System and method to measure and manage urgent care requests
AssigneeEquity Health Partners, LLC
InventorsMark C. Borton, Dean Craig Sperry, Robert Crowell Bausmith, David Alan Kirshenbaum, Arman Ozgun
Life of this patent
Estimating the term…
Abstract
An innovative tracking software system provides independent proof of primary-care physician (PCP) efforts to improve urgent access to care and coordination of care. PCPs are provided with tools and financial incentives to better manage urgent care requests and thereby provide better service while reducing avoidable hospital utilization (ER and re-admissions) and costs. In particular, independent and accurate measurements of provider performance enable the payment of financial incentives to PCPs.
Claims27
A method, for execution on a computing device, comprising:
- accessing, by a computing device, clinical data and medical claims data relating to care for a group of patients;
- by a computing device, establishing relationships between patients and providers, said patients being on a list of eligible patients and said providers being in a directory of providers, including attributing a patient to a provider in accordance with at least one of the medical claims data and a predetermined rule, wherein said step of establishing relationships includes:
- determining from the medical claims data whether a patient may be attributed to one provider only, to a plurality of providers, or to no provider;
- where the patient may be attributed to one provider only, attributing the patient to that provider, requesting confirmation of a patient-to-provider (P2P) relationship from the provider, and receiving communication from the provider regarding acceptance of the P2P relationship,
- where the patient may be attributed to a plurality of providers, attributing the patient to each of said plurality of providers, requesting confirmation of a P2P relationship from each of said plurality of providers, and receiving communication from at least of said plurality of providers regarding acceptance of the P2P relationship, and where the patient may be attributed to no provider, attributing the patient to a provider in the directory of providers in accordance with a first rule;
- requesting confirmation from said provider regarding a patient-provider relationship with said patient;
- and
- recording clinical events related to an urgent care request, said events including an initial communication requesting care, and fulfillment of the request;
- and
- by a computing device, measuring performance of the provider of said care with respect to at least one predetermined criterion.
Dependencies are inferred from the claim text.