METHOD OF OPTIMIZING HEALTHCARE SERVICES CONSUMPTION

摘要

A method of optimizing healthcare services consumption according to the invention includes the steps of assessing the healthcare situation of an employer providing healthcare benefits to a population, identifying a first group of patients from the population likely to generate expensive healthcare claims based on data representing past claims, periodically determining whether patients in the first group have satisfied certain predetermined healthcare requirements, identifying a first group of providers who provide high quality, cost efficient healthcare services based on the practice patterns of the providers, prompting patients who have not satisfied the predetermined healthcare requirements to obtain services from providers in the first group, and responding to healthcare requests from patients by determining whether the requesting patient is seeking services from a provider in the first group, and, if not, urging the patient to obtain such services from a provider in the first group.

主权项

1. A method of optimizing healthcare services consumption, including the steps of:
assessing a healthcare situation of a population of patients that reside and consume healthcare services in a geographic zone, the geographic zone consisting of a plurality of geographic regions, each of which includes at least one of a residential address of a patient in the population and a location of a provider who services patients in the population; using a computing device to transform information generated by the population into data representing a first group of patients from the population likely to have a higher consumption of healthcare services than other patients in the population; periodically determining whether patients in the first group have obtained healthcare services that satisfy predetermined requirements; using a computing device to transform information about providers in the geographic zone into identification of a first group of providers in the geographic zone who provide high quality, cost efficient healthcare services relative to other providers in the geographic zone; prompting patients who have not obtained healthcare services that satisfy the predetermined requirements to obtain additional healthcare services to satisfy the predetermined requirements from providers in the first group of providers; and communicating with patients to urge the patients to obtain the healthcare services from a provider in the first group of providers.