Chronic Population Based Cost Model to Compare Effectiveness of Preventive Care Programs

Abstract

Our invention is a cost model for healthcare, based not on “age”, as it is done currently, but on “chronic illness” as a risk factor. Using the model it is possible to derive two burden numbers, “Primary” and “Secondary” that is an inverse measure of the success of primary and secondary preventive care programs. Using this new metric, a better explanation for cost increases is possible. It can help estimate increases more accurately and make explicit suggestions on where the focus of attention should be to lowering costs. Trendlines of the metric can measure performance of care programs month by month and not have to wait a decade to yield perceptible results. A particular embodiment of this model is the software program described in this application, called Health Keys, which serves as a decision support system for CFOs of companies and healthplans to help institute relevant preventive care programs and measure the success of them. Health Keys is one example of a “useful, concrete and tangible result” that is based on our invention of a new cost model.

Description

[0001]This U.S. Patent Application is a continuation of U.S. patent application Ser. No. 12 / 798,083, filed Mar. 29, 2010, now U.S. Pat. No. 8,676,598; which claims priority to U.S. Provisional Patent Application Ser. No. 61 / 164,929, filed Mar. 31, 2009, the content of which is hereby incorporated by reference herein in its entirety into this disclosure.BACKGROUND OF THE INVENTION[0002](1) Field of the Invention[0003]This invention relates to a method of comparing the effectiveness of preventive care programs for chronic patients using a metric for performance that can then be illustrated via the use of a “Preventive Care Atlas™” and scatter plots of care performance and Costs. More specifically this invention relates to the creation of a new cost model for a population, with chronic disease as the designated risk, so as to calculate trends in incidence, prevalence and severity of chronic conditions in a population and estimate the associated impact on healthcare costs.[0004](2) Desc...

AI Technical Summary

Benefits of technology

The patent text describes a model that represents chronic illness by showing patients in different health states. The model implies that patients may stay in one health state or move to another, more severe condition that results in higher costs. The technical effect is that the model can help researchers better understand the trajectory and impact of chronic illness on patients and the healthcare system.

Problems solved by technology

But the spread and prevalence of chronic illness and cancer have distorted the medical needs of populations beyond the limits of statistical extrapolations.

In analyzing the medical claims data of an employee population it became obvious that it wasn't aging that caused the rise in medical needs but aging in an unhealthy fashion.

In other words, many employees became chronically ill with diseases like hypertension and diabetes and at an early stage these diseases tend to get neglected because there is no pain nor any overt signs of problems.

In time the disease festers, causing many complications and they are mistakenly attributed to aging.

The primary one has to do with the inability of current healthcare cost models to predict next year's costs accurately based solely on statistical factors.

In other words, while the model does not predict which enrollees will develop a chronic condition or complications, once identified by the diagnosis code in the claim as belonging to a specific health state then the annual medical cost for the new health state is known.

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