Systems, computer programs, and methods for controlling costs of a healthcare practice

A system to manage costs of one or more physicians in an insurance network, the system comprising:

• one or more databases having data of a plurality of physicians participating in an insurance network associated therewith, the data including a plurality of ancillary medical procedures used by one or more of the plurality of physicians to treat one or more of a plurality of patients, costs of one or more of the plurality of ancillary medical procedures, and a plurality of preferred ancillary medical procedures;
• one or more processors being positioned in communication with the one or more databases and being configured to process the data;
• and
• non-transitory memory encoded with one or more computer programs operable by the one or more processors so that during operations thereof, the one or more processors being operable to perform the following steps:
• measuring, in a first computer process, average ancillary medical costs of one or more of the plurality of ancillary medical procedures used by the plurality of physicians to treat the plurality of patients on a per-member-per-month basis;
• calculating, in a second computer process, an average of the per-member-per-month basis over a predetermined period of time to determine a baseline per-member-per-month of the plurality of ancillary medical cost;
• determining, in a third computer process, a baseline-per-member-per-year using the baseline per-member-per-month of the plurality of ancillary medical costs;
• identifying, in a fourth computer process, at least one of the plurality of physicians who has used one or more of the plurality of ancillary medical procedure that is not preferred;
• generating, in a fifth computer process, information for the at least one of the plurality of physicians representative of one or more recommended alternative ancillary medical procedures that are preferred;
• determining, in a sixth computer process, whether the costs of the plurality of physicians have reached at least a predetermined level below the baseline-per-member-per-year over a predetermined time;
• calculating, in a seventh computer process, a predetermined percentage of costs savings for the plurality of physicians responsive to determining the costs of the plurality of physicians have reached at least the predetermined level below the baseline-per-member-per-year;
• and
• determining, in an eighth computer process, a portion of the costs savings attributable to behavior modification of one or more of the plurality of physician by practicing the recommended one or more alternative ancillary medical procedures, the behavior modifications including one or more of:
• one-on-one review of resort cards, placement of one or more chart inserts, a newsletter, treatment guidelines tied to formulas, permission documentation from one or more patient's physicians to communicate with the one or more corresponding patient, communication from one or more ancillary medical procedure provider indicating switch to new ancillary medical procedure, and generation by one or more processors of a new ancillary medical procedure with the ancillary medical procedure provider.

A system to manage costs of a plurality of physicians in an insurance network, the system comprising

• one or more databases having data of a plurality of physicians in a healthcare practice participating in an insurance network associated therewith, the data including a plurality of ancillary medical procedures used by one or more of the plurality of physicians to treat one or more of a plurality of patients, costs of one or more of the plurality of ancillary medical procedures, and a plurality of preferred ancillary medical procedures;
• one or more processors configured to process the data;
• and
• non-transitory memory encoded with one or more computer programs operable by the one or more processors so that during operations thereof, the one or more processors being operable to perform the following steps:
• determining, in a first computer process, baseline costs of one or more the plurality of ancillary medical procedures used by the plurality of physicians to treat the plurality of patients using data stored in the one or more databases, the baseline costs being determined by measuring average ancillary medical costs of the plurality of ancillary medical procedures on a per-member-per-month basis, and
• calculating an average of the per-member-per-month basis over a predetermined period of time to determine a baseline per-member-per-month of the plurality of ancillary medical cost;
• identifying, in a second computer process, at least one of the plurality of physicians who has used one or more of the plurality of ancillary medical procedure that is not preferred for cost management behavior modification of one or more of the plurality of ancillary medical procedures;
• generating, in a third computer process, information for the at least one of the plurality of physicians indicating recommended one or more alternative ancillary medical procedures that are preferred to modify cost management behavior of the at least one of the plurality of physicians in the healthcare practice with respect to management of ancillary medical costs;
• determining, in a fourth computer process, whether the costs of the plurality of physicians have reached at least a predetermined level below the baseline over a predetermined period of time;
• and
• calculating, in a fifth computer process, a predetermined percentage of costs savings responsive to determining the costs of the plurality of physicians have reached at least the predetermined level below the baseline, at least a portion of the costs savings being attributable to behavior modification of one or more of the plurality of physician by practicing the recommended one or more alternative ancillary medical procedures, and wherein the behavior modifications include one or more of:
• one-on-one review of report cards, placement of one or more chart inserts, a newsletter, treatment guidelines tied to formulas, permission documentation from one or more patient's physicians to communicate with the one or more corresponding patient, communication from one or more ancillary medical procedure provider indicating switch to new ancillary medical procedure, and generation by one or more processors of a new ancillary medical procedure with the ancillary medical procedure provider.