Medicare advantage risk adjustment
OwnerSeth Flam, Arnold Mentze +1inventors
InventorsSeth Flam, Arnold Mentze, Shawn Terry
Life of this patent
Estimating the term…
Abstract
An apparatus includes a memory and a processor coupled to the memory. The processor may receive a diagnosis input, where the diagnosis input represents a condition of a patient. The processor may also identify a health risk value in a data file stored in the memory using the diagnosis input. In the data file, the diagnosis input is associated with the health risk value. The health risk value is a numerical risk factor that represents an increased risk of treating the patient with the condition. The processor may also calculate a raw risk score based at least in part on the health risk value, where the raw risk score indicates a multiplier that is used at least in part to determine payments to a health care plan.
Claims20
An apparatus comprising:
- a memory;
- and
- a processor coupled to the memory, wherein the processor is configured to:
- receive a diagnosis input, wherein the diagnosis input represents a condition of a patient;
- identify a health risk value in a data file stored in the memory using the diagnosis input, wherein in the data file the diagnosis input is associated with the health risk value, and wherein the health risk value is a numerical risk factor that represents an increased risk of treating the patient with the condition;
- and
- calculate a raw risk score based at least in part on the health risk value, wherein the raw risk score indicates a multiplier that is used at least in part to determine payments to a health care plan.
A method comprising:
- receiving, by a processor of a computing device, a diagnosis input, wherein the diagnosis input represents a condition of a patient;
- identifying, by the processor of the computing device, a health risk value in a data file stored in a memory using the diagnosis input, wherein in the data file the diagnosis input is associated with the health risk value, and wherein the health risk value is a numerical risk factor that represents an increased risk of treating the patient with the condition;
- and
- calculating, by the processor of the computing device, a raw risk score based at least in part on the health risk value, wherein the raw risk score indicates a multiplier that is used at least in part to determine payments to a health care plan.
A non-transitory computer readable medium having instructions stored thereon for execution by a processor, the instructions comprising:
- instructions to receive, by the processor, a diagnosis input, wherein the diagnosis input represents a condition of a patient;
- instructions to identify, by the processor, a health risk value in a data file stored in a memory using the diagnosis input, wherein in the data file the diagnosis input is associated with the health risk value, and wherein the health risk value is a numerical risk factor that represents an increased risk of treating the patient with the condition;
- and
- instructions to calculate, by the processor, a raw risk score based at least in part on the health risk value, wherein the raw risk score indicates a multiplier that is used at least in part to determine payments to a health care plan.
Dependencies are inferred from the claim text.