representing patients'"'"' symptoms; (i) accessing said data bank memory means responsive to input of said patients'"'"' symptoms for displaying recommended treatments, for identifying recommended treatments which are selected for utilization review, for displaying indicia identifying said treatments which are selected for utilization review, and identifying those recommended treatments for which ancillary services are indicated; (j) identifying payor-approved charges for said treatments; (k) comparing said payor-approved charges for said treatments with corresponding actual charges assessed by a proposed health care provider and identifying any insufficiency of payor-approved charges compared to said actual charges; (l) providing payroll deduction and supplying said insufficiency by payroll deduction for patients that are paid on organization payrolls; (m) providing medical care quality control; (n) providing both in-patient and out-patient care; and (o) preparing recommended post-treatment routines. - View Dependent Claims (98, 99, 100, 101)
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102. A method of managing an integrated health care management system having input means, payment means and memory storage comprising:
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(a) storing through said input means into said memory storage personal health profile data for each of a predetermined plurality of persons; (b) storing into said memory storage symptoms and treatment data for each of a predetermined plurality of health profiles and problems; (c) storing in said memory storage criteria for identifying treatments requiring utilization review; (d) storing in said memory storage criteria for identifying treatments requiring second opinions; (e) entering into said system information identifying a proposed medical treatment for one of said plurality of persons; (f) identifying whether or not said proposed medical treatment requires utilization review; and (g) preventing said system from approving payment for said proposed medical treatment if said proposed medical treatment requires utilization review until such utilization review has been conducted.
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Specification