Patent Application Titled “System And Method For Eligible Patient Identification, Leakage Quantification And Workflow Software” Published Online (USPTO 20210304861): Patent Application

2021 OCT 15 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- According to news reporting originating from Washington, D.C., by NewsRx journalists, a patent application by the inventor STEVENSON, Daniel Whitney (Quincy, MA, US), filed on August 15, 2019, was made available online on September 30, 2021.

No assignee for this patent application has been made.

Reporters obtained the following quote from the background information supplied by the inventors: “The current state of the art involves a nurse, pharmacy technician or pharmacist monitoring a healthcare provider’s electronic health records system for details on patients, including what medications the patients have been prescribed, and where they are currently filling their medications. Once the practitioner determine these details, they then begin a benefits investigation including a test claim to determine the patient’s pharmacy benefit and whether the patient is eligible to fill a particular prescribed medication at a pharmacy.

“The nurse, pharmacy technician or pharmacist uses the IT systems to run a benefits investigation, for example, a pharmacy’s management system (e.g., Willow, Rx30, QS1), the health system’s electronic medical records system (e.g., EPIC, Cerner, Allscripts), an eligibility portal (e.g., Emdeon or Nehan), a Medicaid eligibility finder (e.g., epaces, MassHealth portal) calling the patient’s existing pharmacy, or ultimately calling the patient. Once the appropriate information is gathered, the pharmacy management system then conducts a test claim based on that patient’s BIN, PCN, and Group number and the NDC code of the drug. This approach takes a substantial amount of time to complete (e.g., 15 minutes per patient and up to 60 minutes per patient), spread across many patients (in some instances >100 patients) per day for a single clinic makes this process untenable and does not allow for a user to fully understand the eligible patient roster of their clinic or disease state.

“Further, this patient-by-patient approach invites errors, requires review of every patients’ medications, medication regimen and insurance coming through the clinic. Ultimately many patients are missed and are not appropriately triaged to the pharmacy of the patient’s choosing to receive the highest level of care and financially benefit the health system as well as the patient.”

In addition to obtaining background information on this patent application, NewsRx editors also obtained the inventor’s summary information for this patent application: “The invention encompasses systems and methods to identify patients of a health system or healthcare provider and gain insight as to the areas of opportunity for a pharmacy to focus its efforts in order to improve care for the patients in greatest medical need as well as identify patients eligible to fill one or more medications at a particular pharmacy.

“The invention generally encompasses a system and method wherein a user (e.g., a prescriber, nurse, case manager, pharmacy liaison, administrative staff, pharmacy technician or pharmacist) is presented with a list of one or more patients who are eligible to fill a prescription with the pharmacy of the user’s or patient’s choosing (including, but not limited to, a hospital-owned specialty pharmacy or third-party contract pharmacy, collectively “pharmacies”). In certain embodiments, the user is provided with the appropriate method (in-person vs. telephonically) to begin a discussion with the patient about the benefits of the pharmacies. This decision-tree logic regarding the most effective means to enroll the patient in a pharmacy program ensures the patient receives the highest level of care (as appropriate) and provides valuable insight to the user about the patient’s medication adherence.

“Accordingly, a first embodiment of the invention encompasses a system for identifying and matching patients to fill a prescription from a pharmacy comprising a server in communication with a user computing device or a plurality of user computing devices and one or more databases, wherein the server is configured to:

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“(a) receive a request from the user computing device or plurality of user computing devices to process one or more identifiable indicators of a patient comprising medical history, prescription medication history, personal health insurance information, or medication fulfillment history;

“(b) in response to receipt of the request, retrieve data related to a patient, comprising prescription drug information, medical history, prescription medication history, personal health insurance information, medication fulfillment history and/or patient scheduling information from a database;

“© match the retrieved data with a predetermined list of prescription drugs, physicians, clinics, and/or patient scheduling information;

“(d) create an appointment list based on matches between drugs, physicians, clinics, and/or patient scheduling information in the predetermined lists;

“(e) provide the matched data and a subset of the retrieved data to users to confirm eligibility of the patients; and

“(f) determine whether or not the patient has a scheduled visit to a medical provider.

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“In an exemplary embodiment, the system for identifying and matching patients to fill a prescription includes the determining whether or not the patient has a scheduled visit to a medical provider and further includes:

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“(i) if the eligible patient has a scheduled visit, advising the user of a list of patients to meet at their visit to enroll the patient with a pharmacy; or

“(ii) if the eligible patient does not have a scheduled visit within a pre-determined time period, advising the user to further communicate with a patient to enroll the patient with a pharmacy.

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“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription, a list of patients eligible to fill a prescription using a hospital’s pharmacy or pharmacy of the prescriber’s choosing and who have been contacted in a given period is delivered to the user through one or more user interfaces.

“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription, one or more user interfaces provide contacted patients and uncontacted patient rosters and financial information to advise a health system of quality of patient care, medication adherence, and financial growth for the health system.

“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription, the pharmacy is a hospital-owned pharmacy or third-party pharmacy in which a health care system or healthcare provider has a contractual relationship.

“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription of claim 1, further comprising an algorithmic filtering process to process large amounts data from disparate systems including appointment data and electronic prescription data.

“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription, the data comprise healthcare providers’ electronic medical record system, pharmacy management system data, and eligibility verification data.

“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription, includes a management system data that comprises data for patients who already fill prescriptions with the pharmacies.

“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription the eligibility verification data comprises confirmation that a patient’s insurance covers the medication.

“In another exemplary embodiment of the system for identifying and matching patients to fill a prescription, the user is a practitioner, clinician, prescriber, or administrator.

“In another embodiment, the invention encompasses a method for identifying and matching patients to fill a prescription from a pharmacy comprising:

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“(a) receiving a request from the user computing device or plurality of user computing devices to process one or more identifiable indicators of a patient comprising medical history, prescription medication history, personal health insurance information, or medication fulfillment history;

“(b) retrieving data related to a patient, comprising prescription drug information, medical history, prescription medication history, personal health insurance information, medication fulfillment history and/or patient scheduling information from a database;

“© matching the retrieved data with a predetermined list of prescription drugs, physicians, clinics, and/or patient scheduling information;

“(d) creating an appointment list based on matches between drugs, physicians, clinics, and/or patient scheduling information in the predetermined lists;

“(e) providing the matched data and a subset of the retrieved data to users to confirm eligibility of the patients; and

“(f) determining whether the patient has a scheduled visit to a medical provider.

“

“In an exemplary embodiment, the method for identifying and matching patients to fill a prescription includes determining whether or not the patient has a scheduled visit to a medical provider and further comprises:

“

“(i) advising the user of a list of patients to meet at their visit to enroll the patient with a pharmacy if the eligible patient has a scheduled visit, or

“(ii) advising the user to further communicate with a patient to enroll the patient with a pharmacy if the eligible patient does not have a scheduled visit within a pre-determined time period.

“

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription a list of patients eligible to fill a prescription using a hospital’s pharmacy or pharmacy of the prescriber’s choosing and who have been contacted in a given period is delivered to the user through one or more user interfaces.

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription the one or more user interfaces provide contacted patients and uncontacted patient rosters and financial information to advise a health system of quality of patient care, medication adherence, and financial growth for the health system.

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription the pharmacy is a hospital-owned pharmacy or third-party pharmacy in which a health care system or healthcare provider has a contractual relationship.

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription further comprises an algorithmic filtering process to process large amounts data from disparate systems including appointment data and electronic prescription data.

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription, the data comprise healthcare providers’ electronic medical record system data, pharmacy management system data, and prior authorization data.

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription, the pharmacy management system data comprises data for patients who already fill prescriptions with the pharmacies.

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription, wherein the prior authorization data comprises confirmation that a patient’s insurance covers the medication.

“In another exemplary embodiment of the method for identifying and matching patients to fill a prescription, wherein the user is a practitioner, clinician, prescriber, or administrator.”

The claims supplied by the inventors are:

“1. A system for identifying and matching patients to fill a prescription from a pharmacy comprising: a server in communication with a user computing device or a plurality of user computing devices and one or more databases, wherein the server is configured to: (a) receive a request from the user computing device or plurality of user computing devices to process one or more identifiable indicators of a patient comprising medical history, prescription medication history, personal health insurance information, or medication fulfillment history; (b) in response to receipt of the request, retrieve data related to a patient, comprising prescription drug information, medical history, prescription medication history, personal health insurance information, medication fulfillment history and/or patient scheduling information from a database; © match the retrieved data with a predetermined list of prescription drugs, physicians, clinics, and/or patient scheduling information; (d) create an appointment list based on matches between drugs, physicians, clinics, and/or patient scheduling information in the predetermined lists; (e) provide the matched data and a subset of the retrieved data to users to confirm eligibility of the patients; and (f) determine whether or not the patient has a scheduled visit to a medical provider.

“2. The system for identifying and matching patients to fill a prescription of claim 1, wherein the determining whether or not the patient has a scheduled visit to a medical provider further comprises: (i) if the eligible patient has a scheduled visit, advising the user of a list of patients to meet at their visit to enroll the patient with a pharmacy; or (ii) if the eligible patient does not have a scheduled visit within a pre-determined time period, advising the user to further communicate with a patient to enroll the patient with a pharmacy.

“3. The system for identifying and matching patients to fill a prescription of claim 2, wherein a list of patients eligible to fill a prescription using a hospital’s pharmacy or pharmacy of the prescriber’s choosing and who have been contacted in a given period is delivered to the user through one or more user interfaces.

“4. The system for identifying and matching patients to fill a prescription of claim 3, wherein the one or more user interfaces provide contacted patients and uncontacted patient rosters and financial information to advise a health system of quality of patient care, medication adherence, and financial growth for the health system.

“5. The system for identifying and matching patients to fill a prescription of claim 1, wherein the pharmacy is a hospital-owned pharmacy or third-party pharmacy in which a health care system or healthcare provider has a contractual relationship.

“6. The system for identifying and matching patients to fill a prescription of claim 1, further comprising an algorithmic filtering process to process large amounts data from disparate systems including appointment data and electronic prescription data.

“7. The system for identifying and matching patients to fill a prescription of claim 6, wherein the data comprise healthcare providers’ electronic medical record system, pharmacy management system data, and eligibility verification data.

“8. The system for identifying and matching patients to fill a prescription of claim 7, wherein the management system data comprises data for patients who already fill prescriptions with the pharmacies.

“9. The system for identifying and matching patients to fill a prescription of claim 7, wherein the eligibility verification data comprises confirmation that a patient’s insurance covers the medication.

“10. The system for identifying and matching patients to fill a prescription of claim 1, wherein the user is practitioner, clinician, prescriber, or administrator.

“11. A method for identifying and matching patients to fill a prescription from a pharmacy comprising: (a) receiving a request from the user computing device or plurality of user computing devices to process one or more identifiable indicators of a patient comprising medical history, prescription medication history, personal health insurance information, or medication fulfillment history; (b) retrieving data related to a patient, comprising prescription drug information, medical history, prescription medication history, personal health insurance information, medication fulfillment history and/or patient scheduling information from a database; © matching the retrieved data with a predetermined list of prescription drugs, physicians, clinics, and/or patient scheduling information; (d) creating an appointment list based on matches between drugs, physicians, clinics, and/or patient scheduling information in the predetermined lists; (e) providing the matched data and a subset of the retrieved data to users to confirm eligibility of the patients; and (f) determining whether the patient has a scheduled visit to a medical provider.

“12. The method for identifying and matching patients to fill a prescription of claim 11, wherein the determining whether or not the patient has a scheduled visit to a medical provider further comprises: (i) advising the user of a list of patients to meet at their visit to enroll the patient with a pharmacy if the eligible patient has a scheduled visit, or (ii) advising the user to further communicate with a patient to enroll the patient with a pharmacy if the eligible patient does not have a scheduled visit within a pre-determined time period.

“13. The method for identifying and matching patients to fill a prescription of claim 12, wherein a list of patients eligible to fill a prescription using a hospital’s pharmacy or pharmacy of the prescriber’s choosing and who have been contacted in a given period is delivered to the user through one or more user interfaces.

“14. The method for identifying and matching patients to fill a prescription of claim 13, wherein the one or more user interfaces provide contacted patients and uncontacted patient rosters and financial information to advise a health system of quality of patient care, medication adherence, and financial growth for the health system.

“15. The method for identifying and matching patients to fill a prescription of claim 11, wherein the pharmacy is a hospital-owned pharmacy or third-party pharmacy in which a health care system or healthcare provider has a contractual relationship.

“16. The method for identifying and matching patients to fill a prescription of claim 11, further comprising an algorithmic filtering process to process large amounts data from disparate systems including appointment data and electronic prescription data.

“17. The method for identifying and matching patients to fill a prescription of claim 16, wherein the data comprise healthcare providers’ electronic medical record system, pharmacy management system data, and prior authorization data.

“18. The method for identifying and matching patients to fill a prescription of claim 17, wherein the management system data comprises data for patients who already fill prescriptions with the pharmacies.

“19. The method for identifying and matching patients to fill a prescription of claim 17, wherein the prior authorization data comprises confirmation that a patient’s insurance covers the medication.

“20. The method for identifying and matching patients to fill a prescription of claim 11, wherein the user is practitioner, clinician, prescriber, or administrator.”

For more information, see this patent application: STEVENSON, Daniel Whitney. System And Method For Eligible Patient Identification, Leakage Quantification And Workflow Software. Filed August 15, 2019 and posted September 30, 2021. Patent URL: https://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%2220210304861%22.PGNR.&OS=DN/20210304861&RS=DN/20210304861

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