Methods, program product, and systems for healthcare practice management

Abstract

Methods, program product, and systems are provided for optimizing profits for healthcare practices and insurance networks. The methods, program product, and systems include modifying physician's cost management behavior to enhance profitability of healthcare practices and insurance networks by identifying physicians that are not profitable because of cost management behavior and providing intervention to change the management behavior of the physician.

Description

RELATED APPLICATIONS [0001] The application is a continuation of and claims priority to and the benefit of U.S. patent application Ser. No. 09 / 812,704, titled “Methods and System for Healthcare Practice Management,” filed Mar. 19, 2001, related to U.S. patent application Ser. No. 09 / 812,703 titled “Methods For Collecting Fees For Healthcare Management Group” filed Mar. 19, 2001, which are each incorporated herein by reference in its entirety.BACKGROUND OF THE INVENTION [0002] 1. Field of the Invention [0003] The present invention relates to the healthcare industry and, more particularly, to the field of healthcare management. [0004] 2. Description of Related Art [0005] In the healthcare industry, as illustrated in FIG. 1, physicians generally organize themselves into practice groups 25 and normally subcontract to an insurance network 30. The insurance network 30 is not limited to traditional insurance networks, i.e., Blue Cross Blue Shield, Aetna, United Healthcare, etc., but also i...

AI Technical Summary

Benefits of technology

[0023] An embodiment of the present invention advantageously strengthens the relationship between insurance companies and physicians by providing an intermediary that provides information to make modifications to ancillary medical treatment procedures to both the physicians and the insurance network. The information provided by the intermediary includes scientific and medical research literature and advantageously eliminates the research time and costs necessary for the physicians and the insurance networks to make informed decisions and recommendations regarding patient care. The research necessary to make the informed decisions is advantageously provided to the physicians and the insurance networks.

[0024] An embodiment of the present invention also advantageously provides educational information regarding alternative ancillary medical procedures to patients that insist on a particular ancillary medical procedure, i.e., insis...

Problems solved by technology

These requirements often fall within varying cost centers, such as pharmaceutical, laboratory, anesthesiology, and radiation costs, for example.

This arrangement is disadvantageous for the physician practice 25 participating in the insurance network 30 because it requires a great deal of management and organization to follow the requirements of the insurance network 30.

The system is even more disadvantageous for the physician practice 25 if it participates in multiple insurance networks 30.

As noted ab...

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