Methods, program product, and systems for healthcare practice management

Abstract

Methods, program product, and systems are provided for optimizing profits for healthcare practices and insurance networks. The methods, program product, and systems include modifying physician's cost management behavior to enhance profitability of healthcare practices and insurance networks by identifying physicians that are not profitable because of cost management behavior and providing intervention to change the management behavior of the physician.

Description

RELATED APPLICATIONS [0001] The application is a continuation of and claims priority to and the benefit of U.S. patent application Ser. No. 09 / 812,704, titled “Methods and System for Healthcare Practice Management,” filed Mar. 19, 2001, related to U.S. patent application Ser. No. 09 / 812,703 titled “Methods For Collecting Fees For Healthcare Management Group” filed Mar. 19, 2001, which are each incorporated herein by reference in its entirety.BACKGROUND OF THE INVENTION [0002] 1. Field of the Invention [0003] The present invention relates to the healthcare industry and, more particularly, to the field of healthcare management. [0004] 2. Description of Related Art [0005] In the healthcare industry, as illustrated in FIG. 1, physicians generally organize themselves into practice groups 25 and normally subcontract to an insurance network 30. The insurance network 30 is not limited to traditional insurance networks, i.e., Blue Cross Blue Shield, Aetna, United Healthcare, etc., but also i...

AI Technical Summary

Benefits of technology

[0017] With the foregoing in mind. Embodiments of the present invention advantageously provides a system and methods for managing a healthcare practice which optimizes profits of the healthcare practice. The system and methods of Embodiments of the present invention also advantageously assist physicians and insurance providers in providing cost-effective healthcare services to patients. The system and methods of managing the healthcare practice of Embodiments of the present invention additionally advantageously eliminates the time necessary for physicians to conduct exhaustive research in determining if alternative, and more profitable, ancillary medical procedures are beneficial to their patients. The system and methods according to embodiments of the present invention further advantageously assist in controlling the rising costs of medical care by reducing physicians' ancillary medical costs. The system and methods according to embodiments of the present invention still further advantageously strengthens the relationship between physicians and insurance providers by providing an intermediary between the two.

[0018] More particularly, an embodiment of the present invention provides a method of managing a healthcare practice participating in an insurance network to optimize profitability of the healthcare practice with respect to a predetermined reimbursement amount for selected ancillary medical costs. The method advantageously includes gathering data from each of a plurality of physicians in the healthcare practice participating in the insurance network regarding management of the selected ancillary medical costs. The method further includes identifying at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs. The method also includes modifying the at least one physician's management behavior regarding the ancillary medical costs to substantially reduce the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network.

[0023] An embodiment of the present invention advantageously strengthens the relationship between insurance companies and physicians by providing an intermediary that provides information to make modifications to ancillary medical treatment procedures to both the physicians and the insurance network. The information provided by the intermediary includes scientific and medical research literature and advantageously eliminates the research time and costs necessary for the physicians and the insurance networks to make informed decisions and recommendations regarding patient care. The research necessary to make the informed decisions is advantageously provided to the physicians and the insurance networks.

[0024] An embodiment of the present invention also advantageously provides educational information regarding alternative ancillary medical procedures to patients that insist on a particular ancillary medical procedure, i.e., insist on a prescription for a brand name medication, so that the patient can also make a more informed decision as to their treatment. When the patient is made a part of the decision to modify medical care, the patient is more likely to trust both the physician and the insurance network. Therefore, Embodiments of the present invention also advantageously strengthens the relationship between the patients, physicians, and insurance network.

[0025] Embodiments of the present invention further advantageously decreases physicians' overall ancillary medical costs, thereby enhancing the profitability of the physician practice groups and insurance networks. Increased savings attributed to ancillary medical costs can advantageously be passed on to patients, thereby decreasing the cost of medical care and co-payments for prescription medications. Embodiments of the present invention allows the patient in the healthcare system to be the real winner.

Problems solved by technology

These requirements often fall within varying cost centers, such as pharmaceutical, laboratory, anesthesiology, and radiation costs, for example.

This arrangement is disadvantageous for the physician practice 25 participating in the insurance network 30 because it requires a great deal of management and organization to follow the requirements of the insurance network 30.

The system is even more disadvantageous for the physician practice 25 if it participates in multiple insurance networks 30.

As noted above, however, this takes a great deal of time that can better be used to treat patients 35.

This is disadvantageous because an office manager can be extremely costly and will normally need office space.

The method described in Siegrist, Jr. et al., however, is disadvantageous to group physicians in organizing and managing healthcare costs that are dependant upon preferred treatment of the insurance network.

No matter which result occurs, however, the ultimate end result is higher medical costs for patients 35.

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