Methods and systems for healthcare practice management

A method of managing a healthcare practice participating in an insurance network to enhance profitability of the healthcare practice with respect to a predetermined reimbursement amount for medical costs other than those attributed directly to a medical procedure performed by a physician to thereby define ancillary medical costs, the method comprising:

• gathering data in a tangible computer medium from each of a plurality of physicians in the healthcare practice participating in the insurance network including ancillary medical costs;
• analyzing the gathered data;
• identifying responsive to the analysis at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in medical procedures other than those attributed directly to a medical procedure performed by a physician and that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs;
• and
• after the step of identifying, modifying management behavior of the at least one of the plurality of physicians at risk regarding the ancillary medical costs;
• and
• determining that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced to increase the profitability of the healthcare practice.

A method of optimizing the profitability of an insurance network having a plurality of physicians in a healthcare practice participating therein by managing ancillary medical costs, the method comprising the steps of:

• gathering data in a tangible computer medium from each of the plurality of physicians in the healthcare practice participating in the insurance network including management of medical costs other than those attributed directly to medical procedures performed by any of the plurality of physicians to thereby define ancillary medical costs;
• analyzing the gathered data:
• identifying responsive to the analysis at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by performing activities that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs;
• after the step of identifying, modifying management behavior of the at least one of the plurality of physicians' in the healthcare practice regarding ancillary medical costs that are not profitable for the insurance network responsive to the gathered data;
• and
• providing a financial incentive to the insurance network and the plurality of physicians in the healthcare practice participating in the insurance network to modify the plurality of physicians' management behavior of ancillary medical costs that are not as profitable to the insurance network.

A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network comprising:

• a first database comprising medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures that are preferred by the insurance network;
• a second database comprising medical costs other than those attributed directly to medical procedures performed by any of the plurality of physicians to thereby define ancillary medical costs of each of the plurality of physicians participating in the insurance network;
• and
• computer executable program product stored on a tangible computer medium, comprising:
• an analyzer in communication with the first and second databases for analyzing the data in the first and second database and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify ancillary medical costs of the physicians that are not preferred by the insurance network and
• managing means responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing means including an identifier for identifying responsive to the analyzer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, and a modifier responsive to the identifier for modifying ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary medical costs, the managing means further determining responsive to the modifier that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced.

A healthcare management optimization system for a healthcare practice including a plurality of physicians participating in an insurance network comprising:

• a server having at least one database, the at least one database comprising a first and second database, the first database including the ancillary medical procedures that are more preferred by the insurance network, the second database including ancillary medical costs of each of the plurality of physicians participating in the insurance network;
• a communications network positioned to be in communication with the server;
• a plurality of computers positioned to be in communication with the communications network, each including a user interface responsive to a user;
• computer executable program product stored on a tangible computer medium positioned on the server, comprising:
• an updater responsive to the user interface updating each of the plurality of physicians in the healthcare practice of any changes in the management of medical costs other than those attributed directly to a medical procedure performed directly by any of the plurality of physicians to thereby define ancillary medical costs and that are preferred by the insurance network,
• recommending means responsive to the user interface for recommending to each of the plurality of physicians alternative medical procedures other than those performed directly by any of the plurality of physicians to thereby define ancillary medical procedures and that are preferred by the insurance network,
• an analyzer in communication with the first and second databases for analyzing the data in the first and second databases and comparing the ancillary medical procedures that are preferred by the insurance network with the ancillary medical costs of the plurality of physicians participating in the insurance network to thereby identify the ancillary medical costs of the physicians that are not preferred by the insurance network, and
• managing means responsive to the analyzer for managing the ancillary medical costs of the healthcare practice identified as not being preferred by the insurance network to thereby modify the ancillary medical costs of the physicians in the healthcare practice to be more profitable to the insurance network, the managing means including an identifier for identifying responsive to the analyzer at least one of the plurality of physicians in the healthcare practice participating in the insurance network that is at a greater risk of not receiving a predetermined reimbursement amount for the ancillary medical costs from the insurance network by engaging in ancillary medical procedures that are detrimental to receiving the predetermined reimbursement amount for the ancillary medical costs, and a modifier responsive to the identifier for modifying ancillary medical costs management behavior of the at least one of the plurality of physicians at the greater risk regarding the ancillary medical costs, the managing means further determining responsive to the modifier that the risk of not receiving the predetermined reimbursement amount for the ancillary medical costs from the insurance network has been reduced.