System and method of prioritizing and administering healthcare to patients having multiple integral diagnoses

Abstract

A method of administering healthcare to patients with multiple integral diagnoses such that the clinical outcomes and health-related quality of life of said patients are improved while medical costs are minimized. A patient population is first identified. The population is then stratified into specific levels of intervention. Each individual patient is then assigned a Priority Care Nurse Manager who serves to establish communication between the patient, the patient's Primary Care Physician, and any healthcare providers. The most appropriate treatment plan is cooperatively developed and the patient receives treatment according to the plan. The most appropriate treatment may include home care and palliative measures. The patient may appoint a Health Care Agent to make medical decisions for the patient should the patient be unable to make decisions.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS [0001] Not Applicable STATEMENT RE: FEDERALLY SPONSORED RESEARCH / DEVELOPMENT [0002] Not Applicable BACKGROUND [0003] The present invention is directed to systems and methods for administering healthcare resources amongst patients within a patient population. More particularly, the present invention comprises systems and methods for prioritizing treatment of patients having multiple integral diagnoses based on the severity of confirmed medical conditions. [0004] The ability to render high quality healthcare in a cost effective manner is an elusive object that many healthcare plans and providers have attempted but few have actually attained. Despite substantial efforts made by healthcare plans, health maintenance organizations (HMO), physician networks, government-sponsored health care plans and the like, there is lacking a system for facilitating healthcare treatment for patients with multiple integral diagnoses, wherein the patients' quality o...

AI Technical Summary

Benefits of technology

"The present method is about improving healthcare for patients with multiple diagnoses by providing personalized care and minimizing medical costs. The method involves identifying patients who qualify for healthcare, assigning a Priority Care Nurse Manager (PCNM) to each patient, and establishing communication between the PCNM, the patient's Primary Care Physician (PCP), and the patient to develop a treatment plan. The healthcare services determined by the treatment plan are then rendered to the patient. The method may be used with patients enrolled in healthcare organizations or with specific medical conditions. The PCNM may communicate with a specialist physician, a provider of healthcare service, a patient's family member, or a person designated by the patient. The method may also include documenting all communications and results of periodic contact with the patient. The patient may complete a Health Care Proxy (HCP) form to appoint a Health Care Agent (HCA) to make medical decisions for her in situations where she is unable to do so."

Problems solved by technology

Despite substantial efforts made by healthcare plans, health maintenance organizations (HMO), physician networks, government-sponsored health care plans and the like, there is lacking a system for facilitating healthcare treatment for patients with multiple integral diagnoses, wherein the patients' quality of life is improved while at the same time medical costs are minimized in order to be able to provide the best care to the most patients.

It is well known that patients with multiple integral diagnoses face poor clinical outcomes and a low quality of life that is further exacerbated by the patient not abiding by the prescribed treatment plan.

Also, many patients with multiple integral diagnoses are not fully educated as to all of the options available to them within their medical plan coverage and accordingly do not avail themselves of all possibilities for treatment of their conditions.

Furthermore, under traditional healthcare plans, different members of a patient's health care team are often unaware of each other's activities and of the patient's overall treatment plan.

As such, oftentimes a patient with multiple integral diagnoses that if carefully managed would be able to vastly improve her clinical outcome and health-related quality of life suffers due to lack of maintaining a developed treatment plan, lack of education, and / or lack of healthcare team coordination.

Additionally, medical costs are often wasted due to this lack of coordination and lack of educating the patient to all possibilities for treatment causing an overall loss in funds available for treatment of the entire patient population.

For example, many patients with multiple integral diagnoses are unaware of the possibility of avoiding hospitalization and extreme life sustaining treatments.

It has been assumed that the treatment of disease includes hospitalizing the patient and taking all measures necessary in order to prolong the life of the patient, irregardless of what that patient's quality of life will be.

Traditional healthcare plans often do not focus on what may be the best option for the patient, or do not take the patient's desires into consideration when reaching a medical treatment plan.

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