Population Management Application for Preventative Healthcare Compliance

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Solution Overview

Problem

Current healthcare delivery methods focus primarily on patients' chief complaints, leaving little time for preventative care, and existing methods for administering preventative healthcare to patient populations are not cost-effective or efficient in ensuring quality measures are met, particularly in the context of Accountable Care Organizations (ACO) where reimbursement is based on treatment outcomes.

Innovation Solution

A population management application that integrates comprehensive healthcare data to provide 'To Do' lists for providers, calculates performance scores against quality measures, and uses a central database linked to electronic health records, pharmacy, lab, and claims data to identify eligible patients, ensure compliance with preventative care standards, and implement follow-up measures for non-compliant patients.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Speed

If healthcare providers focus primarily on patients' chief complaints during office visits, then the speed of addressing acute issues is improved, but the quality of preventative care deteriorates

Engineering Contradiction:

Improvespeed of addressing chief complaintsVSAvoidquality of preventative care

Core Design Contradiction:

SpeedVSReliability

Solution Approach 1:

The system performs preliminary identification of patients who need preventative care services before the office visit occurs. By pre-screening the patient population and generating ready-to-review lists of needed services, the system ensures that preventative care needs are identified and addressed during the visit without delaying acute care delivery.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The population management application serves as an intermediary between the patient population and healthcare providers. It automatically screens patients, identifies preventative care needs, and presents organized information to providers, thereby bridging the gap between limited provider time and comprehensive preventative care requirements.

Inventive Principle:

Principle #24Intermediary (Mediator)

2Measurement precision

If comprehensive healthcare data is manually reviewed to identify patients needing preventative care, then the precision of patient identification is improved, but the time and resources required deteriorate

Engineering Contradiction:

Improveprecision of patient identificationVSAvoidtime for data review

Core Design Contradiction:

Measurement precisionVSLoss of time

Solution Approach 1:

The system replaces manual mechanical review of healthcare data with automated computer-based screening. The population management application automatically queries electronic health records, pharmacy data, lab results, and claims information to identify patients needing preventative care, eliminating time-consuming manual review while maintaining identification precision.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

Solution Approach 2:

The system enables self-service automated screening where the population management application independently performs data aggregation, patient identification, and list generation without requiring manual intervention. This automation maintains precise patient identification while significantly reducing the time and resources needed for data review.

Inventive Principle:

Principle #25Self-service

3Ease of operation

If traditional utilization-based compensation is used, then the ease of provider reimbursement is improved, but the quality of treatment outcomes deteriorates

Engineering Contradiction:

Improveease of provider reimbursementVSAvoidquality of treatment outcomes

Core Design Contradiction:

Ease of operationVSReliability

Solution Approach 1:

The system implements feedback mechanisms that track and report on the delivery of preventative care services and their impact on quality measures. By monitoring whether patients receive recommended services and measuring outcomes, the system provides data that can inform compensation models and incentivize quality improvement while maintaining operational simplicity.

Inventive Principle:

Principle #23Feedback

Data Source

PatentUS10586298B2Methods for administering preventative healthcare to a patient population

Publication Date: 2020.03.10 QUALITY STANDARDS

AI summary

Methods for administering preventative healthcare measures to a patient population are disclosed. A patient population eligible to receive certain healthcare benefits is defined and thereafter multiple sources of healthcare data are compiled and analyzed to create health profiles for each individual. An objective set of criteria for providing preventative care is provided to eligible members within the patient population and appropriate healthcare is administered to the degree necessary to make sure a sufficient percentage of the population receives adequate healthcare treatment consistent with the recognized, objective healthcare standards. Patients remaining non-compliant are sought for further administration of healthcare until requisite compliance standards are met.