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Title: US5845254: Method and apparatus for objectively monitoring and assessing the performance of health-care providers based on the severity of sickness episodes treated by the providers
[ Derwent Title ]


Country: US United States of America

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23 pages

 
Inventor: Lockwood, Edward J.; Burlington, CT
Tarrant, Jeffrey; Hartford, CT
Volpe, Michael; Hartford, CT

Assignee: Cigna Health Corporation, Bloomfield, CT
other patents from CIGNA HEALTH CORPORATION (736753) (approx. 2)
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Published / Filed: 1998-12-01 / 1996-06-04

Application Number: US1996000658991

IPC Code: Advanced: G06Q 30/00;
IPC-7: G06F 17/00; G06F 159/00;

ECLA Code: G06Q30/02; G06Q30/06; G06Q40/08; G06Q50/22; G06Q50/24;

U.S. Class: Current: 705/002; 705/003; 705/004;
Original: 705/002; 705/003; 705/004;

Field of Search: 705/002,3,4

Priority Number:
1996-06-04  US1996000658991
1995-06-07  US1995000487462

Abstract:     A method and apparatus for objectively monitoring the performance of a group of health-care providers. In-patient payment claim records representative of in-patient health-care services performed for patients by health-care providers within the group of health-care providers and out-patient payment claim records representative of out-patient health-care services performed for patients by health-care providers within group of health-care providers are stored in databases. A plurality of sickness episode data records are built from the in-patient payment claim records and the out-patient payment claim records, and an objective severity adjustment analysis is performed on the sickness episode data records to form a plurality of severity-adjusted sickness episode data records. A cost-efficiency performance level is determined for each individual health-care provider within the group of health-care providers from the plurality of severity-adjusted sickness episode data records, and a qualitative performance level is determined for the group of health-care providers as a whole.

Attorney, Agent or Firm: Reed Smith Shaw & McClay LLP ;

Primary / Asst. Examiners: MacDonald, Allen R.; Rhodes, Jason W.

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Related Applications:
Application Number Filed Patent Pub. Date  Title
US1995000487462 1995-06-07    1998-01-06  Method and apparatus for objectively monitoring and assessing the performance of health-care providers


       
Parent Case:

CROSS-REFERENCES TO RELATED APPLICATIONS
    This is a continuation-in-part of application Ser. No. 08/487,462, filed Jun. 7, 1995, now U.S. Pat. No. 5,706,441.

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First Claim:
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What is claimed is:     1. An apparatus for objectively monitoring the performance of a group of health-care providers, comprising:
  • (A) a database storage means for storing in-patient payment claim records representative of in-patient health-care services performed for patients by health-care providers within said group of health-care providers and out-patient payment claim records representative of out-patient health-care services performed for said patients by health-care providers within said group of health-care providers;
  • (B) episode building means, coupled to said database storage means, for building a plurality of sickness episode data records from said in-patient payment claim records and said out-patient payment claim records;
  • (C) severity adjustment means, coupled to said episode building means, for performing an objective severity adjustment analysis on said plurality of sickness episode data records to form a plurality of severity-adjusted sickness episode data records; and
  • (D) a computer workstation, coupled to said database storage means, said computer workstation including:
    • (i) cost-efficiency performance assessment means, responsive to said plurality of severity adjusted sickness episode data records, for objectively determining a cost-efficiency performance level for each individual health-care provider within said group of health-care providers;
    • (ii) qualitative-performance assessment means, responsive to said in-patient payment claim records and said out-patient payment claim records, for objectively measuring a qualitative performance level of said group of health-care providers as a whole; and
    • (iii) budget monitoring means for determining a total illness cost value representing costs incurred by said group of health-care providers as a whole for treating a selected condition and comparing said total illness cost value to a predetermined budgeted illness cost value associated with said selected condition.


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Forward References: Show 60 U.S. patent(s) that reference this one

       
U.S. References: Go to Result Set: All U.S. references   |  Forward references (60)   |   Backward references (5)   |   Citation Link

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PDF
Patent  Pub.Date  Inventor Assignee   Title
Get PDF - 14pp US5365425  1994-11 Torma et al.  The United States of America as represented by the Secretary of the Air Force Method and system for measuring management effectiveness
Get PDF - 293pp US5508912  1996-04 Schneiderman  Schneiderman; Barry Clinical database of classified out-patients for tracking primary care outcome
Get PDF - 130pp US5544044  1996-08 Leatherman  United Healthcare Corporation Method for evaluation of health care quality
Get PDF - 32pp US5557514  1996-09 Seare et al.  Medicode, Inc. Method and system for generating statistically-based medical provider utilization profiles
Get PDF - 8pp US5724379  1998-03 Perkins et al.  HealthChex, Inc. Method of modifying comparable health care services
       
Foreign References: None

Other Abstract Info: DERABS G98-086464

Other References:
  • Horn, Susan D. "Measuring Severity: How Sick is Sick? How Well is Well?" Healthcare Financial Management, Oct. 1996, pp. 21-31.


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