Maximizing patient referral outcome through healthcare utilization and/or referral evaluation

A method for maximizing healthcare referral outcomes, comprising:

• detecting a first healthcare referral of a first patient, the first healthcare referral from a first healthcare provider to a second healthcare provider;
• generating a first referral log comprising a provider UID of the first healthcare provider, a provider UID of the second healthcare provider, a referral time of the first healthcare referral, and a type of service;
• storing the first referral log;
• detecting a second healthcare referral of the first patient, the second healthcare referral from the first healthcare provider to a third healthcare provider;
• generating a second referral log comprising the provider UID of the first healthcare provider, a provider UID of the third healthcare provider, a referral time of the second healthcare referral, and the type of service;
• storing the second referral log;
• determining a referral association between the first healthcare referral and the second healthcare referral;
• storing a first database association linking the second referral log and the first referral log;
• initiating a referral request to refer a second patient to a referral healthcare provider;
• generating a referral profile for the second patient, the referral profile comprising a type of service range and optionally a place of service range;
• comparing the referral profile to a referral dataset comprising a set of referral logs associated with the provider UID of the first healthcare provider;
• generating a reduced dataset comprising a subset of referral logs extracted from the referral dataset matching the referral profile,
• wherein at least one of the first referral log and the second referral log matches the referral profile;
• referencing a first time period value;
• calculating, using the subset of referral logs in the reduced dataset, an inbound re-referral rate of the second healthcare provider within the first time period value;
• applying a referral ruleset to at least one of score, rank, and qualify the second healthcare provider based on criteria comprising the inbound re-referral rate of the second healthcare provider;
• and
• adding the provider UID of the second healthcare provider to a referral data.

A system, comprising:

• a log server comprising:
• a processor of the log server,
• a memory of the log server,
• a set of healthcare utilization logs, each comprising the provider UID of a healthcare provider, one or more instances of a type of service value, and one or more instances of a place of service value,
• a set of healthcare referral logs each comprising the provider UID of the healthcare provider as a referral provider, a provider UID of a referring provider, one or more instances of the type of service value, and one or more instances of the place of service value,
• a first set of database associations associating one or more of the set of healthcare utilization logs with one or more of the set of healthcare referral logs,
• a second set of database associations associating one or more of the set of healthcare referral logs with one or more of a different set of healthcare referral logs from the referring provider to a different healthcare provider as a different referral provider,
• a referral server, comprising:
• a referral request agent comprising computer readable instructions that when executed on the processor of the of the referral server:
• receives a referral request to refer a patient for healthcare services;
• and
• at least one of generates and receives a referral profile;
• a profile matching engine comprising computer readable instructions that when executed on the processor of the of the referral server:
• compares the referral profile to the set of healthcare referral logs and the set of healthcare utilization logs;
• and
• determines matching instances of the set of healthcare utilization logs and the set of referral logs to the referral profile;
• a dataset reduction subroutine comprising computer readable instructions that when executed on the processor of the of the referral server:
• generates a reduced dataset comprising a subset of the set of utilization logs and a subset of the set of referral logs matching the referral profile;
• a utilization rate routine comprising computer readable instructions that when executed on the processor of the of the referral server:
• calculates, using the subset of utilization logs in the reduced dataset, a POS utilization rate of a referral healthcare provider for each instance of the place of service value;
• a referral rate routine comprising computer readable instructions that when executed on the processor of the of the referral server:
• calculates, using the subset of referral logs in the reduced dataset, an inbound re-referral rate of the referral healthcare provider;
• a hybrid ruleset specifying criteria for to at least one of score, rank, and qualify the healthcare provider based on criteria comprising the POS utilization rate and the inbound re-referral rate,
• a referral generation subroutine comprising computer readable instructions that when executed on the processor of the of the referral server:
• generates a referral data comprising the provider UID of the referral provider, a name of the referral provider, and optionally a referral evaluation data comprising at least one of a score, a rank, and a qualification resulting from application of the hybrid ruleset on the reduced dataset, and
• a network.