Predictive modeling system and method for disease management
Inventors
Petit, Parker H. • Olson, Martin L.
Assignees
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Publication Number
US-7685000-B1
Publication Date
2010-03-23
Expiration Date
Abstract
A method and system for administering a disease management program to improve healthcare quality, reduce healthcare costs, and optimize delivery of healthcare services. A multi-condition risk assessment is conducted for all or a substantial portion of a population of program participants, and collected multi-condition risk assessment data are combined with claims data for predictive modeling of future healthcare risk and expense. Participants are risk-stratified into one or more classifications of future healthcare cost risk, and appropriate intervention or delivery of healthcare services is made based on the risk classification.
Core Innovation
The invention provides a method of disease management embodied in a computer program product executed on an instruction processing system. The method filters claims data of program participants to define a population and conducts a multi-condition risk assessment of substantially all participants within the defined population. The method then combines data gathered from the multi-condition risk assessment with claims data for participants within the defined population.
Based on the combination of claims data and data gathered from the multi-condition risk assessment, the method classifies future healthcare risk of participants. The classification drives determining an appropriate level of disease management intervention and support for program participants. The intervention and support range from patient education for lower risk individuals, passive monitoring and reporting of progress and program compliance for middle risk individuals, to more active intervention and close one-on-one case management for higher risk individuals.
The invention further includes generating a patient record based on the multi-condition risk assessment and providing differing degrees of healthcare intervention based on the patient record. In addition, the invention provides for optimizing delivery of healthcare services by conducting a multi-condition risk assessment, categorizing individual program participants selected from the population into at least a higher-risk category and a lower-risk category, and providing more intensive healthcare intervention to higher-risk participants and less intensive healthcare intervention to lower-risk participants.
Claims Coverage
The document includes three independent claims that consistently center on multi-condition risk assessment of participants and assignment of differing intervention intensity based on future healthcare risk or risk categories. Across the independent claims, the main inventive features are claims-data filtering to define a population, multi-condition risk assessment of substantially all or at least a substantial portion, combination of multi-condition risk assessment data with claims data, future-risk or record-based participant stratification, and intervention and support levels ranging from patient education to close one-on-one case management.
Claims-data filtering to define a population for multi-condition risk assessment
Filtering claims data of program participants to define a population, and conducting a multi-condition risk assessment of substantially all participants within the defined population.
Combining multi-condition risk assessment with participant claims to classify future healthcare risk
Combining data gathered from said multi-condition risk assessment with claims data for participants within the defined population, and classifying future healthcare risk of participants based on the combination of claims data and data gathered from said multi-condition risk assessment.
Risk-driven intervention intensity spanning patient education to close one-on-one case management
Determining an appropriate level of disease management intervention and support for program participants based on the future healthcare risk classification that ranges from patient education for lower risk individuals, passive monitoring and reporting of progress and program compliance for middle risk individuals, to more active intervention and close one-on-one case management for higher risk individuals.
Patient record generation from multi-condition risk assessment for differing degrees of intervention
Conducting a multi-condition risk assessment of at least a substantial portion of program participants within a defined population; generating a patient record based on the multi-condition risk assessment; and providing differing degrees of healthcare intervention for program participants based on their patient record.
Risk-category based optimization of healthcare service delivery
Conducting a multi-condition risk assessment of at least a substantial portion of a population; categorizing individual program participants selected from the population into at least a higher-risk category and a lower-risk category; and providing more intensive healthcare intervention to program participants categorized in the higher-risk category and less intensive healthcare intervention to program participants categorized in the lower-risk category.
Across the independent claims, the inventive approach repeatedly uses multi-condition risk assessment data, optionally combined with claims data, to classify future healthcare risk or to generate patient records and risk categories, and then assigns differing levels of healthcare intervention ranging from patient education and passive monitoring to more active intervention and close one-on-one case management.
Stated Advantages
Provides differing degrees of healthcare intervention and support for program participants based on future healthcare risk classification or a patient record.
Enables more intensive healthcare intervention for higher-risk category participants and less intensive healthcare intervention for lower-risk category participants.
Documented Applications
Disease management programs for program participants in which future healthcare risk is classified based on multi-condition risk assessment combined with claims data, and tailored intervention intensity is provided.
Optimizing delivery of healthcare services to participants in a disease management program by categorizing participants into higher-risk and lower-risk categories based on multi-condition risk assessment.
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