Method, system, and computer program product for physician efficiency measurement and patient health risk stratification
AssigneeCave Consulting Group, Inc.
InventorDouglas G. Cave
Life of this patent
Estimating the term…
Abstract
A method for measuring physician efficiency and patient health risk stratification is disclosed. Episodes of care are formed from medical claims data and an output process is performed. Physicians are assigned to report groups, and eligible physicians and episode assignments are determined. Condition-specific episode statistics and weighted episode statistics are calculated, from which physician efficiency scores are determined.
Claims30
A healthcare analytics computer system for determining a health care provider efficiency score, said healthcare analytics computer system comprising a memory device for storing data and a processor in communication with said memory device, said processor programmed to:
- receive a claims file in a hierarchical format, the hierarchical format including (i) a plurality of subscriber records, (ii) at least one claim record embedded within each of the plurality of subscriber records, and (iii) at least one claim line item record embedded within each of the at least one claim records;
- parse the claims file to generate patient treatment records in a flattened data structure;
- form episode of care records, wherein each episode of care record links a respective episode of a respective medical condition to corresponding patient treatment records in the flattened data structure;
- assign the episode of care records among a plurality of health care providers;
- determine eligible health care providers and episode of care assignments;
- calculate condition-specific episode of care statistics from the episode of care records and the corresponding patient treatment records;
- calculate, using direct standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type;
- and
- determine efficiency scores for the healthcare providers from the calculated condition-specific episode of care statistics and the weighted episode of care statistics calculated across medical conditions.
A healthcare analytics computer system for determining a health care provider efficiency score, said healthcare analytics computer system comprising a memory device for storing data and a processor in communication with said memory device, said processor programmed to:
- receive a claims file in a hierarchical format, the hierarchical format including (i) a plurality of subscriber records, (ii) at least one claim record embedded within each of the plurality of subscriber records, and (iii) at least one claim line item record embedded within each of the at least one claim records;
- parse the claims file to generate patient treatment records in a flattened data structure;
- form episode of care records, wherein each episode of care record links a respective episode of a respective medical condition to corresponding patient treatment records in the flattened data structure;
- assign the episode of care records among a plurality of health care providers;
- determine eligible health care providers and episode of care assignments;
- calculate condition-specific episode of care statistics from the episode of care records and the corresponding patient treatment records;
- calculate, using indirect standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type;
- and
- determine efficiency scores for the healthcare providers from the calculated condition-specific episode of care statistics and the weighted episode of care statistics calculated across medical conditions.
A computer-implemented method for determining a health care provider efficiency score implemented on a healthcare analytics computer system, the healthcare analytics computer system comprising a memory device for storing data and a processor in communication with the memory device, said method comprising steps performed by the processor of:
- receiving a claims file in a hierarchical format, the hierarchical format including (i) a plurality of subscriber records, (ii) at least one claim record embedded within each of the plurality of subscriber records, and (iii) at least one claim line item record embedded within each of the at least one claim records;
- parsing the claims file to generate patient treatment records in a flattened data structure;
- forming episode of care records, wherein each episode of care record links a respective episode of a respective medical condition to corresponding patient treatment records in the flattened data structure;
- assigning the episode of care records among a plurality of health care providers;
- determining eligible health care providers and episode of care assignments;
- calculating condition-specific episode of care statistics from the episode of care records and the corresponding patient treatment records;
- calculating, using direct standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type;
- and
- determining efficiency scores for the healthcare providers from the calculated condition-specific episode of care statistics and the weighted episode of care statistics calculated across medical conditions.
A computer-implemented method for determining a health care provider efficiency score implemented on a healthcare analytics computer system, the healthcare analytics computer system comprising a memory device for storing data and a processor in communication with the memory device, said method comprising steps performed by the processor of:
- receiving a claims file in a hierarchical format, the hierarchical format including (i) a plurality of subscriber records, (ii) at least one claim record embedded within each of the plurality of subscriber records, and (iii) at least one claim line item record embedded within each of the at least one claim records;
- parsing the claims file to generate patient treatment records in a flattened data structure;
- forming episode of care records, wherein each episode of care record links a respective episode of a respective medical condition to corresponding patient treatment records in the flattened data structure;
- assigning the episode of care records among a plurality of health care providers;
- determining eligible health care providers and episode of care assignments;
- calculating condition-specific episode of care statistics from the episode of care records and the corresponding patient treatment records;
- calculating, using indirect standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type;
- and
- determining efficiency scores for the healthcare providers from the calculated condition-specific episode of care statistics and the weighted episode of care statistics calculated across medical conditions.
A non-transitory computer-readable storage device having processor-executable instructions embodied thereon for determining a health care provider efficiency score, wherein when executed by a processor of a healthcare analytics computer system, the processor-executable instructions cause the processor to:
- receive a claims file in a hierarchical format, the hierarchical format including (i) a plurality of subscriber records, (ii) at least one claim record embedded within each of the plurality of subscriber records, and (iii) at least one claim line item record embedded within each of the at least one claim records;
- parse the claims file to generate patient treatment records in a flattened data structure;
- form episode of care records, wherein each episode of care record links a respective episode of a respective medical condition to corresponding patient treatment records in the flattened data structure;
- assign the episode of care records among a plurality of health care providers;
- determine eligible health care providers and episode of care assignments;
- calculate condition-specific episode of care statistics from the episode of care records and the corresponding patient treatment records;
- calculate, using direct standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type;
- and
- determine efficiency scores for the healthcare providers from the calculated condition-specific episode of care statistics and the weighted episode of care statistics calculated across medical conditions.
A non-transitory computer-readable storage device having processor-executable instructions embodied thereon for determining a health care provider efficiency score, wherein when executed by a processor of a healthcare analytics computer system, the processor-executable instructions cause the processor to:
- receive a claims file in a hierarchical format, the hierarchical format including (i) a plurality of subscriber records, (ii) at least one claim record embedded within each of the plurality of subscriber records, and (iii) at least one claim line item record embedded within each of the at least one claim records;
- parse the claims file to generate patient treatment records in a flattened data structure;
- form episode of care records, wherein each episode of care record links a respective episode of a respective medical condition to corresponding patient treatment records in the flattened data structure;
- assign the episode of care records among a plurality of health care providers;
- determine eligible health care providers and episode of care assignments;
- calculate condition-specific episode of care statistics from the episode of care records and the corresponding patient treatment records;
- calculate, using indirect standardization, weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type;
- and
- determine efficiency scores for the healthcare providers from the calculated condition-specific episode of care statistics and the weighted episode of care statistics calculated across medical conditions.
Dependencies are inferred from the claim text.