Systems and methods for assessing and optimizing healthcare administration

Abstract

A comprehensive patient data assessment system and method for use in generating, tracking and analyzing medical data related to healthcare administered by a group of physicians to a specified patient population. The system is operative to track data related to the claims history, case management, pharmacy data, and lab tests / results for each patient treated by each patient's primary care physician preferably through electronic medical records that are accessible over a computer network. The system is operative to generate data indicative of the utilization of healthcare resources utilized to treat each patient within the patient population, as well as ensure that each primary care physician utilizes appropriate codes for each diagnosis and procedure / test administered to each patient. The system further provides for categorization of patients afflicted with chronic conditions that require high-cost care. The systems are exceptionally effective in conserving medical resources, ensuring uniformity in administering healthcare, and achieving optimal patient outcomes.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS[0001]The present application is a continuation application of U.S. patent application Ser. No. 11 / 063,268, entitled SYSTEMS AND METHODS FOR ASSESSING AND OPTIMIZING HEALTHCARE ADMINISTRATION, filed Feb. 22, 2005, the teachings of which are incorporated herein by reference.STATEMENT RE: FEDERALLY SPONSORED RESEARCH / DEVELOPMENT[0002]Not ApplicableBACKGROUND OF THE INVENTION[0003]The present invention is directed to systems and methods for comprehensively assessing and optimizing the administration of healthcare as rendered by a group of physicians to a specific patient population. More particularly, the present invention comprises systems and methods that conserve medical resources utilized to care for the patient population, ensure uniformity in the procedures / tests utilized to render such care, identify and assess those patients afflicted with a chronic condition requiring high-cost healthcare, and provide means to continuously monitor and eva...

AI Technical Summary

Benefits of technology

"The present invention is a comprehensive medical information and treatment system that can track and review the administration of healthcare by a group of physicians and healthcare administration institutions to a specific patient population. The system uses a uniform coding procedure to assemble a comprehensive medical history for each patient by compiling data related to each diagnosis, test, and procedure ordered by a physician for a specific patient. The system also assesses the appropriateness of each diagnosis and procedure based on standardized care criteria and coding practices. The data related to high-cost chronic conditions is separately compiled to enable the development of cost-effective treatment strategies that may be custom tailored to provide optimal patient treatment. The system is designed to facilitate standardized electronic transactions as provided for in the Health Insurance Portability and Accountability Act (HIPAA) of 1996."

Problems solved by technology

Along these lines, it is contemplated that a number of statistical analyses can be applied in reviewing the electronic medical records that are operative to assess potentially inappropriate coding practices, which are thus indicative of wasteful, unnecessary or sub-optimal healthcare.

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