Method of care assessment and health management

• US 7,493,264 B1
• Filed: 06/11/2002
• Issued: 02/17/2009
• Est. Priority Date: 06/11/2001
• Status: Active Grant

• Current Assignee: Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Kelly, Miriam A., Lotvin, Alan M.
• Primary Examiner(s): Gilligan; C Luke
• Assistant Examiner(s): Rines; R. David
• Application Number:
  US10/166,298
• Time in Patent Office: 2,443 Days
• Field of Search: 705/2, 705/3, 600/300, 600/549, 600/557, 600/587, 600/595, 128/903, 128/904, 128/923, 128/924, 128/925, 455/73
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/06 Resources, workflows, human or project management; Enterprise or organisation planning; Enterprise or organisation modelling
• CPC Class Codes: G06Q 10/06398 Performance of employee with respect to a job function
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: Y10S 128/903 Radio telemetry
• CPC Class Codes: Y10S 128/904 Telephone telemetry
• CPC Class Codes: Y10S 128/923 by comparison of patient data to other data
• CPC Class Codes: Y10S 128/924 using artificial intelligence
• CPC Class Codes: Y10S 128/925 Neural network

Abstract

An interactive computer assisted method compiles comprehensive health care information on patients in a central repository, assesses and analyzes this information, and identifies high utilizers of health care services using a computer and a user associated therewith. The method includes the steps of creating a central repository of various databases containing patient information, including demographic information and behavior, and optionally the results of a core survey of health status questions. The invention optionally involves the step of determining the appropriate core questions and the criteria to determine whether and when to ask certain questions of particular patients based on their response to prior questions. The invention accurately predicts risk of a medical condition or progression of a medical condition utilizing an interactive administration of a set of core survey questions combined with diagnostic data and places patients efficiently, reliably, and accurately into the appropriate treatment intervention programs. The invention eliminates redundant, repetitive surveying of patients with multiple medical conditions.

Claims

1. An interactive computer assisted method of reviewing, analyzing, and compiling patient profile information from a plurality of different sources into a centralized patient profile database, including an interactive survey designed to evaluate the health status of a health care consumer, said method comprising the steps of:

(a) developing and updating interactive questions for the interactive survey of the patient to assess the overall health status wherein the survey questions are interactively modified, priority of questions reordered based on answers to the questions, and questions are automatically determined based on previous answers;

(b) developing and updating rules for determining if the patient is likely to be a high utilization health care consumer;

(c) periodically accessing the patient profile information from the centralized patient profile database and determining if at least one core survey was completed during a predetermined time interval;

(d) utilizing the patient profile information stored in the centralized patient profile database and information received in said periodically accessing Step (c) to update core questions, and querying a predetermined number of the patient using at least one of the core survey and the updated core questions to determine if the patient is at risk;

(e) collecting and storing in a computer storage system patient related information comprising demographic information, health care program availability and eligibility criteria, current health care participation information, patient medical claims, patient drug claims, prior medical history, prior drug usage patterns including nonprescription drug usage, patient behavior factors, and demand management program information;

(f) interactively evaluating if the patient is likely to be the high utilization health care consumer responsive to said utilizing step (d) and said collecting and storing step (e), and optionally responsive to an outbound communication from a health care representative to the patient;

(g) determining whether at least one intervention program may reduce health care utilization and improve health of the patient and wherein said determining is automatically executed by a computer analyzing results from said survey and said patient profile;

(h) determining if the patient is eligible for the at least one intervention program;

(i) when said determining step (h) determines that the patient is eligible, enrolling the patient in the at least one intervention program or other health care program;

(j) generating reports on the state of the at least one intervention program responsive to said enrolling step (i), including patient drug utilization, patient evaluation, patient health, comparisons with respect to desired patient health, patient satisfaction, and other information; and

(k) periodically updating patient profiles, and periodically modifying the rules for determining the risk behaviors for the high utilization health care consumer.

2. An interactive computer assisted method according to claim 1, further comprising the step of (l) conducting the patient survey and assessing whether the patient is a high utilizer of health care services through a direct telephone survey to the patient by a physician, nurse, survey taker or other health care personnel, said conducting step (l) further comprising the steps of:

(1) determining from a review of the centralized patient profile database which of the patients to call as part of the survey;

(2) calling the patient and administering the core survey questions;

(3) interactively evaluating based on the response to the questions, if the patient is the potential high utilization health care consumer;

(4) determining if there are intervention programs which could reduce utilization and improve health of the patient;

(5) determining if the patient is eligible for such programs;

(6) if eligible, enrolling the patient in the intervention program or other health care program;

(7) generating at least one report;

(8) updating the patient profile and the centralized patient profile database.

3. An interactive computer assisted method according to claim 1, further comprising the step of (l) conducting the patient survey and assessing whether the patient is the high utilization health care consumer through a nurse triage or other demand care telephone call from the patient to a nurse, survey taker or other health care professional, said conducting step (l) further comprises the steps of:

(1) responding to the specific patient inquiries that caused the patient to call the nurse triage or the other demand care telephone call;

(2) administering the core survey questions;

(3) interactively evaluating based on patient response to the core survey questions received in said step (2) whether the patient is the high utilization health care consumer;

(4) determining whether there are other intervention programs which could reduce utilization and improve health of the patient;

(5) determining if the patient is eligible for the other intervention programs;

(6) when eligible, enrolling the patient in the other intervention program;

(7) generating at least one report; and

(8) updating the patient profile and the centralized patient profile database.

4. An interactive computer assisted method according to claim 1, further comprising the step of (l) administrating the at least one core survey via a live interview with a nurse, survey taker or other health care professional and assessing whether the patient is the high utilization health care consumer, said administrating step (l) further comprises the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care personnel, in person, telephone or via data connection;

(2) responding to specific patient inquiries regarding health care conditions;

(3) administering the at least one core survey;

(4) interactively evaluating in person, telephone or via data connection based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

5. An interactive computer assisted method according to claim 1, further comprising the step of (l) conducting the at least one core survey and assessing whether the patient is at risk an Internet inquiry from the patient as part of a demand care system, said conducting step (l) comprising the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care via an Internet data connection;

(2) responding to specific patient inquiries regarding health care conditions via the Internet;

(3) administering the at least one core survey via the Internet;

(4) interactively evaluating via the Internet based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program via the Internet;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

6. An interactive computer assisted method according to claim 1, further comprising the step of (l) conducting the at least one core survey and assessing whether the patient is the high utilization health care consumer through patient response using a touch screen or keyboard at a kiosk, physician office, insurance company office or other location, said conducting step (l) comprising the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(2) responding to specific patient inquiries regarding health care conditions via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(3) administering the at least one core survey via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(4) interactively evaluating via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location, based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

7. An interactive computer assisted method according to claim 1, further comprising the step of (l) conducting the at least one core survey and assessing whether the patient is the high utilization health care consumer through a mail survey to the patient or a mail inquiry from the patient including electronic mail, said conducting step (l) further comprising the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care via the mail or electronic mail;

(2) responding to specific patient inquiries regarding health care conditions via the mail or electronic mail;

(3) administering the at least one core survey via the mail or electronic mail;

(4) interactively evaluating via the mail or electronic mail based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program via the mail or electronic mail;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

8. An interactive computer assisted method according to claim 1, where when the at least one core survey is administered, the determination of whether the patient is a health risk and potentially a high utilization health care consumer, the availability of health care intervention programs, and the enrollment of the patient in the appropriate program is performed automatically by an automated computer expert system rather than the physician, the nurse, the survey taker, or the other health care personnel.

9. An interactive computer assisted method according to claim 1, where when the at least one core survey is administered, the determination of whether the patient is the high utilization health care consumer, the availability of health care intervention programs, and the enrollment of the patient in the appropriate program is performed with the assistance of an automated computer expert system to be used in conjunction with, or by, the physician, the nurse, the survey taker, or the other health care personnel.

10. An integrated method of reviewing, analyzing, and compiling patient profile information from a plurality of different sources into a centralized patient profile database, including an interactive survey designed to identify high utilization health care consumers, said method comprising the steps of:

(a) developing and updating interactive questions for the interactive survey of the patients to assess the utilization of health care, respectively wherein the survey questions are interactively modified, priority of questions reordered based on answers to the questions, and questions are automatically determined based on previous answers;

(b) developing and updating rules for determining which of the patients are likely to be the high utilization health care consumer;

(c) periodically accessing the patient profile information, drug claims records, self-reported information, medical claims records, general demographic data, eligibility data, and demand for medical services from the centralized patient profile database and determining if at least one core survey was completed during a predetermined time interval, the patient profile information including at least current medications, medication use pattern, over the counter medication use, patient understanding of treatment goals, adverse effects, compliance history, medical history, family history, hospitalization history, pertinent laboratory work, patient demographics, patient behavior and lifestyle risk factor information, and the response to the at least one core survey;

(d) utilizing the patient profile information stored in the centralized patient profile database and information received in said periodically accessing Step (c) to update core questions, and querying a predetermined number of the patients using at least one of the core survey and the updated core questions to determine which of the patients are likely to be the high utilization health care consumers, wherein said querying step further comprises the steps of;

(d1) conducting the patient survey and assessing whether the patient is a high utilizer of health care services through a direct telephone survey to the patient by a physician, nurse, survey taker or other health care personnel;

(d2) conducting the patient survey and assessing whether the patient is the high utilization health care consumer through a nurse triage or other demand care telephone call from the patient to a nurse, survey taker or other health care professional;

(d3) administrating the at least one core survey via a live interview with a nurse, survey taker or other health care professional and assessing whether the patient is the high utilization health care consumer;

(d4) conducting the at least one core survey and assessing whether the patient is the high utilization health care consumer through an internet inquiry from the patient as part of a demand care system;

(d5) conducting the at least one core survey and assessing whether the patient is the high utilization health care consumer through patient response using a touch screen or keyboard at a kiosk, physician office, insurance company office or other location;

(d6) conducting the at least one core survey and assessing whether the patient is the high utilization health care consumer through a mail survey to the patient or a mail inquiry from the patient including electronic mail;

(e) collecting and storing in a computer storage system patient related information comprising demographic information, health care program availability and eligibility criteria, current health care participation information, patient medical claims, patient drug claims, prior medical history, prior drug usage patterns including nonprescription drug usage, patient behavior factors, and demand management program information;

(f) interactively evaluating if the patient is likely to be the high utilization health care consumer responsive to said utilizing step (d) and said collecting and storing step (e), and optionally responsive to an outbound communication from a health care representative to the patient;

(g) determining whether at least one intervention program may reduce health care utilization and improve health of the patient;

(h) determining if the patient is eligible for the at least one intervention program;

(i) when said determining step (h) determines that the patient is eligible, enrolling the patient in the at least one intervention program or other health care program;

(j) generating reports on the state of the at least one intervention program responsive to said enrolling step (i), including patient drug utilization, patient evaluation, patient health, comparisons with respect to desired patient health, patient satisfaction, and other information; and

(k) periodically updating member profile and central repository, and periodically modifying the rules for determining the high utilization health care consumer.

11. An interactive computer assisted method according to claim 10, wherein said conducting step (d1) further comprises the steps of:

(1) determining from a review of the centralized patient profile database which patient to call as part of the survey;

(2) calling the patient and administering the core survey questions;

(3) interactively evaluating based on the response to the questions, if the patient is the potential high utilization health care consumer;

(4) determining if there are intervention programs which could reduce utilization and improve health of the patient;

(5) determining if the patient is eligible for such programs;

(6) if eligible, enrolling the patient in the intervention program or other health care program;

(7) generating at least one report;

(8) updating the patient profile and the centralized patient profile database.

12. An interactive computer assisted method according to claim 11, wherein said conducting step (d2) further comprises the steps of:

(1) responding to the specific patient inquiries that caused the patient to call the nurse triage or the other demand care telephone call;

(2) administering the core survey questions;

(3) interactively evaluating based on patient response to the core survey questions received in said step (2) whether the patient is the high utilization health care consumer;

(4) determining whether there are other intervention programs which could reduce utilization and improve health of the patient;

(5) determining if the patient is eligible for the other intervention programs;

(6) when eligible, enrolling the patient in the other intervention program;

(7) generating at least one report; and

(8) updating the patient profile and the centralized patient profile database.

13. An interactive computer assisted method according to claim 12, wherein said administrating step (d3) further comprises the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care personnel, in person, telephone or via data connection;

(2) responding to specific patient inquiries regarding health care conditions;

(3) administering the at least one core survey;

(4) interactively evaluating in person, telephone or via data connection based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

14. An interactive computer assisted method according to claim 13, wherein said conducting step (d4) comprises the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care via an Internet data connection;

(2) responding to specific patient inquiries regarding health care conditions via the Internet;

(3) administering the at least one core survey via the Internet;

(4) interactively evaluating via the Internet based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program via the Internet;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

15. An interactive computer assisted method according to claim 14, wherein said conducting step (d5) comprises the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(2) responding to specific patient inquiries regarding health care conditions via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(3) administering the at least one core survey via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(4) interactively evaluating via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location, based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program via the touch screen or keyboard at the kiosk, the physician office, the insurance company office or the other location;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

16. An interactive computer assisted method according to claim 15, wherein said conducting step (d6) further comprises the steps of:

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care via the mail or electronic mail;

(2) responding to specific patient inquiries regarding health care conditions via the mail or electronic mail;

(3) administering the at least one core survey via the mail or electronic mail;

(4) interactively evaluating via the mail or electronic mail based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program via the mail or electronic mail;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database.

17. An interactive computer assisted method according to claim 16, where when the at least one core survey is administered, the determination of whether the patient is at risk and potentially a high utilization health care consumer, the availability of health care intervention programs, and the enrollment of the patient in the appropriate program is performed with the assistance of an automated computer expert system rather than the physician, the nurse, the survey taker, or the other health care personnel.

18. An interactive computer assisted method according to claim 16, where when the at least one core survey is administered, the determination of whether the patient is the high utilization health care consumer, the availability of health care intervention programs, and the enrollment of the patient in the appropriate program is performed with the assistance of an automated computer expert system to be used in conjunction with, or by, the physician, the nurse, the survey taker, or the other health care personnel.

19. An interactive computer assisted method of reviewing, analyzing, and compiling patient profile information from a plurality of different sources into a centralized patient profile database, including an interactive survey designed to identify high utilization health care consumers, said method comprising the steps of:

(a) developing and updating interactive questions for the interactive survey of a patient to assess the utilization of health care, respectively wherein the survey questions are interactively modified, priority of questions reordered based on answers to the questions, and questions are automatically determined based on previous answers;

(b) developing and updating rules for determining if the patient is likely to be the high utilization health care consumer;

(c) periodically accessing the patient profile information from the centralized patient profile database and determining if at least one core survey was completed during a predetermined time interval, the patient profile information including at least current medications, medication use pattern, over the counter medication use, patient understanding of treatment goals, adverse effects, compliance history, medical history, family history, hospitalization history, pertinent laboratory work, patient demographics, patient behavior and lifestyle risk factor information, and the response to the at least one core survey;

(d) utilizing the patient profile information stored in the centralized patient profile database and information received in said periodically accessing Step (c) to update core questions, and querying a predetermined number of the patient using at least one of the core survey and the updated core questions to determine which of the patients are likely to be the high utilization health care consumers;

(e) collecting and storing in a computer storage system patient related information comprising demographic information, health care program availability and eligibility criteria, current health care participation information, patient medical claims, patient drug claims, prior medical history, prior drug usage patterns including nonprescription drug usage, patient behavior factors, and demand management program information;

(f) interactively evaluating if the patient is likely to be the high utilization health care consumer responsive to said utilizing step (d) and said collecting and storing step (e), and optionally responsive to an outbound communication from a health care representative to the patient;

(g) predicting whether at least one intervention program may reduce health care utilization and improve health of the patient;

(h) determining if the patient is eligible for the at least one intervention program;

(i) when said determining step (h) determines that the patient is eligible, enrolling the patient in the at least one intervention program or other health care program;

(j) generating reports on the state of the at least one intervention program responsive to said enrolling step (i), including patient drug utilization, patient evaluation, patient health, comparisons with respect to desired patient health, patient satisfaction, and other information; and

(k) periodically updating member profile and central repository, and periodically modifying the rules for determining the high utilization health care consumer.

20. An interactive computer assisted method of reviewing, analyzing, and compiling patient profile information from a plurality of different sources into a centralized patient profile database, including an interactive survey designed to evaluate health status and identify high utilization health care consumers, said method comprising at least one of the sequential, non-sequential and sequence independent steps of:

(a) developing and updating interactive questions for the interactive survey of the patients to assess whether the patient is at least one of a low, medium, and high level utilizer of health care wherein the survey questions are interactively modified, priority of questions reordered based on answers to the questions, and questions are automatically determined based on previous answers;

(b) developing and updating rules for determining which of the patients are likely to become the high utilization health care consumer responsive to said developing step (a);

(c) periodically accessing the patient profile information from the centralized patient profile database and optionally determining if at least one core survey was completed during a predetermined time interval, the patient profile information including at least current medications, medication use pattern, over the counter medication use, patient treatment goals, adverse effects, compliance history, medical history, family history, hospitalization history, laboratory work, patient demographics, patient behavior and lifestyle risk factor information, and the response to the at least one core survey;

(d) utilizing the patient profile information stored in the centralized patient profile database and information received in said periodically accessing Step (c) to optionally update core questions, and optionally querying a predetermined number of the patients using at least one of the core survey and the updated core questions to determine which of the patients are at risk;

(e) collecting and storing in a computer storage system patient related information comprising demographic information, health care program availability and eligibility criteria, current health care participation information, patient medical claims, patient drug claims, prior medical history, prior drug usage patterns including nonprescription drug usage, patient behavior factors, and demand management program information;

(f) evaluating if the patient is at risk responsive to said utilizing step (d), and optionally responsive to an outbound communication from a health care representative to the patient and said collecting and storing step (e);

(g) determining whether at least one intervention program may reduce health care utilization and improve health of the patient;

(h) determining if the patient is eligible for the at least one intervention program;

(i) when said determining step (h) determines that the patient is eligible, enrolling the patient in the at least one intervention program or other health care program;

(j) generating reports on the state of the at least one intervention program responsive to said enrolling step (i), including patient drug utilization, patient evaluation, patient health, comparisons with respect to desired patient health, patient satisfaction; and

(k) periodically updating member profile, and periodically modifying the rules for determining the high utilization health care consumer.

21. An interactive computer assisted method of reviewing, analyzing, and compiling patient profile information from a plurality of different sources into a centralized patient profile database, including an interactive survey designed to identify high utilization health care consumers, said method comprising at least one of the sequential, non-sequential and sequence independent steps of:

(a1) developing and updating interactive questions for the interactive survey of the patients to assess the utilization of health care wherein the survey questions are interactively modified, priority of questions reordered based on answers to the questions, and questions are automatically determined based on previous answers;

(a2) conducting the at least one core survey and assessing whether the patient is at risk an Internet inquiry from the patient as part of a demand care system, said conducting step (k) comprising the steps of;

(1) interviewing the patient interactively by doctor, nurse, survey taker, or some other health care via an Internet data connection;

(2) responding to specific patient inquiries regarding health care conditions via the Internet;

(3) administering the at least one core survey via the Internet;

(4) interactively evaluating via the Internet based on the response to the questions, if the patient is the high utilization health care consumer;

(5) determining if there are other intervention programs which could reduce utilization and improve health of the patient;

(6) determining if the patient is eligible for the other intervention programs;

(7) when eligible, enrolling the patient in the intervention program or the other intervention program via the Internet;

(8) generating at least one report; and

(9) updating the patient profile and the centralized patient profile database;

(b) developing and updating rules for determining which of the patients are likely to be the high utilization health care consumer responsive to said developing step (a);

(c) accessing the patient profile information, drug claims records, self-reported information, medical claims records, general demographic data, eligibility data, and demand for medical services from the centralized patient profile database and determining if at least one core survey was completed during a predetermined time interval, the patient profile information including at least current medications, medication use pattern, over the counter medication use, patient treatment goals, adverse effects, compliance history, medical history, family history, hospitalization history, laboratory work, patient demographics, patient behavior and lifestyle risk factor information, and the response to the at least one core survey;

(d) utilizing the patient profile information stored in the centralized patient profile database and information received in said accessing Step (c) to update core questions, and querying a predetermined number of the patients using the core survey and the updated core questions to determine which of the patients are likely to be the high utilization health care consumers;

(e) collecting and storing in a computer storage system patient related information comprising demographic information, health care program availability and eligibility criteria, current health care participation information, patient medical claims, patient drug claims, prior medical history, prior drug usage patterns including nonprescription drug usage, patient behavior factors, and demand management program information;

(f) predicting if the patient is likely to be the high utilization health care consumer responsive to said utilizing step (d) and said collecting and storing step (e), and responsive to an outbound communication from a health care representative to the patient and wherein said predicting is accomplished by a computer analyzing the centralized patient profile database, wherein the predicting if the patient is likely to be high utilization health care consumer, the availability of health care intervention programs, and the enrollment of the patient in the appropriate program is performed with the assistance of an automated computer expert system to be used in conjunction with, or by, the physician, the nurse, the survey taker, or the other health care personnel; and

(g) automatically presenting to the patient at least one of an intervention program, drug therapy program, and therapy program predicted by the computer to reduce health care utilization and improve health of the patient.