IDENTIFICATION, STRATIFICATION, AND PRIORITIZATION OF PATIENTS WHO QUALIFY FOR CARE MANAGEMENT SERVICES

摘要

Methods, systems, and computer-readable media are provided for identifying, stratifying, and prioritizing patients who are eligible for care management services. For each patient, patient health data is used to determine one or more of a disease burden associated with the patient, an amount of health system utilization by the patient, and an amount of money spent on healthcare services for the patient. It is further determined if the patient exceeds a respective threshold value associated with each of these criteria. If the patient exceeds the respective threshold value, the patient is stratified into a category comprising one of high-risk senior, high-risk adult, high-risk pediatrics, or high-risk maternity. The patient may also be prioritized based on one or more factors, and a notification may be sent to the patient informing the patient of his/her eligibility for care management services.

主权项

1. One or more computer-readable media having computer executable instructions embodied thereon that, when executed by a computing device, perform a method of identifying and stratifying a population of patients eligible for care management services, the method comprising:
receiving data associated with the population of patients from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data; for each patient within the population of patients, using the data to determine: (1) a disease burden associated with the each patient, (2) an amount of health system utilization by the each patient, and (3) an amount of money spent on healthcare services for the each patient; determining that a first patient within the population of patients exceeds a predetermined threshold value associated with one or more of the disease burden, the amount of health system utilization, or the amount of money spent on healthcare services; subsequent to determining that the first patient exceeds the predetermined threshold value, categorizing the first patient into one of the following categories: (1) high-risk senior, (2) high-risk adult, (3) high-risk pediatrics, or (4) high-risk maternity; and generating a notification that the first patient is eligible for care management services.