System and method for patient specific customized recommendations of hospitals and ACOs

Patent metadata

Field	Value
Publication number	US-10846774-B2
Application number	US-201414339533-A
Country	US
Kind code	B2
Filing date	Jul 24, 2014
Priority date	Jul 24, 2013
Publication date	Nov 24, 2020
Grant date	Nov 24, 2020

Abstract

A system, method and computer readable storage medium for selecting a medical provider from a plurality of available medical providers. The selection being made by receiving medical data and one of geographical and financial data corresponding to a patient, comparing the medical data and the one of the geographical and financial data corresponding to the patient to corresponding data of a plurality of medical provider databases to determine a relationship therebetween and generating, via a recommendation generator, a recommendation of a first medical provider for the patient based on the medical data and the one of geographical and financial data and the comparison to the corresponding data of the medical provider databases.

First claim

The invention claimed is:

1. A method, comprising:
receiving medical data, geographical data and financial data corresponding to a patient;
comparing the medical data, the geographical data and the financial data to corresponding data of a plurality of medical provider databases to determine a relationship therebetween,
wherein at least one medical provider database is connected to a corresponding incentive generation process;

displaying at least one incentive for selecting a particular medical provider, the incentive including one or both of a financial and priority-based incentive;
executing an algorithm to determine a degree of similarity between the patient and previous patients served by each of the plurality of medical providers, wherein the algorithm comprises inputs related to patient demographics and symptoms, and the previous patients are similar to the patient when the degree of similarity is within a predetermined threshold; and
generating, via a recommendation generation tool, a recommendation of a first medical provider for the patient based on parameters including the medical data, the geographical data, the financial data, the comparison to the corresponding data of the medical provider databases, the available incentives for selecting a particular medical provider, an outcome-based performance of the medical providers across similar previous patients, and one of an emergency situation or a non-emergency situation wherein a first interface is displayed for an emergency mode and a second interface is displayed for a non-emergency mode, wherein the second interface includes data in the recommendation that is not included in the first interface, the data comprising past and present conditions and future plans of a user.

2. The method of claim 1 , wherein each of the plurality of medical providers is a hospital.

3. The method of claim 1 , wherein each of the plurality of medical providers is a hospital network further comprising one or more hospitals associated therewith, the method further comprising the step of generation of a recommendation of a hospital within the hospital network.

4. The method of claim 1 , wherein each of the plurality of medical providers is an Accountable Care Organization (ACO) further comprising one or more hospitals associated therewith, the method further comprising the step of generation of a recommendation of a hospital within the ACO.

5. The method of claim 1 , wherein the incentive generation process is based on a vacancy of hospital beds with the predetermined medical provider.

6. The method of claim 1 , further comprising the step of receiving, via a patient data entry interface, data corresponding to one or more of medical, demographic, geographical and financial data of the patient and using this data to make the recommendation.

7. The method of claim 1 , further comprising the step of receiving, via a patient future plan entry interface, data corresponding to one or more of future medical, future financial and future geographical plans of the patient and using this data to make the recommendation.

8. The method of claim 1 , wherein the medical provider database includes all information proprietary to the medical provider on demographic, medical, claims-related, and financial aspects of all the individuals served in the past and present by the insurance provider as well as all the information publicly reported by an insurance provider.

9. The method of claim 1 , wherein the medical provider database includes all information proprietary to the medical provider on procedural, diagnostic, outcomes-related and financial aspects of all the patients served in the past and present by the medical provider as well as information publicly reported by the medical provider.

10. The method of claim 1 , wherein the recommendation generation results in two or more pareto-optimal recommendations.

11. The method of claim 1 , wherein the recommendation is for emergency situations, the recommendation generation tool including a terminal accessible to the patient through one or more of a computer, smart-phone and a 911 call-center.

12. The method of claim 1 , wherein the recommendation is for non-emergency situations.

13. The method of claim 1 , wherein the geographical data is more heavily weighted in generating the recommendation during the emergency situation than during the non-emergency situation.

14. A system for selecting a medical provider from a plurality of available medical providers, comprising:
a memory storing a plurality of medical provider databases associated with each of a plurality of medical providers, the medical provider databases including data corresponding to demographic, medical, geographic, claims-related and financial aspects of patients served in the past by each respective medical provider and a set of instructions,
wherein at least one medical provider database is connected to a corresponding incentive generation process, the incentive generation process displaying at least one available incentive for selecting a particular medical provider, the incentive including one or both of a financial and priority-based incentive; and

a processor that executes the instructions to perform operations, comprising executing an algorithm to determine a degree of similarity between the patient and previous patients served by each of the plurality of medical providers, wherein the algorithm comprises inputs related to patient demographics and symptoms, and the previous patients are similar to the patient when the degree of similarity is within a predetermined threshold, determining a medical provider suited to patient data including_medical, geographical and financial needs of a patient, the determination being made based on a comparison of the patient data with the one or more medical provider databases, the at least one available incentive for selecting a particular medical provider, and an outcome-based performance of the medical providers across similar previous patients, generating a recommendation based on the comparison and one of an emergency situation or a non-emergency situation, and generating a display for the recommendation on a display to the patient wherein a first interface is displayed for an emergency mode and a second interface is displayed for a non-emergency mode, wherein the second interface includes data in the recommendation that is not included in the first interface, the data comprising past and present conditions and future plans of a user.

15. The system of claim 14 , wherein the processor is adapted to compare the patient data with past patient data of a subset of patients having similar medical diagnoses.

16. The system of claim 14 , wherein the processor is adapted to make the recommendation based on future patient data corresponding to one or more of future medical data, future financial data and future geographical data.

17. The system of claim 14 , wherein the medical provider is one of a hospital, hospital network and ACO.

18. The system of claim 17 , wherein if the medical provider is a hospital network or ACO, the process generates a further recommendation corresponding to a particular hospital associated with the hospital or ACO.

19. A non-transitory computer-readable storage medium with an executable program stored thereon, wherein the program instructs a processor to perform the following operations:
receiving medical data, geographical data and financial data corresponding to a patient;
comparing the medical data, the geographical data and the financial data

Assignees

• Koninklijke Philips Nv

Inventors

• Vaze Vikrant Suhas
• Bagheri Saeed Reza
• Cao Hanqing

Classifications

• G16H40/20

  for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms · CPC title

• G06Q30/0631 Primary

  Recommending goods or services · CPC title

• G06Q50/22

  Social work or social welfare, e.g. community support activities or counselling services · CPC title

• G06Q10/10

  Office automation; Time management · CPC title