Method and apparatus for providing incentives to physicians under an accountable care model

A computer-implemented method, executed in a first computer operated by an incentive administrator that is coupled to a second computer operated by a payer and a third computer operated by a medical services organization, of providing an apportioned monetary incentive upon completion of a course of treatment for a patient with a condition during an episode of care, the method comprising:

• identifying a provider to perform a specific set of tasks in the course of treatment, wherein the provider is part of an accountable care organization (ACO) who is compensated by providing efficient patient care in accordance with a negotiated compensation between the provider and the ACO;
• creating an initial baseline value related to the course of treatment;
• receiving over the computer network, a diagnosis of the patient provided to the payer, along with an associated cost quantified by the baseline value;
• creating an episode of care based upon the diagnosis of the provider and the course of treatment for the condition;
• summing a plurality of claims processed during the episode of care to obtain a total treatment cost;
• determining, in a processor-based computer, if the total treatment cost is less than the baseline value, thus resulting in a cost savings for the course of treatment;
• analyzing, in the processor-based computer, the specific set of tasks performed by the provider to determine whether a change in the specific set of tasks performed by the provider would result in a greater cost savings without any decrease in a quality of care established for the course of treatment,
• generating an optimized course of treatment if a modified set of tasks for the provider results in the greater cost savings;
• representing in the processor-based computer, the cost savings as an incentive payment that is to be apportioned among the provider, the payer and the incentive administrator;
• causing a first portion of the incentive payment to be sent to the provider in the form of a monetary incentive that is individually calculated based on the episode of care, and correlated to the total treatment cost, and that is in addition to an ACO incentive paid to the responsible provider by the ACO;
• causing a second portion of the incentive payment to be sent to the payer, the second portion constituting a savings in the amount paid out for the course of treatment;
• and
• causing a third portion of the incentive payment to be retained by the incentive administrator, wherein the provider, the payer, and the incentive administrator are independent parties.