System for providing medical information
AssigneeIngenix, Inc.
InventorJONATHAN C. JAVITT
Life of this patent
Estimating the term…
Abstract
A managed care expert system provides a graphical, interactive computer system which accepts user input relating to contract variables for a plurality of alternative contract scenarios, consults a database of national and locality-specific utilization data, performs a utilization and revenue analysis for both commercial and Medicare-age beneficiaries, and provides a synthetic fee schedule for comparing the likely revenue under capitation for a plurality of services to revenue for those services under a current reimbursement scenario. The system of the invention in its preferred embodiment enables a physician or other health care professional to use a broad array of assumptions to forecast utilization of medical procedures and estimated revenue per procedure under multiple capitation scenarios.
Claims11
A device for aiding in managed health care decision-making, comprising:
- means for selecting a plurality of medical procedures for analysis;
- means for storing a first database of health care utilization data indicating levels of utilization for said plurality of procedures under a first scenario;
- means for receiving user input of at least one variable affecting an amount of revenue derived from providing health care under a second scenario;
- means for creating, based at least in part upon said variable affecting revenue and data in said said first database, a second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario;
- means for projecting a first revenue amount relating to said first scenario, said first revenue amount being derived at least in part from said the data in said first database;
- means for projecting a second revenue amount relating to said second scenario, said second revenue amount being derived at least in part from said the data in said second database;
- and,
- means for displaying said first and second revenue amounts.
A device for aiding in managed care decision-making, comprising:
- means for selecting a plurality of medical procedures for analysis;
- means for storing a database of health care utilization data indicating levels of utilization for a plurality of procedures;
- means for receiving user input of at least one desired revenue amount for insuring provision of said plurality of procedures to a population;
- means for calculating, based at least upon said data in said database and said at least one desired revenue amount, a capitation rate reflecting a level of compensation statistically required to achieve said desired revenue amount;
- and,
- means for displaying said capitation rate.
A device for aiding in managed health care decision-making, comprising:
- means for selecting a plurality of medical procedures for analysis;
- means for storing a first database of health care utilization data indicating levels of utilization for said plurality of procedures under a first scenario;
- means for receiving user input of at least one variable affecting revenue derived from providing health care under a second scenario;
- means for creating, based at least in part upon said variable affecting revenue and data in said said first database, a second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario;
- means for displaying said second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario.
A device for aiding in managed health care decision-making, comprising:
- means for selecting a plurality of medical procedures for analysis;
- means for storing a first database of health care utilization data indicating levels of utilization for said plurality of procedures under a first scenario;
- means for receiving user input of at least one variable affecting revenue derived from providing health care under a second scenario;
- means for creating, based at least in part upon said variable affecting revenue and data in said said first database, a second database of health care utilization data indicating levels of utilization for said plurality of procedures under said second scenario;
- means for storing a third database of data representing relative value units for each of said plurality of medical procedures;
- means for creating a fourth database of relative-value-units-per-service based at least in part upon said data in said second database and said data in said third database.
Dependencies are inferred from the claim text.