Patent ID: 11869656
Assignee: EMBOLD HEALTH, INC.
Field: Medical technology (Instruments)
Classification: CPC G | IPC G

Claim 18:
19. A computer-implemented method of determining a performance score of a provider, comprising:
first mapping at least one clinical priority area and at least one candidate measure concept to one or more coding fields of claims data;
wherein the at least one candidate measure concept is identified based, at least in part, on an identified key-clinical decision point, the key-clinical decision point based, at least in part, on a decision represented in the claims data and made by a provider before an initial diagnosis of a condition of the patient;
defining at least one first performance measure based on the one or more coding fields of claims data mapped to the at least one clinical priority area and the at least one candidate measure concept;
performing one or more validation processes using the at least one first performance measure;
obtaining a validation result responsive to the one or more validation processes;
adjusting one or more specifications of the at least one first performance measure based on the obtained validation result;
second mapping the at least one clinical priority area and the at least one candidate measure concept to one or more coding fields of claims data responsive to the validation result;
obtaining at least one final performance measure responsive to the second mapping;
obtaining, from a third-party, claims data include data specific to the provider; and
applying the at least one final performance measure to the claims data to determine at least one composite performance score of the provider;
provide, to a user via a graphical user interface (GUI) of a client device, the at least one composite performance score responsive to a user request for performance data.