Apparatus and method for self-reporting medical information

A patient list is provided to a medical provider. The medical provider may be prompted to review particular patients on the list or they may review these patients on their own. In any case, a patient is selected from the list and the provider determines if a medical metric associated with the patient is accurate or complete. The provider may then selectively enter self-report data concerning the accuracy or completeness of the medical metric. A provider assessment (e.g., score) is recalculated based at least in part on the self-reported data as well as the data that has already been collected. The re-calculated score may be provided to the medical plan.

FIELD OF THE INVENTION

The field of the invention relates to data reporting approaches and, more specifically, to data reporting approaches used to report medical information.

BACKGROUND

Today's health care industry is structured so that, in most cases, service providers (e.g., doctors, hospitals, other medical professionals) receive reimbursements from medical plans (e.g., private insurance plans or government-sponsored medical plans). Under these approaches, the medical plan typically determines how much to reimburse a provider for a particular procedure or service. The health plan may also determine if it even will reimburse a provider for a service and, if the service is reoccurring, how often to reimburse the provider for the service.

Quality of service concerns have been raised by many with respect to today's health care environment. Unfortunately, available methods of reimbursement have provided little financial reward for improvements in the quality of healthcare delivery. For instance, fee-for-service payments encouraged overuse while capped payments encouraged underuse, and neither approach rewarded providers based on quality. Pay-for-Performance (P4P) initiatives have been implemented in the health care industry with the intent of addressing rising healthcare costs and improving quality.

In many previous P4P approaches, the amount of reimbursement was determined by a provider performance assessment (e.g., a score). For instance, the health plan tracked the records of patients (enrolled in the health plan) and whether the provider had provided (or offered to provide) certain services for patients having a particular condition. The more patients of the provider that met the standard, the higher the score for the provider. Moreover, the higher the score, the higher the reimbursement for a provider offered by the health plan.

In some previous systems, medical chart data was sometimes used for reimbursement purposes. While medical chart data was considered an accurate source of information regarding the care provided by physicians, data collection on a wide scale for the purposes of provider performance assessment was not cost effective and placed a significant burden on providers from an administrative perspective. Hence, health plans focused on the use of administrative claims (and the data included with these claims) submitted by the provider to determine performance assessment measurements.

However, problems have arisen regarding the accuracy of using administrative claims data alone for provider performance assessment measurements. For instance, the health plan may be mistaken that a particular procedure was not performed on a patient, thus incorrectly lowering the score. In another example, a valid reason (e.g., an exclusion) may exist for not providing a service for a patient, again resulting in the incorrect lowering of the provider score. Previous approaches have not addressed these concerns.

Additionally, as P4P programs have continued to mature, providers in turn have grown in their understanding of measures, scoring practices and other program design issues. Previous systems have not been structured to provide transparency for the provider in terms of the how their assessment is calculated.

The technology used to implement previous systems has also proved problematic. For instance, in systems that use paper communications, the provider typically filed a paper request for reimbursement, this paper request was received and analyzed by the health plan, a reimbursement decision was made, and the reimbursement decision (with any reimbursement) was communicated to the provider. Unfortunately, this type of system was slow and prone to errors.

Although computer-based systems have more recently allowed data to be more quickly communicated and analyzed, these systems often required that the provider purchase custom software in order to participate and required significant time to learn. These limitations resulted in inconvenience and extra cost for the service provider.

Because of the above-mentioned problems, the frustration level of service providers has increased and the quality of service offered by the health care industry has decreased. As a result, health plans are finding it increasingly more difficult to increase or maintain provider participation and increase their quality of service.

Skilled artisans will appreciate that elements in the figures are illustrated for simplicity and clarity and have not necessarily been drawn to scale. For example, the dimensions and/or relative positioning of some of the elements in the figures may be exaggerated relative to other elements to help to improve understanding of various embodiments of the present invention. Also, common but well-understood elements that are useful or necessary in a commercially feasible embodiment are often not depicted in order to facilitate a less obstructed view of these various embodiments of the present invention. It will further be appreciated that certain actions and/or steps may be described or depicted in a particular order of occurrence while those skilled in the art will understand that such specificity with respect to sequence is not actually required. It will also be understood that the terms and expressions used herein have the ordinary meaning as is accorded to such terms and expressions with respect to their corresponding respective areas of inquiry and study except where specific meanings have otherwise been set forth herein.

DESCRIPTION

Approaches are provided for the self-reporting of data from a medical provider and the calculation and distribution of a provider assessment. The self-reporting approaches described herein provide transparency for providers to examine how assessments are determined and provide for a quick and convenient mechanism for these providers to update and improve their assessments. In so doing, the attractiveness of medical plans and provider participation in these plans is enhanced and increased. The self-reporting approaches described herein are convenient for providers to use, do not require providers to purchase or install additional or costly software, are constantly available, and provide for the secure storage and use of confidential and sensitive patient information. A two-way communication procedure between the provider and health plan is supported.

In many of these embodiments, a patient list is provided to a medical provider. The medical provider may be prompted to review the records of particular patients on the list or may retrieve and review the records of these patients on their own initiative. In any case, a patient is selected from the list and the provider determines if a medical metric associated with the patient is accurate or complete. The provider may then selectively enter self-report data concerning the accuracy or completeness of the medical metric. A provider assessment (e.g., a score) is recalculated based at least in part on the self-report data as well as the data that has already been collected. The re-calculated score may be then provided to the medical provider.

The self-reporting approaches describe herein address concerns about the limitations of administrative claims data for provider assessment (e.g., score determination). More specifically, these approaches allow providers to enter self-report data regarding various metrics (e.g., clinical quality indicators) to supplement the other data that is available through the administrative data received by the health plan. In some examples, the providers may be given a set time period (e.g., 60 days), during which they can review the medical chart of those members that were identified by the health plan as having service gaps relating to the selected indicators. If there is evidence that the patient (i.e., member of the health plan) met certain exclusion criteria or indeed received the indicated service or procedure, the provider can use this time period to report this information. Data that is captured through this process is incorporated into the processing steps so that a “hybrid assessment” (e.g., a hybrid score), which includes self-reported and administrative claims data, can be made and this hybrid assessment can be reported to the provider.

These approaches are accessible via different communication networks (e.g., an Internet connection) at all times (i.e., 24 hours a day, 7 days a week, 365 days a year). Because there are no client side software requirements on the provider side, providers can login to the system from their office, home, or any other location where an appropriate communication link or connection (e.g., an Internet connection) is available.

These approaches also provide a repository for historical performance results. Thus, there is no need to keep track of paper based reports over time, which can often be misplaced. By simply selecting a measurement period from a menu of reports, providers can view their most recent reports or go as far back in time as needed to evaluate performance over time.

The approaches described herein also have the ability to provide access to program information metrics (or indicators) including indicator descriptions, terms and definitions, and summaries of how scores are derived. Not only do providers benefit by having all key reports and documentation in one place, but health plans also reduce the need to generate and distribute these materials over time.

Providers can additionally view personal performance results for both clinical quality and cost of care. Many of these approaches are implemented as an Internet-based application that enables providers to login through a secure system to view their own personalized performance results for both clinical quality and cost of care. These approaches report performance data to providers that is accurate, actionable and clinically relevant.

The information can be used for various other purposes. For example, providers can download a list of members (patients) into a disease management system or target members for specific interventions. Other uses for the information are possible.

Enhanced security is also provided with the present approaches. For instance, providers may have an assigned username and password to access the application, which utilizes secure socket layer (SSL) and encryption to secure transmission. In some examples, a role based security system is utilized to ensure that providers can only view their own performance results. Thus, using these approaches, health plans no longer need to worry about paper reports being delivered to the wrong provider or being misplaced. This is particularly relevant if providers request a listing of members for which service gaps were identified.

The hardware/software utilized to implement these approaches can be offered as a standard alone application where providers receive a uniform resource locator (URL) and login with a username and password. In addition, health plans that have an existing provider portal can make the system available to providers using a single sign-on approach.

These approaches provide the ability to create, store, maintain, and view historical reports so that providers can access to compare performance over time. A trend graph can be constructed to help summarize the performance of the provider over time by metric.

Referring now toFIG. 1a,one example of a system for self-reporting medical data is described. A health plan104is connected to a database102and to providers116,118, and120via a communication network (e.g., the Internet)114. The health plan104includes a performance evaluation module108, a self-reporting module112, a network interface110and other functions module106. It will be appreciated that the performance evaluation module108, self-reporting module112, and network interface110may be implemented as some combination of computer software instructions executed on a processing device (e.g., a microprocessor, general purpose computer, or the like). In other examples, some or all of these modules may be implemented primarily as electronic hardware.

The database102may be any type of memory storage device. For example, the database102may be a random access memory (RAM), read only memory (ROM), programmable read only memory (PROM), or any other type of memory device. The database102holds administrative data previously calculated and the self-report data as it is received from the providers116,118, and120. Various reports analyzing both the administrative data and/or self-report data may be stored for historical evaluation purposes.

The providers116,118, and120represent any type of professional medical service provider such as doctors or hospitals. The providers may access the communication network114via any type of electronic device and/or interface using any type of communication technology or protocol. For example, the providers116,118,120may use personal computers, personal digital assistants (PDAs), cellular phones, or the like to access the communication network114.

The communication network114is any type of network such as the Internet, a cellular communication network, or a satellite communication network. In addition, the communication network may be combinations of these networks. These networks may transmit and receive information according to any type of protocol or standard.

Turning now to the components of the health plan104, the performance evaluation module108evaluates the performance of different providers and determines an assessment of this performance. For example, the assessment may be calculated by a formula that divides a denominator into a numerator. In one example, the denominator indicates the number of patients in the patient pool (for a particular provider), and the numerator the indicates the number of patients that have received particular services (for a particular provider). For example, the denominator may indicate the number of children patients and the numerator may indicate the number that have received the MMR vaccine. The assessment (e.g., score) is determined my dividing the numerator by the denominator. Other examples of assessment formulas are possible.

The self-reporting module112may generate self-report display screens or questions that are forwarded to the provider116,118, or120via the network interface110. The self-reporting module112may also receive self-report information from the providers116,118, or120via the network interface110.

The self-report information can relate to any type of medical metric (or indicator). The medical metric represents a service, treatment, or some other medical indicator received, associated with, or given to a patient. For example, the medical metric can relate to childhood immunizations such as measles, mumps and rubella (MMR) or the Varicella-zoster virus (VZV) vaccine and whether a patient has received these vaccinations. In another example, the metric may be related to diabetes care such as the diabetic retinal exam, the lipid panel for diabetes, screening for diabetic nephropathy, or HbA1C testing for diabetes and whether a patient has received these services. In yet another example, the metric is related to preventive screening such as colorectal cancer screening, cervical cancer screening, mammography screening, or Chlamydia screening and whether the patient has received these services. Other examples of metrics are possible.

After receiving the information, the self-reporting module112may analyze this information (e.g., determine the type of information received and whether a new assessment will be determined). If a new assessment is to be determined, it may supply information to the performance evaluation module108or, alternatively, it may determine the assessment itself. Once the new assessment is made, the self-reporting module112may communicate this information to the providers116,118, or120via the network interface110and network114.

The self-reporting module112may also determine that there are service gaps for particular patients. For example, the self-reporting module112may determine that for a given condition, various treatments are required and that for particular patients of particular providers, gaps in service exist. The existence of gaps may be communicated to the appropriate providers116,118, or120via the network interface110and the provider116,118, or120may respond to these gaps with self-report data.

The network interface110is configured and adapted as an interface between the network114and the modules within the health plan104. In this regard, the network interface110receives information according to a network protocol or standard and converts this information in a form that is usable by the remaining modules of the health plan104. In another example, the network interface110receives information from the modules within the health plan104and transmits and performs any needed conversions of this information so that this information can be transmitted over the communication network114.

The network interface110may also be configured to provide various security functions. For instance, providers116,118, and120may have an assigned username and password to access the other health plan modules, which utilizes secure socket layer (SSL) and encryption to secure transmission. In some examples, a role based security system is utilized to ensure that providers116,118, and120can only view their own performance results.

The other functions module106may provide other services for the health plan104. For example, the other functions module106may supply survey questions to the providers116,118, or120. In another example, the other functions module106may receive other types of inquiries from the providers116,118, or120and respond to these inquiries accessing the database102as needed to provide the answers to the inquiries from providers. Reminders and/or other search functions may be provided that allow providers to see all the service gaps for a given member.

In one example of the operation of the system ofFIG. 1, providers116,118, and120may login to the health plan104via the communication network114and by using the network interface110. The interface110provides security to only allow authorized users access to the health plan104. The performance evaluation module108may determine preliminary results using administrative data stored in the database102and present these to the providers116,118, and120.

The self-reporting module112may determine that there are service gaps for patients of particular providers and then sends this information to the providers116,118, or120. This information may be sent to providers116,118, and120by the interface110and network114. Alternatively, the providers116,118and120may access their quality of service information and request to enter self-reporting data. The self-report data is received at the interface110and forwarded to the performance evaluation module108either directly or via the self-reporting module112. The performance evaluation module108may recalculate the assessment (e.g., score) for the provider116,118, or120and this may be sent to the provider using the network interface110via the communication network114. The provider116,118, or120can then view this information.

Referring now toFIG. 1b,one example of a self-reporting module150(e.g., the self-reporting module112ofFIG. 1a) is described. The module150and its components may be implemented as some combination of electronic hardware and/or software components. For example, the module150and its components may be implemented as computer executed instructions that are executed on a processing device (e.g., a microprocessor, general purpose computer, or the like).

It will be appreciated that the structure indicated inFIG. 1bis one example of a self-reporting module and that other examples are possible. In this case, the module150includes a receiver152, an information analyzer154, a screen generator156, and a service gap identifier158. The service gap identifier function may also be provided at a performance evaluation module (e.g., the performance evaluation module108ofFIG. 1).

The receiver152receives self-report information from users. For example, the receiver152may having buffering capabilities and receive information from an interface (e.g., network interface110ofFIG. 1a).

The information analyzer154may analyze the received information to extract the self-report data. The information analyzer154may also receive information (e.g., administrative data that may include information submitted in claims or from medical charts) from a database (e.g., the database102ofFIG. 1a). Based upon the information received (self-reported by the provider and/or administrative data stored), the information analyzer154may determine particular questions to present to the user. The information analyzer154may send information on to a performance evaluator (e.g., the performance evaluation module108ofFIG. 1a) to determine an assessment that takes into account the self-report data. Alternatively, the information analyzer154may perform this function itself. The information analyzer154may perform other functions as well.

The screen generator156generates self-report display screens to be sent to a provider. The screen generator156may receive information from the information analyzer154instructing the screen generator156to construct and send to a provider a particular customized display screen. For example, the screen generator156may determine a display screen or series of display screens communicating questions relating to childhood vaccinations to a provider.

The service gap identifier158identifies gaps in service for particular patients. The service gap identifier158receives information from the information analyzer154and/or a data storage device (e.g., the database102ofFIG. 1a) and determines for a particular patient and provider if gaps in services exist. For example, the service gap identifier158may identify all children patients and determine for each child if a particular metric (e.g., a particular immunization) has been performed. The service gap identifier158may indicate service gaps to providers, for example, by sending an email to the service provider.

Referring now toFIG. 2a,an approach for self-reporting data is described. At step202, preliminary results (e.g., an initial assessment not based upon any self-report data that only includes administrative data) are posted for providers. As mentioned, these initial assessments are based on the administrative data that has been received and processed by the health plan. At step204the provider logs in to the system. At step206, the preliminary results of the assessment are sent to the provider. At step208, the preliminary results are received by the provider.

At step210, the health plan allows self-reporting for a selected or pre-programmed period of time. For example, the health plan may allow 60 days for providers to enter self-report data. Shorter or longer periods may also be used. At step212, the provider examines the preliminary results that have been posted. At step214, the provider requests more detailed “drill down” information regarding a patient associated with the results. The drill down information may be selected and retrieved by the provider selecting a link on a computer display screen. The selection of a link causes the formation of a request for the more detailed drill down information and at step216, this request for the more detailed drill down information is sent to the health plan. At step218, the request is received at the health plan.

At step220, the requested information is retrieved, and at step222, the information is sent to the provider. At step224, the requested information is received and evaluated by the provider. At step226, the provider determines to self-report some information and enters this information. At step228, the self-report information is sent to the health plan. At step230, the self-report information is received at the health plan and, at step232, the health plan recalculates the assessment based on the self-report data. Alternatively, another entity may recalculate the assessment and receive the needed information to perform the recalculation.

At step234, the final ratings including the recalculated ratings are posted and at step236sent to the provider. At step238the recalculated assessment is received and displayed for viewing by the provider. At step240, the user logs off.

Referring now toFIG. 2b,another example of an approach for self-reporting data is described. At step252, preliminary results are posted for providers. These are based on the administrative data that has been received by the health plan. At step254the provider logs in. At step256, the preliminary results are sent to the provider. At step258, the preliminary results are received by the provider. In other examples, the health plan may send a message or messages to the provider (e.g., via email) alerting the provider that gaps exist in the service for particular patients.

At step260, the health plan allows self-reporting for a selected or pre-programmed period of time. For example, the health plan may allow 60 days for providers to enter self-report data. Shorter or longer periods may also be provided. At step262, the provider examines the preliminary results.

At step264, the provider determines to self-report some information and enters this information. At step266, the self-report information is sent to the health plan. At step268, the self-report information is received at the health plan and at step270, the health plan recalculates the assessment based on the self-report data. Alternatively, another entity may recalculate the assessment.

At step272, the final ratings including the recalculated assessment posted and at step274sent to the provider. At step276the recalculated assessment is received and displayed for viewing by the provider. At step278, the user logs off.

Referring now toFIG. 3, one example of a structure for a system300that provides the ability to self-report medical data to a health plan is described. The system300has a home display screen302where the user (e.g., a service provider) may log in and, after login select a variety of different display screens/functions or other options. In this example, the display screens or functions that may be selected by the user include a summary (cost of care) screen304, a quality summary screen306, a control panel screen306, a logout screen310, a survey screen312, and an other screen314. As described below, the screens include various links that can be used to display or access various types of information or proceed to other screens or functions. Other examples of screens are possible. For instance, screens may be provided to access historical archives of information. It will also be understood that in this example, a web interface accessible via the Internet is used to provide the display screens. However, it will be appreciated that these screens or functions may be provided on any type of electronic device such as a cellular phone or a PDA.

The summary (cost of care) screen304provides cost summary information for the different procedures or services performed by the provider. Links on this screen allow a key episodes screen316to be viewed. The key episodes screen316allows a provider to view components of the cost score. The key episodes screen may show the most and least efficient groups of data, such as those produced by the Episode Treatment Grouping® (ETGs®) tool supplied by Ingenix, Inc. In one example, an episode includes all clinically related service for a discrete diagnostic condition from the onset of symptom to the completion of treatment. All episodes of similar types are associated with a treatment group like Diabetes, Asthma or any other diagnoses.

Links on the screen304also allow a detailed drill down screen318to be viewed. More specifically, different types of cost information for particular clinical procedures may be viewed. For example, for an ophthalmology specialty, cost information for the eye procedure, anesthesia, and out patient services is displayed. A provider average score, specialty average score, percent of episode cost are also displayed.

Links on the screen304allow an all episodes screen317to be viewed, which shows a list of all episodes for a provider. Detailed drill down information can be obtained from the key episodes screen316and the all episodes screen317.

The quality summary screen306shows a summary of the provider's quality assessment information. Through this screen, the user can select a link that activates the self-report screen320or a patients list screen322. The self-report screen320allows the provider to enter self-report information. The patients list screen322includes patients that received and did not receive service.

The control panel306allows the user to select different control settings. For example, the user may be able to select different display parameter links such as the format of the information to be displayed or the amount of information to be displayed. Once these parameters are selected, they may be adjusted as needed by the user. Password administration may also be provided.

The logout screen310allows the user to logout. For example, a link may be selected by the user that logs the user out of the system. A screen stating that the user has successfully logged out may also be displayed.

The survey screen312allows the provider to take part in or view a survey. For example, information relating to the waiting time for a patient to be seen, time spent by provider with patient, or bedside manners may be obtained.

The other screen314allows for the provision of other functions that are not listed above and/or are added at a later date. For example, a message center may indicate messages received from the provider (e.g., indicating service gaps for particular patients). New features may be added to the system and accessed using links on this screen.

Referring now toFIGS. 4-7, examples of display screens that may be provided are described. It will be understood that these are one example of a sequence of screens a user can be presented and that other sequences are possible. It will also be understood that the contents of the screens may also differ and that other examples are possible based upon the requirements of the system or the users of the system.

Referring now toFIG. 4, one example of the cost of care summary screen304is described. The screen304displays summary of information for a particular provider. For example, the average age, percentage male, and percentage female, of patients for a provider are shown and comparison of these statistics to other patients of the health plan is displayed. The ratio of provider to health plan is also provided and displayed. A cost score and a composite score are also shown.

Referring now toFIG. 5, one example of the cost of key episode screen316is described. The screen316shows various medical episodes and categorizes these episodes into most efficient, largest percentage of total costs, and least efficient. For example, it can be seen that a cataract episode was 36 percent of the costs and that there were a total of 9 of these episodes. The standardized cost score is a measure of efficiency. A score below zero indicates that utilization was below the expected cost and while a score above indicates that utilization was above expected and this relates to or is calculated by aggregating (a composite) of every episode treatment group.

Referring now toFIG. 6, one example of the use of a drill down feature by a provider to obtain additional information is described. In this example, the provider selects the “cataract” link to receive more specific information related to the cataract procedure. The resultant screen ofFIG. 6shows specific cataract procedures. The cost and care module provide the capability to highlight categories of utilization where the provider deviates by a predetermined threshold from their peers.

Referring now toFIG. 7, one example of the clinical quality summary screen306is described. Various indicators (metrics) are shown on the screen. A quality score is also shown as is the specialty average and the number of indicators (metrics) scored. Each metric has a link that when selected accesses a list of members who have received the service and another link that accesses a list of eligible members. The selection of a self-report link (if available) retrieves additional self-report screens and this allows for the self-report of data for a particular metric or indicator.

Referring now toFIG. 8, one example of an approach for self-reporting data is described. At step802, a self-report function is actuated. For example, a health plan may alert a provider that there are gaps and service of patients of the provider. This may be done periodically (e.g., by sending email) or the provider may login to the system and initiate self-reporting. At step804, a self-report screen is received by the provider. For example, a screen is presented to the provider that has a patient list. At step806, a self-report function for a particular patient is selected by the provider. This may be done by selecting a link (e.g., button) on the screen and clicking on the link using a computer mouse.

At step808, based on clinically relevant questions, the user enters self-report data. For example, the provider may be asked if they have given a vaccination to a patient or if not, the reason they did not provide the vaccination. At step810, the self-report data is reported to the health plan. The self-report data may be presented and entered in a variety of different ways. For example, a series of yes/no or multiple choice questions may be presented to the provider and the provider may select a link (e.g., a box) on the screen to indicate the answer. In another example, the provider may enter text and this textual information is analyzed by the health plans. Examples of other entry approaches are possible. The health plan and/or some external entity may have access to the data for viewing and/or reassessment purposes.

Referring now toFIG. 9, one example of linking metrics is described. At step902, self-report data is received. At step904, it is determined if the metric shares a common denominator and/or a common exclusion. For example, the common denominator may be diabetes patients and a common exclusion may be gestational diabetes. If the answer at step904is negative, then execution ends. If the answer is affirmative, at step906self-report data is applied to all like indicators, all like indicators related to the common denominator and/or common exclusions.

In one example of this approach, the MMR vaccination metric and the VZV vaccination metric may be linked together. The system will notify the provider that the same self-report data will be applied to a child patient if the child patient appears in or is associated with one of these like-metrics. For instance, if the provider enters a date of birth that makes the child patient ineligible to receive an MMR vaccination, the system will also remove the child patient from the VZV metric assessment. In another example, if the provider enters that the member had a valid exclusion (e.g., gestational diabetes), the member will be removed from all applicable diabetes metrics.

Referring now toFIG. 10, another example of linking metrics is described. At step1002, self-report data is received. At step1004, it is determined whether the metric is linked to other like metrics. If the answer at step1004is negative, then execution ends. If the answer at step1004is affirmative, then at step1006like metrics are polled. At step1008, the provider is asked to enter self-report data for other like metrics.

In one example of this approach, if a provider enters that a patient received an HbA1c test for the HbA1C testing for the diabetes metric, the system will search to see if the patient is a non-numerator hit for other diabetes measures and ask the provider if they wish to enter self-report data for these measures as well. In this example, the patient is a diabetes patient (e.g., a non-numerator hit). Consequently, the system will prompt the provider to see if the provider wishes to enter self-report data for other types of diabetes tests if a service gap for the patient is identified for any one of these metrics.

Referring now toFIGS. 11-16, examples of screen shots for the self-reporting of data are described. It will be understood that these are only examples of a sequence of screens a user can see and that other sequences are possible. It will also be understood that the contents of the screens (e.g., the links present) may also differ and that other examples are possible.

Referring now toFIG. 11, a screen where the self-report function may be selected is described. As shown, a list of services is presented to the provider (under a clinical quality indicator column1102). Some of these services or metrics may allow for self-reporting while other examples may not allow self-reporting to occur. The provider selects an appropriate link1104(under a report column1106) to self-report data for that particular metric (e.g., the metric in this case relates to childhood immunizations).

Referring now toFIG. 12, the result of selecting a self-report link1104inFIG. 11is described. A list of all members who did not receive a service or procedure as defined by the quality indicator or metric is provided. The screen has a column for member identifier (the left most column1202), a date of birth column1204, a last name column1206, and a first name of the patient column1208. The provider selects the “Add self reporting data” link1210(i.e., in the right most column1212) to enter data for a particular member. Additional information may be provided. For example, a date of service column may also be provided.

Referring now toFIG. 13, the result of selecting the “Add self report data” link ofFIG. 12is described. At this point, the provider is asked to confirm the date of birth and age of the member in fields1302. The provider is allowed to correct the date of birth as it could impact member eligibility for the measure. The provider selects the “next” link1304to enter this information.

Referring now toFIG. 14, the result of entering the self-report information using the screen ofFIG. 13is described. As shown, the provider enters the appropriate information in the fields1402. After the information is entered, the provider selects a next button1404to move to the next screen. It will be appreciated that the self-report information requested of the provider is customized to the metric, patient, and/or provider. In this example, the provider selects particular boxes to indicate self-report information. Other examples of screens that are customized according to different metrics are possible. It will also be appreciated that other data entry approaches may be used.

FIG. 15shows the screen presented to the provider if the date of birth is correct and the provider confirms that services were not provided. With this screen, another option will be to enter data in the fields1502that the member met the denominator exclusion criteria. The provider may then select the next link1504to move to the next screen.

FIG. 16shows a final confirmation screen presented to the provider that is needed to submit the data to the health plan for consideration. The screen has a field1602summarizing the self-report data and any linkages made by the system. The provider selects a select link1604to submit the self-report data to the health plan. Once the data is submitted it cannot be further modified by the provider.

Referring now toFIG. 17, a screen is shown that includes the recalculated assessment (i.e., the hybrid rate). The Clinical Quality Indicator includes link to specifications and member lists for each indicator that the provider received a score. The Administrative Rate is a performance rate calculated for the individual provider using administrative claims data as the underlying data source for analysis. The Hybrid Rate is a performance rate calculated for the individual provider using both administrative claims data and the data submitted through the self report system as the underlying data sources. The Plan Rate is the overall performance rate of the plan using administrative claims data as the underlying data source. The Quality Score is a percentile rank of the provider's score for quality performance based on a methodology that is defined in collaboration with the client. It also could be a simple absolute or a relative score. The Cost Score is a percentile rank of provider's score for cost of care performance based on a methodology that is defined in collaboration with the client. It also could be a simple absolute or a relative score. The Composite is a combined score that takes into consideration the providers quality and cost performance levels based on a methodology that is defined in collaboration with the client.

Thus, approaches are provided for the self-reporting of data from a medical provider that allows a provider assessment to be calculated and used. This self-reporting function provides for additional transparency for providers in seeing how their assessments are determined and allows a quick and convenient mechanism for these providers to update and improve their assessments. In so doing, the attractiveness of medical plans and provider participation in these plans are enhanced and increased. The self-reporting tool provided herein is convenient for providers to uses, does not require providers to purchase or install additional or costly software, and is available all the time. These approaches are also secure to use and provide for the display and retrieval of patient records.