Hierarchical Claims Data Grouping for Multi-Level Care Episodes

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Solution Overview

Problem

Existing data grouping systems for medical data are incapable of providing a complete view of multi-faceted treatments over time, failing to automatically generate multi-level, hierarchical data objects that reflect complex patient care scenarios.

Innovation Solution

A computer-based system generates hierarchical episode-based data objects by applying rules to claim records, identifying parent and sub-episodes, and establishing a relational hierarchy using eligibility criteria, allowing for a comprehensive view of patient care.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Adaptability or versatility

If existing data grouping systems are used to organize medical claims data, then basic data organization is achieved, but the systems cannot provide a complete view of multi-faceted treatments or generate hierarchical data objects reflecting complex patient care scenarios

Engineering Contradiction:

Improvecapability to represent complex patient care scenariosVSAvoidsystem complexity for generating hierarchical data objects

Core Design Contradiction:

Adaptability or versatilityVSDevice complexity

Solution Approach 1:

The patent segments medical claims data into hierarchical episodes of care, where parent episodes represent overall treatment periods and sub-episodes represent specific treatment components. This segmentation allows the system to capture complex multi-faceted treatments by breaking them into manageable hierarchical units that can be independently analyzed and displayed.

Inventive Principle:

Principle #1Segmentation

Solution Approach 2:

The patent introduces a temporal dimension to data organization by creating time-based hierarchical structures where episodes have start and end dates, and sub-episodes are nested within specific time ranges. This temporal dimensionality transformation enables the system to represent the evolution of patient care over time, adding depth to the data structure beyond simple flat organization.

Inventive Principle:

Principle #17Another dimension (Dimensionality change)

2Loss of information

If comprehensive rules are applied to identify parent and sub-episodes, then complete hierarchical representation of patient care is achieved, but computational processing time and complexity increase

Engineering Contradiction:

Improvecompleteness of patient care viewVSAvoidcomputational processing time

Core Design Contradiction:

Loss of informationVSLoss of time

Solution Approach 1:

The patent applies preliminary filtering actions by establishing eligibility criteria that must be satisfied before claims can be classified as parent or sub-episodes. These pre-defined rules filter the claims data in advance, identifying only those records that meet specific conditions for hierarchical classification, thereby reducing the computational burden of processing all claims data equally.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The patent applies different processing rules and eligibility criteria to different levels of the hierarchical structure. Parent episodes have specific eligibility requirements distinct from sub-episodes, allowing the system to optimize processing by applying appropriate rules only where needed rather than uniformly across all data, thus balancing completeness with processing efficiency.

Inventive Principle:

Principle #3Local quality

3Measurement precision

If multi-level hierarchical data structures are generated, then detailed representation of treatment relationships is achieved, but data processing and storage requirements increase

Engineering Contradiction:

Improvedetail level of treatment representationVSAvoiddata volume for storage and processing

Core Design Contradiction:

Measurement precisionVSQuantity of substance

Solution Approach 1:

The patent implements a nested hierarchical structure where sub-episodes are contained within parent episodes, creating a doll-like nested arrangement of data. This nesting allows detailed treatment information to be organized within broader treatment contexts, providing high measurement precision for treatment relationships while efficiently managing data volume through hierarchical compression and shared parent references.

Inventive Principle:

Principle #7Nested doll (Nesting)

Data Source

PatentUS12367984B1Computer-implemented systems and methods for multi-level data grouping and generation of a hierarchical data display from uniform claims data

Publication Date: 2025.07.22 OPTUM INC

AI summary

Hierarchical data objects are generated via a computer-based system for applying a series of rules to establish episode-specific data objects reflecting a plurality of discrete claim records before further dissecting the generated episode-specific data objects prior to finalization of those episode-specific data objects to identify claim records within the episode-specific data objects that are eligible for generation of one or more sub-episodes within the episode-specific data objects. The identified sub-episodes are reflected within the episode-specific data object to designate complete episodes of care that additionally reflect interactions with the corresponding parent episode.