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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 ]
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| Country: |
US United States of America
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| Inventor: |
Lockwood, Edward J.; Burlington, CT
Tarrant, Jeffrey; Hartford, CT
Volpe, Michael; Hartford, CT
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| 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
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| Application Number: |
US1996000658991
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| IPC Code: |
Advanced:
G06Q 30/00;
IPC-7:
G06F 17/00;
G06F 159/00;
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| ECLA Code: |
G06Q30/02; G06Q30/06; G06Q40/08; G06Q50/22; G06Q50/24;
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| U.S. Class: |
Current:
705/002;
705/003;
705/004;
Original:
705/002;
705/003;
705/004;
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| Field of Search: |
705/002,3,4
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| Priority Number: |
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| 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.
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| Attorney, Agent or Firm: |
Reed Smith Shaw & McClay LLP ;
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| Primary / Asst. Examiners: |
MacDonald, Allen R.; Rhodes, Jason W.
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| INPADOC Legal Status: |
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| 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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| Family: |
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First Claim:
Show all 28 claims |
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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| Background / Summary: |
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| Drawing Descriptions: |
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| Description: |
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| Forward References: |
Show 41 U.S. patent(s) that reference this one
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