MEDICAL NETWORK MANAGEMENT SYSTEM AND PROCESS

摘要

In a medical network management system (NMS) (20), health plan beneficia- ries access a team of health care profes- sionals over the telephone to help them assess their health needs and select ap- propriate care. The NMS (20) has a pa- tient assessment component (22). The pa- tient assessment component consists of a set of information tools which are used by health care professionals to assess pa- tient conditions and assist in the selection of health care services and to help pa- tients find appropriate care at the appropri- ate time. The tools include a comprehen- sive, automated set of proprietary assess- ment algorithms (26) which are based on branched chain algorithms utilizing Bayes theorem. These unique, clinical tools en- able a trained nurse or other health care professional to sort patients into differ- ent risk categories, safely and effectively without requiring a medical diagnosis. Pa- tients can then be guided to an appropriate level and type of care for their problem(s) based on their level of risk and set of po- tential needs.