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System and method of prioritizing and administering healthcare to patients having multiple integral diagnosesRelated Patent Categories: Data Processing: Financial, Business Practice, Management, Or Cost/price Determination, Automated Electrical Financial Or Business Practice Or Management Arrangement, Health Care Management (e.g., Record Management, Icda Billing)System and method of prioritizing and administering healthcare to patients having multiple integral diagnoses description/claimsThe Patent Description & Claims data below is from USPTO Patent Application 20070192132, System and method of prioritizing and administering healthcare to patients having multiple integral diagnoses. Brief Patent Description - Full Patent Description - Patent Application Claims
CROSS-REFERENCE TO RELATED APPLICATIONS [0001] Not Applicable STATEMENT RE: FEDERALLY SPONSORED RESEARCH/DEVELOPMENT [0002] Not Applicable BACKGROUND [0003] The present invention is directed to systems and methods for administering healthcare resources amongst patients within a patient population. More particularly, the present invention comprises systems and methods for prioritizing treatment of patients having multiple integral diagnoses based on the severity of confirmed medical conditions. [0004] The ability to render high quality healthcare in a cost effective manner is an elusive object that many healthcare plans and providers have attempted but few have actually attained. Despite substantial efforts made by healthcare plans, health maintenance organizations (HMO), physician networks, government-sponsored health care plans and the like, there is lacking a system for facilitating healthcare treatment for patients with multiple integral diagnoses, wherein the patients' quality of life is improved while at the same time medical costs are minimized in order to be able to provide the best care to the most patients. [0005] It is well known that patients with multiple integral diagnoses face poor clinical outcomes and a low quality of life that is further exacerbated by the patient not abiding by the prescribed treatment plan. Also, many patients with multiple integral diagnoses are not fully educated as to all of the options available to them within their medical plan coverage and accordingly do not avail themselves of all possibilities for treatment of their conditions. Furthermore, under traditional healthcare plans, different members of a patient's health care team are often unaware of each other's activities and of the patient's overall treatment plan. As such, oftentimes a patient with multiple integral diagnoses that if carefully managed would be able to vastly improve her clinical outcome and health-related quality of life suffers due to lack of maintaining a developed treatment plan, lack of education, and/or lack of healthcare team coordination. Additionally, medical costs are often wasted due to this lack of coordination and lack of educating the patient to all possibilities for treatment causing an overall loss in funds available for treatment of the entire patient population. [0006] For example, many patients with multiple integral diagnoses are unaware of the possibility of avoiding hospitalization and extreme life sustaining treatments. It has been assumed that the treatment of disease includes hospitalizing the patient and taking all measures necessary in order to prolong the life of the patient, irregardless of what that patient's quality of life will be. Traditional healthcare plans often do not focus on what may be the best option for the patient, or do not take the patient's desires into consideration when reaching a medical treatment plan. [0007] As such, there is a substantial need in the art for a healthcare administration system and method that are operative to effectively and efficiently utilize healthcare resources to administer care to patients with multiple integral diagnoses. There is further a need in the art for such a system and method that serves to improve the patient's clinical outcome and quality of life while minimizing medical expenses. BRIEF SUMMARY [0008] The present method is directed to methods of administering healthcare to patients with multiple integral diagnoses such that the clinical outcomes and health-related quality of life of the patients are improved while medical costs are minimized. According to a preferred embodiment, a patient population is first identified which is entitled to receive such healthcare. The patient population is then stratified into specific levels of intervention. Each patient is then assigned a Priority Care Nurse Manager (PCNM). The PCNM then establishes communication between herself, the patient's Primary Care Physician (PCP), and the patient in order to cooperatively develop the most appropriate treatment plan available to the patient. Finally, the healthcare services determined by the treatment plan are rendered to the patient. [0009] The identified patients may be actively enrolled in a Health Maintenance Organization (HMO), a governmental health program, or some similar health plan. Patients enrolled in an HMO may be commercial patients, Medicaid patients, or Medicare Advantage patients. Governmental health programs may include Medicaid and Medicare. Further, the identified patients may have ongoing needs to maintain optimal health status. These ongoing needs may include having a chronic medical condition, having a recurring medical condition, having multiple emergency room visits within the previous year, having functional or emotional impairments, having a mental or physical handicap or a developmental disability, having a terminal illness, being an organ transplant recipient, being a pain management recipient, being dependent on medical, technological support, or having multiple surgeries or hospitalization within the previous year. Alternatively, the identified patients may have a specific condition requiring continuing treatment and monitoring. These specific conditions may include HIV/AIDS, cardiovascular conditions, multiple traumas or neurological conditions, sick neonates, obstetric conditions, or malignant cancerous conditions. [0010] The stratification into specific levels of intervention may be based upon the severity of the patients' confirmed medical conditions. The patient population may then be divided into three specific groups based upon the confirmed severity. [0011] The PCNM may further communicate with a specialist physician, a provider of healthcare service, a patient's family member, and/or a person designated by the patient. After receiving the patient's consent, it may be determined that the most appropriate treatment plan includes not hospitalizing the patient. The treatment plan may further include maintaining the patient at her home, an assisted living facility, or a hospice facility, forgoing aggressive life-continuing treatment, and providing palliative care. [0012] The method may further include the PCNM periodically contacting the patient. This contact may be used to determine the patient's overall status, compliance with the established treatment plan, and to identify any needed changes in the treatment plan. [0013] The method may include documentation of all communications. All healthcare services rendered may also be documented. Finally, the results of all periodic contact with the patient may be documented. [0014] The method may also include the patient completing a Health Care Proxy (HCP) form. The HCP form may be used to appoint a Health Care Agent (HCA) who may make medical decisions for the patient in situations where the patient is unable to make medical decisions for herself. BRIEF DESCRIPTION OF THE DRAWINGS [0015] These and other features and advantages of the various embodiments disclosed herein will be better understood with respect to the following description and drawings, in which like numbers refer to like parts throughout, and in which: [0016] FIG. 1 is a flowchart depicting the steps for practicing the present invention as it relates to administering healthcare to a population of patients afflicted with multiple integral diagnoses, including the development of the most appropriate treatment plan for each patient with the aid of a Priority Care Nurse Manager. DETAILED DESCRIPTION [0017] The present invention is directed to methods of effectively administering healthcare to patients with multiple integral diagnoses. To this end, such patients are enrolled in a Priority Care Management Program (PCMP). The goals of the PCMP are to improve the patients' clinical outcomes and health-related quality of life, while at the same time minimizing medical costs, by increasing patient adherence to the physician established treatment plan for the management of the patient's medical conditions. The result is decreased numbers of avoidable hospitalizations, decreased numbers of hospital readmissions, decreased numbers of Emergency Room visits, decreased patient mortality, and improved patient and physician satisfaction. [0018] According to a preferred embodiment illustrated in FIG. 1, a patient population is first identified in step 10 which will receive this healthcare. The identification of such patient population in step 10 may be achieved by identifying patients with Multiple Integral Diagnoses (MID). Such patients are identified with chronic conditions that if carefully managed will result in improved clinical outcomes and medical cost savings. This may be achieved by analyzing claims and referral utilization data to identify patients that would qualify for the program. It is contemplated that members eligible for participation in the PCMP would be actively enrolled in a Health Maintenance Organization (HMO), a governmental health program, or some similar medical plan. In one embodiment, the PCMP would be completely voluntary and provided to the patients at no additional charge above any premiums they already pay to their individual medical plan. Continue reading about System and method of prioritizing and administering healthcare to patients having multiple integral diagnoses... 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