Patent Issued for Method And System For Producing Statistical Analysis Of Medical Care Information (USPTO 10,685,746)

2020 JUN 29 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Cave Consulting Group Inc. (San Mateo, California, United States) has been issued patent number 10,685,746, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Cave, Douglas G. (San Mateo, CA); Alexandrian, Yuri (San Ramon, CA); Calvin, John T. (Mountain View, CA); Lara, Jenine A. (San Francisco, CA).

This patent was filed on June 3, 2019 and was published online on June 29, 2020.

From the background information supplied by the inventors, news correspondents obtained the following quote: “Health care costs continue to rise at a rapid rate and total national health expenditures are expected to rise at twice the rate of inflation in 2008. U.S. health care spending is expected to increase at similar levels for the next decade.

“One factor contributing to rising health care costs is due to 10% to 20% of physicians, across specialty types, practicing inefficiently. Efficiency means using an appropriate amount of medical resources in an appropriate setting to treat a medical condition or given number of medical conditions, and achieving a desired health outcome and quality of patient care. Thus, efficiency is a function of unit price, volume of service, intensity of service, and quality of service. The inefficient practitioners are often those 10% to 20% of practitioners by specialty type utilizing significantly more services to treat a given grouping of patients with equivalent medical conditions or condition-specific episodes of care as compared to their immediate peer group or best practice guideline. The inefficient practitioners can be responsible for driving 10% to 20% of the unnecessary, excess, medical expenditures incurred by employers and other health care purchasers, equating to billions of dollars nationally.

“Currently health plans, insurance companies, third party administrators (TPAs), health maintenance organizations, and other health firms (which collectively shall be called ‘health plans’) expend a significant amount of technical, clinical, and analytical resources trying to identify the inefficient practitioners.

“Once health plans have identified inefficient practitioner, they realize that each practitioner has a different practice pattern to deal with and has its own little `microcosm` of practice. At the microcosm level, many clinical and analytical resources are currently expended trying to determine the microcosm practice patterns for each practitioner for each specialty type. The result is that health plans may end up managing hundreds of different practice patterns which is time and resource intensive and makes monitoring over time difficult.

“It is often extremely difficult and costly to identify and target the one or two services most associated with practitioner efficiency. Different practice patterns of each practitioner as well as the inability to easily identify services most associated with practitioner efficiency, make it challenging and costly for health plans to embark on strategies to reduce expenditure and improve quality. Programs such as targeted practitioner education and behavioral change, Pay for Performance (P4P) and value-based benefit plan design become more resource intensive and costly and less effective due to difficulties in knowing where to focus and areas to target for improvements. Additionally, the lack of focus results in challenges in monitoring and measuring improvements over time.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “A method and system for producing statistical analysis of medical care information comprises: aggregating medical care providers to a peer group level; aggregating medical care information at the peer group level and at the medical care provider level; computing a statistical analysis, such as performing Pearson’s correlation analysis; and generating peer group level and medical care provider level results utilizing the computed statistical analysis.

“Also, a method for producing statistical analysis of medical care information for a medical care provider efficiency measurement comprises: applying minimum unit of analysis criteria for medical care providers to be used in statistical analysis; calculating an overall weighted average medical care information measure for each medical care provider; calculating a medical condition-specific medical care information measure for each medical care provider; removing outlier medical care providers from statistical analysis at medical care information level; calculating a statistical analysis to medical care provider efficiency measurement at each medical care information level using a statistical calculation; and selecting statistically related medical care information to identify medical care providers meeting a desired practice pattern.”

The claims supplied by the inventors are:

“What is claimed is:

“1. A computer-implemented method of identifying a practice pattern associated with an efficiency of medical care providers, said method comprising: providing, at a computer system, a plurality of episodes of care records, wherein each of the plurality of episodes of care records is identified by one of a plurality of episode-of-care identifiers, and includes one of a plurality of provider identifiers identifying one of a plurality of medical care providers; providing, at the computer system, a plurality of patient treatment claim records, wherein each of the plurality of patient treatment claim records includes (i) an associated one of the episode-of-care identifiers, and (ii) at least one of a plurality of codes, each of the plurality of codes associated with at least one of a procedure and service in a medical care field associated with the plurality of medical care providers; providing, at the computer system, a plurality of medical care provider overall efficiency measurements each associated with one of the plurality of provider identifiers; calculating, at the computer system for each of the plurality of medical care providers using the episodes of care records for the respective medical care provider and the corresponding patient treatment claim records, a provider rate of utilization for each of the codes; calculating, at the computer system using the episodes of care records across the plurality of medical care providers and the corresponding patient treatment claim records, a group rate of utilization for each of the codes; associating, by the computer system, with each of the plurality of medical care providers, a code score for each of the codes, wherein the code score is based on (i) the provider rate of utilization for the respective code and the respective medical care provider relative to (ii) the group rate of utilization for the respective code; calculating, for each of the codes, an association value based on a plurality of pairs of values, each pair of values corresponding to a respective one of the plurality of medical care providers and comprising: the overall efficiency measurement associated with the respective medical care provider, and the code score associated with the respective code for the respective medical care provider; displaying, to a user, a code report including (i) an identifier of at least a portion of the codes, and (ii) the association value corresponding to each included code; receiving, from the user, a designation of a set of the included codes as the practice pattern associated with efficiency; and displaying, to the user, a provider target report, wherein the provider target report includes (i) a respective identifier of each of a subset of the plurality of medical care providers, (ii) for each medical care provider in the subset, an identifier of a number of the designated codes in the practice pattern for which the provider rate of utilization exceeds the group rate of utilization by a second threshold amount, and (iii) for each medical care provider in the subset, a link to a detail display of the provider rate of utilization for the included codes in the practice pattern.

“2. The method in claim 1, wherein the provider rate of utilization and the group rate of utilization are calculated with respect to episodes of a specified medical condition.

“3. The method in claim 1, wherein the provider rate of utilization and the group rate of utilization are calculated with respect to episodes of a set of medical conditions associated with a practice category associated with the plurality of medical care providers.

“4. The method in claim 1, wherein the provider rate of utilization and the group rate of utilization are based on a percentage of episodes of care of a specified medical condition in which the code was utilized.

“5. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a percentage of episodes of care associated with a set of medical conditions in which the code was utilized, the set of medical conditions associated with a practice category of the plurality of medical care providers.

“6. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total number of instances of utilization of the code per a specified number of episodes of care of a specified medical condition.

“7. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total number of instances of utilization of the code per a specified number of episodes of care of a set of medical conditions associated with a practice category of the plurality of medical care providers.

“8. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total cost of utilization of the code per a specified number of episodes of care of a specified medical condition.

“9. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total cost of utilization of the code per a specified number of episodes of care of a set of medical conditions associated with a practice category of the plurality of medical care providers.

“10. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total number of instances of utilization of the code per number of patients.

“11. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total cost of utilization of the code per number of patients.

“12. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total number of instances of utilization of the code per number of members.

“13. The method in claim 1 wherein the provider rate of utilization and the group rate of utilization are based on a total cost of utilization of the code per number of members.

“14. The method in claim 1 wherein at least one medical care provider of the plurality of medical care providers is an individual practitioner.

“15. The method in claim 1 wherein at least one medical care provider of the plurality of medical care providers is an aggregation of individual practitioners.

“16. The method in claim 15 wherein the aggregation of individual practitioners is associated with a health plan.

“17. The method in claim 15 wherein the aggregation of individual practitioners is associated with a geographic region.

“18. The method in claim 1 wherein the association value is a Pearson’s correlation.

“19. The method in claim 18 wherein the threshold is 0.2.

“20. The method in claim 18 wherein the threshold is 0.4.

“21. The method in claim 1 wherein the association value is a Spearman’s rank-order correlation.

“22. The method in claim 1 wherein the association value is a percent difference.

“23. The method in claim 1, further comprising determining that the at least portion of the codes has each been performed by at least a minimum percentage of medical care providers in a practice category associated with the plurality of medical care providers, prior to the step of displaying, to the user, the code report including the identifier of the at least portion of the codes.

“24. The method in claim 23 wherein the minimum percentage is 30 percent.

“25. The method in claim 1 wherein each of the codes comprises one or more procedure codes or service codes in a designated medical care field.

“26. The method in claim 1 wherein the plurality of codes numbers more than 100.

“27. The method in claim 1 wherein the plurality of codes numbers more than 300.

“28. The method in claim 1 wherein the plurality of episodes of care records numbers at least 10,000.

“29. The method in claim 28 wherein the plurality of medical care providers numbers at least 90.

“30. A computer system for identifying a practice pattern associated with an efficiency of medical care providers, said computer system comprising: a processor capable of executing computer instructions; a memory coupled to the processor containing computer instructions for: accessing a plurality of episodes of care records, wherein each of the plurality of episodes of care records is identified by one of a plurality of episode-of-care identifiers, and includes one of a plurality of provider identifiers identifying one of a plurality of medical care providers; accessing a plurality of patient treatment claim records, wherein each of the plurality of patient treatment claim records includes (i) an associated one of the episode-of-care identifiers, and (ii) at least one of a plurality of codes, each of the plurality of codes associated with at least one of a procedure and service in a medical care field associated with the plurality of medical care providers; accessing a plurality of medical care provider overall efficiency measurements each associated with one of the plurality of provider identifiers; calculating, for each of the plurality of medical care providers using the episodes of care records for the respective medical care provider and the corresponding patient treatment claim records, a provider rate of utilization for each of the codes; calculating, using the episodes of care records across the plurality of medical care providers and the corresponding patient treatment claim records, a group rate of utilization for each of the codes; associating, with each of the plurality of medical care providers, a code score for each of the codes, wherein the code score is based on (i) the provider rate of utilization for the respective code and the respective medical care provider relative to (ii) the group rate of utilization for the respective code; calculating, for each of the codes, an association value based on a plurality of pairs of values, each pair of values corresponding to a respective one of the plurality of medical care providers and comprising: the overall efficiency measurement associated with the respective medical care provider, and the code score associated with the respective code for the respective medical care provider; displaying, to a user, a code report including (i) an identifier of at least a portion of the codes, and (ii) the association value corresponding to each included code; receiving, from the user, a designation of a set of the included codes as the practice pattern associated with efficiency; and displaying, to the user, a provider target report, wherein the provider target report includes (i) a respective identifier of each of a subset of the plurality of medical care providers, (ii) for each medical care provider in the subset, an identifier of a number of the designated codes in the practice pattern for which the provider rate of utilization exceeds the group rate of utilization by a second threshold amount, and (iii) for each medical care provider in the subset, a link to a detail display of the provider rate of utilization for the included codes in the practice pattern.

“31. A non-transitory computer-readable medium containing computer instructions for identifying a practice pattern associated with an efficiency of medical care providers, said computer instructions when executed by at least one processor cause the at least one processor to perform steps of: accessing a plurality of episodes of care records, wherein each of the plurality of episodes of care records is identified by one of a plurality of episode-of-care identifiers, and includes one of a plurality of provider identifiers identifying one of a plurality of medical care providers; accessing a plurality of patient treatment claim records, wherein each of the plurality of patient treatment claim records includes (i) an associated one of the episode-of-care identifiers, and (ii) at least one of a plurality of codes, each of the plurality of codes associated with at least one of a procedure and service in a medical care field associated with the plurality of medical care providers; accessing a plurality of medical care provider overall efficiency measurements each associated with one of the plurality of provider identifiers; calculating, for each of the plurality of medical care providers using the episodes of care records for the respective medical care provider and the corresponding patient treatment claim records, a provider rate of utilization for each of the codes; calculating, using the episodes of care records across the plurality of medical care providers and the corresponding patient treatment claim records, a group rate of utilization for each of the codes; associating, with each of the plurality of medical care providers, a code score for each of the codes, wherein the code score is based on (i) the provider rate of utilization for the respective code and the respective medical care provider relative to (ii) the group rate of utilization for the respective code; calculating, for each of the codes, an association value based on a plurality of pairs of values, each pair of values corresponding to a respective one of the plurality of medical care providers and comprising: the overall efficiency measurement associated with the respective medical care provider, and the code score associated with the respective code for the respective medical care provider; displaying, to a user, a code report including (i) an identifier of at least a portion of the codes, and (ii) the association value corresponding to each included code; receiving, from the user, a designation of a set of the included codes as the practice pattern associated with efficiency; and displaying, to the user, a provider target report, wherein the provider target report includes (i) a respective identifier of each of a subset of the plurality of medical care providers, (ii) for each medical care provider in the subset, an identifier of a number of the designated codes in the practice pattern for which the provider rate of utilization exceeds the group rate of utilization by a second threshold amount, and (iii) for each medical care provider in the subset, a link to a detail display of the provider rate of utilization for the included codes in the practice pattern.”

For the URL and additional information on this patent, see: Cave, Douglas G.; Alexandrian, Yuri; Calvin, John T.; Lara, Jenine A. Method And System For Producing Statistical Analysis Of Medical Care Information. U.S. Patent Number 10,685,746, filed June 3, 2019, and published online on June 29, 2020. 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=10,685,746.PN.&OS=PN/10,685,746RS=PN/10,685,746

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