System and method for predictive modeling in disease management
Inventors
Petit, Parker H. • Olson, Martin L.
Assignees
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Publication Number
US-7877277-B1
Publication Date
2011-01-25
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
A computer-implemented disease management 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 combines data gathered from the multi-condition risk assessment with claims data for participants within the defined population, and based on the combination, classifies future healthcare risk of participants.
The classified future healthcare risk participants are output to a tangible storage medium. In related implementations, the multi-condition risk assessment is conducted using participant-provided information, including an internet-based question-and-answer session, and the assessment includes selection of data about one or more medical conditions and selection of treatment data, including regimen-related compliance.
A patient record is generated based on the multi-condition risk assessment, and differing degrees of healthcare intervention are provided for program participants based on their patient record. Participants are categorized into at least a higher-risk category and a lower-risk category, and more intensive healthcare intervention is provided to higher-risk participants while less intensive healthcare intervention is provided to lower-risk participants.
Claims Coverage
The provided material includes three independent claims. Across these claims, the inventive features focus on multi-condition risk assessment applied to substantially all or a substantial portion of a defined population, combination with claims data, risk stratification into risk classifications or categories, and linking those classifications to output and differing degrees of disease-management intervention.
Claims data filtering to define a population and multi-condition risk assessment of substantially all participants
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.
Combination of multi-condition risk assessment data with claims data for future healthcare risk classification
Combining data gathered from the multi-condition risk assessment with claims data for participants within the defined population, and classifying future healthcare risk of participants based on the combination.
Outputting classified future healthcare risk to storage
Outputting the classified future healthcare risk participants to the tangible storage medium.
Multi-condition risk assessment, patient record generation, and intervention based on patient record
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.
Optimizing healthcare services delivery via higher- and lower-risk categorization
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 core claim coverage centers on performing a multi-condition risk assessment for substantially all or a substantial portion of a defined population, combining risk-assessment data with claims data where required, and producing risk-based outputs that drive differing intensity of healthcare intervention for participants categorized as higher-risk versus lower-risk.
Stated Advantages
Documented Applications
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