Patent Issued for Computer System and Method for Processing Data Relating to Nurse Intervention Program Decisions (USPTO 9218592)

By a News Reporter-Staff News Editor at Journal of Engineering -- HARTFORD FIRE INSURANCE COMPANY (Hartford, CT) has been issued patent number 9218592, according to news reporting originating out of Alexandria, Virginia, by VerticalNews editors.

The patent's inventors are Adams, Jonathan Kaleb (Middletown, CT); Gawel, Ryan A. (Bristol, CT); Pagano, Joseph D. (Wallingford, CT).

This patent was filed on August 27, 2013 and was published online on December 22, 2015.

From the background information supplied by the inventors, news correspondents obtained the following quote: "A nurse intervention program may be used to improve the health care services provided to an injured worker. Consider, for example, a worker who submits a workers compensation claim as a result of an injury he or she received while at work. In such a situation, an insurer might arrange for a nurse to visit and provide additional health care to the worker while he or she recovers at home. Note that the improved care could result in the worker returning to his or job sooner (as compared to a worker with a similar injury who did not receive additional health care). As a result, the insurer can also benefit from providing improved health care (e.g., because the worker returned to work sooner and thus a total amount of benefits paid by the insurer might be reduced). Determining when it is appropriate to utilize a nurse intervention program, however, can be a difficult and time consuming task. For example, the decision might depend on a nature of the injury as well as details about the particular claimant. Moreover, an insurer might handle claims associated with many different accounts, and each account might have different rules and benefits that need to be considered when determining whether or not a nurse intervention program is appropriate for a particular claim.

"Although some systems have attempted to apply simple rules to help determine whether or not a nurse intervention program is appropriate for a particular claim, such approaches may not effectively identify which patients and/or injuries may benefit most from these services.

"The present inventors have recognized the utility of a predictive model for determining that certain insurance claims should be identified and referred for a nurse intervention program. Moreover, the use of the predictive model can be significantly enhanced by expanding the types of information used to train the predictive model and included in current claim transaction data to which the predictive model is applied, as well as by considering account-specific information associated with a particular insurance claim."

Supplementing the background information on this patent, VerticalNews reporters also obtained the inventors' summary information for this patent: "A computer system is disclosed which includes a data storage module to receive, store and provide access to historical claim transactions and to current claim transactions. The computer system further includes a predictive model component that is coupled to the data storage module and determines whether to identify a given one of the current claim transactions for referral to a nurse intervention program.

"The computer system also includes a computer processor that executes programmed instructions and stores and retrieves the data related to current claim transactions. Further included in the computer system is a program memory, coupled to the computer processor, and which stores program instruction steps for execution by the computer processor.

"A model training component is also included in the computer system. The model training component is coupled to the computer processor and trains the predictive model component based on the data related to the historical claim transactions in accordance with program instructions stored in the program memory and executed by the computer processor. As a consequence, a trained predictive model component is provided.

"Still further included in the computer system is an output device. The output device is coupled to the computer processor and outputs an output indicative of whether the current claim transaction in question should be referred to a nurse intervention program. The computer processor generates the output in accordance with program instructions in the program memory and executed by the computer processor. The output is generated in response to application of data for the current claim transaction in question to the trained predictive model component. The computer system further includes a routing module which directs workflow based on the output from the output device.

"The present inventors have observed that effective indicators in an insurance claim file that a claim may be beneficially referred to a nurse intervention program. By incorporating this data, or information extracted therefrom, in historical data used to train a predictive model, and in current transaction information applied to the predictive model, the performance of the predictive model may be enhanced, and the ability of the model to recommend nurse intervention may be improved. As a result, improved decisions associated with a nurse intervention program may be provided.

"With these and other advantages and features of the invention that will become hereinafter apparent, the invention may be more clearly understood by reference to the following detailed description of the invention, the appended claims, and the drawings attached hereto."

For the URL and additional information on this patent, see: Adams, Jonathan Kaleb; Gawel, Ryan A.; Pagano, Joseph D.. Computer System and Method for Processing Data Relating to Nurse Intervention Program Decisions. U.S. Patent Number 9218592, filed August 27, 2013, and published online on December 22, 2015. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=9218592.PN.&OS=PN/9218592RS=PN/9218592

Keywords for this news article include: Information Technology, Information and Data Storage, HARTFORD FIRE INSURANCE COMPANY.

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