# Patent

## Title
Health and life sciences payer high performance capability assessment

## Abstract

A high-performance capability assessment model helps a health and life sciences business meet the challenges of the global marketplace. As a result, the health and life sciences business can achieve the clarity, consistency, and well-defined execution of core processes that reduce inefficiencies and waste that result from unnecessary process complexity and exceptions. In addition, the high-performance capability assessment model helps the health and life sciences business to identify specific areas in which improvements may be made, to understand how to make said improvements, and to establish levels of capability along the way to reaching an ultimate capability goal.

## Background
BACKGROUND OF THE INVENTION
1. Technical Field
This disclosure concerns a system and method to identify the performance of an organization on a scale of mastery across representative capabilities of the organization's industry. In particular, this disclosure relates to an efficient and cost effective way to assess the performance level of key capability areas within the processes of a health and life sciences organization, and in particular a payer in a health and life sciences organization.
2. Background Information
Modern health and life sciences organizations operate in an increasingly challenging environment. To survive, health and life sciences organizations must adapt to this environment and execute in a clear, consistent, and efficient manner. Furthermore, the competitive nature, regulatory requirements, low profit margins, and competitive challenges of health and life sciences businesses greatly increase the complexity and difficulty of surviving on a day-to-day basis.
Despite the need for a health and life sciences organization to meet the challenges of the global marketplace, it is still often the case that the business lacks clarity, consistency, and well-defined execution of its core processes. These shortcomings severely constrain the business, and lead directly to inefficiencies and waste due to unnecessary complexity, process exceptions, and customer dissatisfaction. At the same time, it can be very difficult to identify specific processes to which improvements may be made, either because the business itself does not have the expertise to identify the processes or because the complexities of the business frustrate attempts to clearly delineate the processes to be improved.
Even if the health and life sciences business, on its own, could identify one of the many processes that it needs to improve, the business would not necessarily know how to improve the process or be able to identify a concrete and measurable improvement goal. Another difficulty exists in determining whether there are any intermediate goals that should be reached along the way. As health and life sciences businesses struggle to meet the demands of the modern economic landscape, they fail to identify opportunities for maximizing sales and margin improvement, category expansion, multi-channel execution, customer satisfaction improvement, and to reach other important goals.
Therefore, a need exists for an efficient and effective system and method to assess the performance level of key assessment areas within the processes of an organization.
SUMMARY
A high-performance capability assessment (HPCA) model helps health and life sciences businesses meet the challenges of the global marketplace by defining a scale of performance mastery along which the current practices of the business may be located. The HPCA model accelerates the discovery of process and performance gaps within business operations. In addition, the HPCA model also helps the business to identify specific areas in which improvements may be made, how to make the improvements, and how to establish performance measures during the course of attempting to achieve an ultimate goal. As a result, the business can achieve the clarity, consistency, and well-defined execution of core processes that maximize the operating budget for optimum outcomes.
The HPCA model includes a key factor dimension and a performance mastery scale dimension. The performance mastery scale dimension defines multiple mastery levels. The performance mastery levels form a scale of increasing organizational performance. The scale includes a ‘Basic’ mastery level, a ‘Competitive’ mastery level, and a ‘Market Leading’ mastery level along a horizontal axis. Each performance mastery level includes criteria specific to a corresponding key assessment area. Each key assessment area identifies some aspect of a capability of a health and life sciences business with respect to a payer organization, such as for example, an insurance company when dealing with the private sector.
A business capability can be defined as a bundle of closely integrated skills, knowledge, technologies, and cumulative learning that is exercised through a set of processes and that collectively represents an organization's ability to create value by producing outcomes and results. Capability areas do not represent a delineation of organizational responsibilities as the business outcomes of a capability may be the result of a number of cross-functional teams. Capabilities of a business may be grouped into areas and/or platforms, including platforms and sub-platforms, depending on the organizational structure of the business.
For example, the HPCA model groups the capabilities of the health and life sciences industry for a payer into five main areas or high-level platforms, which may also be thought of as “business areas,” namely a direct and guide the organization platform, a develop and maintain market platform, a coordinate health care services platform, a manage operations platform, and a support the organization platform. Each platform includes multiple platforms and/or sub-platforms. For example, the coordinate health care services platform may include four sub-platforms, namely a perform health care management sub-platform, a develop and manage networks sub-platform, a service the networks sub-platform, and a manage pharmacy sub-platform.
Some of the platforms and sub-platforms may include additional or further sub-platforms or granularity, while others may not, and may also include capabilities at their lowest level. Examples of capabilities within the perform health care management sub-platform, include for example, design and incentives capabilities, segment and target capabilities, reach and engage capabilities, collaborate and support capabilities, evaluate and improve capabilities, and a cross-core functions capabilities.
The key factor dimension establishes a set of key assessment areas in which to analyze the capabilities of a business. Key assessment areas include performance capability criteria. Performance capability criteria populate the performance capability assessment model. The performance capability criteria may be specific to any one of many different business capabilities. Any number of performance capability assessment models and performance capability criteria may be defined and stored in a capability detail pool for subsequent retrieval and application to a business under examination. Accordingly, the HPCA model provides a flexible and adaptive scale of performance capability against which business practices may be compared to ascertain where the capabilities of a business under examination fall along the scale.
Other systems, methods, features, and advantages will be, or will become, apparent to one with skill in the art upon examination of the following figures and detailed description. All such additional systems, methods, features, and advantages are included within this description, are within the scope of the invention, and are protected by the following claims.



BRIEF DESCRIPTION OF THE DRAWINGS
The health and life sciences industry high-performance capability assessment model and system may be better understood with reference to the following drawings and description. The elements in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the capability assessment techniques. In the figures, like-referenced numerals designate corresponding parts throughout the different views.
FIG. 1 shows a high-performance capability assessment model with a performance scale of mastery and performance criteria shown for different capabilities showing multiple platforms, including a direct and guide the organization platform, a develop and maintain market platform, a coordinate health care services platform, a manage operations platform, and a support the organization platform.
FIG. 2 shows a high-performance capability assessment model with capabilities for sub-platforms including a perform health care management sub-platform, a develop and manage networks sub-platform, a service the networks sub-platform, and a manage pharmacy sub-platform, all corresponding to the coordinate health care services platform.
FIG. 3 shows a high-performance capability assessment model with capabilities for design and incentives, segment and target, reach and engage, collaborate and support, evaluate and improve, and cross-core functions, all corresponding to the perform health care management sub-platform.
FIG. 4 shows a high-performance capability assessment model with further capabilities corresponding to design and incentives.
FIG. 5 shows a high-performance capability assessment model with further capabilities corresponding to segment and target.
FIG. 6 shows a high-performance capability assessment model with further capabilities corresponding to reach and engage.
FIG. 7 shows a high-performance capability assessment model with further capabilities corresponding to collaborate and support.
FIG. 8 shows a high-performance capability assessment model with further capabilities corresponding to evaluate and improve.
FIG. 9 shows a high-performance capability assessment model with further capabilities corresponding to cross-core functions.
FIG. 10 shows a capability detail pool providing a multidimensional health and life sciences industry performance reference set where multiple key assessment performance reference tables are collected and stored.
FIG. 11 shows a capability assessment system.
FIG. 12 shows a flow diagram for establishing high-performance capability assessment models.
FIG. 13 shows a flow diagram for retrieving and applying high-performance capability assessment models.
FIG. 14 shows a flow diagram for analyzing representative practice data to determine a health and life sciences industry and a health and life sciences key assessment area to which the representative practice data applies.



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
FIG. 1 shows a high-performance capability assessment (HPCA) model 100. The HPCA model 100 specifies five platforms, including a direct and guide the organization platform 102, a develop and maintain market platform 104, a coordinate health care services platform 106, a manage operations platform 108, and a support the organization platform 110. Each platform 102, 104, 106, 108 and 110 may include sub-platforms. The HPCA model 100 is not limited to the form shown in FIG. 1. Instead, the HPCA model 100 may be adapted and modified to fill a wide variety of analysis roles. Additional, different, or fewer platforms may be used in other implementations, with each platform defining additional, different, or fewer capabilities. Each platform and/or sub-platform includes one or more multiple <platform/sub-platform name> capabilities 130.
The HPCA model 100 establishes a multidimensional health and life sciences industry performance reference set that includes multiple key assessment performance levels 138, further described below in reference Tables 1-3. The performance levels 138 establish a scale of increasing effectiveness in delivery of each capability. The key assessment performance reference tables include a ‘Basic’ 140 delivery level, a ‘Competitive’ 142 delivery level and a ‘Market Leading’ 144 delivery level. The performance levels establish a scale of mastery 146 along which current business practices may be located and identified with respect to any platform and capability within a platform according to an analysis of performance capability criteria (PCC). The capability under evaluation may be assigned the performance level 138 based on a delivery effectiveness position 158 along the scale of mastery 146.
The ‘Basic’ delivery level 140 specifies ‘Basic’ performance assessment criteria, the ‘Competitive’ delivery level 142 specifies ‘Competitive’ performance assessment criteria, and the ‘Market Leading’ delivery level 144 specifies ‘Market Leading’ performance assessment criteria. The HPCA model 100 receives input data that specifies a health and life sciences business platform (e.g., a health and life sciences industry area) and a health and life sciences industry key assessment area for analysis. The HPCA model 100 searches the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry platform and corresponding industry capability within the platform and the health and life sciences industry key assessment area, and retrieves the matching key assessment performance reference table. The HPCA model 100 initiates analysis of the matching key assessment performance reference table to obtain a resultant performance assessment level for the health and life sciences industry key assessment area.
Tables 1-3 below provide an explanation of each of the capability levels 140, 142, and 144.







TABLE 1





‘Basic’ Delivery Level
















Description:
Capability mastery at the basic level is competitive on a 



domestic or local level and selectively on a global basis.
















TABLE 2





‘Competitive’ Delivery Level
















Description:
Capability mastery at a competitive level is in the top 



50% of performers when compared to domestic and 



international peer groups.
















TABLE 3





‘Market Leading’ Delivery Level
















Description:
Capability mastery at a market leading level implies that 



few companies globally are performing at this level, and 



can include emerging capabilities where companies have 



committed significant levels of investment and resources.









For FIGS. 2-9 the capability under evaluation may be assigned a level of mastery 138 based on the business' position along the scale of mastery 146 (e.g., the ‘basic,’ ‘competitive,’ or ‘market leading’ delivery level). Performance criteria corresponding to the basic 140, competitive 142, and market leading 144 performance levels populate the HPCA model 100. The performance criteria capture characteristics, and/or other features of the delivery of a capability at a particular performance level. Examples below illustrate performance criteria that provide analysis and benchmarking for health and life sciences organizations. The HPCA model 100 performance criteria provide a tool for determining where a platform and capability under examination falls along the scale of mastery 146.
For example, business consultants and business process engineers may interview a business or receive data about the business to determine, measure, or otherwise ascertain the characteristics, criteria, and other features of a particular capability implemented within the business. The consultants and engineers may compare the characteristics of the business to the performance criteria in the HPCA model 100 and arrive at an assessment level 138 for the capability under examination. In doing so, for example, the consultants and engineers may identify where the capability under examination falls in terms of the performance level for each key assessment area of a capability and determine an overall position on the scale of mastery 146 for the capability under examination. Performance criteria may populate the HPCA model 100 in whole or in part. Multiple high-performance capability assessments may be collected and stored with the performance criteria for future retrieval and possible modification in a capability detail pool, discussed below.
FIG. 2 shows the coordinate health care services platform 106 divided into respective capability areas 202. The coordinate health care services platform 106 includes a perform health care management sub-platform 220, a develop and manage networks sub-platform 222, a service the networks sub-platform 224, and a manage pharmacy sub-platform 226.
FIG. 3 shows the perform health care management sub-platform 220 (corresponding to the coordinate health care services platform 106) divided into respective capability areas 302. The perform health care management sub-platform 220 includes a design and incentives capability 320, a segment and target capability 322, a reach and engage capability 324, a collaborate and support capability 326, an evaluate and improve capability 328, and a cross-core functions capability 330.
FIGS. 4-9 show the capabilities associated with the sub-platform entitled perform health care management 220. The capabilities associate with the develop and manage networks sub-platform 222, service the networks sub-platform 224, and manage pharmacy sub-platform 226 are not shown in this document. FIG. 4 shows further capabilities 402 including a design and innovative products capability 420, a design services capability 422, and a design campaigns capability 424.
FIG. 5 shows further capabilities 502 including a project population health and wealth indicators capability 520, and an identify individual intervention opportunities capability 522.
FIG. 6 shows further capabilities 602 including a perform proactive and reactive outreach capability 620, a provide inbound advisory services capability 622, a coordinate care capability 624, a promote optimal lifestyle capability 626, and a provide decision support capability 628.
FIG. 7 shows further capabilities 702 including an engage provider capability 720, and an engage employer/purchasers capability 722.
FIG. 8 shows further capabilities 802 including a manage results capability 820, a communicate value to stakeholders capability 822, and an execute purchaser specific consultative services capability 824.
FIG. 9 shows further capabilities 902 including a content management capability 920, a transparency capability 922, a quality management capability 924, and a policy oversight capability 926.
The tables provided in the appendix immediately following the abstract, which form part of this disclosure, provide an explanation of the capabilities and corresponding key assessment areas and performance criteria for some of the capabilities within the respective sub-platforms. Each capability may include one or more key assessment areas. Each key assessment area may include one or more additional key assessment areas. In other words, a business capability may include sub-capabilities, and therefore, key assessment areas corresponding to the multiple sub-capabilities. The tables in the appendix show specific criteria used to analyze each capability.
FIG. 10 shows a multidimensional health and life sciences industry performance reference set 1000 (“reference set 1000”) that provides a capability detail pool from which the system described below may obtain benchmarking tables for a health and life sciences business. The reference set 1000 includes multiple key assessment performance reference tables (“reference tables”), two of which are labeled 1002 and 1004. Each reference table may provide the benchmarking criteria for a specific capability, such as those noted above with respect to FIGS. 2-9.
One dimension of each table may establish the ‘Basic’ performance level 140 specifying ‘Basic’ performance assessment criteria, the ‘Competitive’ performance level 142 specifying ‘Competitive’ performance assessment criteria, and the ‘Market Leading’ performance level 144 specifying ‘Market Leading’ performance assessment criteria. Another dimension of each table may specify one or more key assessment areas (KAAs), several of which are labeled 1006, 1008, and 1010. As noted above, performance criteria, e.g., the PCC 1012, populates each key assessment performance reference table to provide benchmark criteria for ‘Basic,’ ‘Competitive,’ and ‘Market Leading’ characteristics.
The reference set 1000 represents the HPCA model 100. Consistent with the HPCA model 100, the reference set 1000 may organize multiple reference tables into a hierarchical structure defining discrete changes in granularity. In one implementation, the hierarchical structure includes reference tables, high-level platforms, platforms, sub-platforms, and models. FIG. 10 labels three sub-platforms 1014, 1016, and 1018. The reference set 1000 may further organize the platforms, two of which are labeled 1020 and 1022. Platforms aggregate into the HPCA model 100 and corresponding reference set 1000. Additional, different, or fewer levels of granularity may be defined in the HPCA model 100.
The reference set 1000 may dynamically populate the reference tables with the most up-to-date performance criteria, for example upon retrieval and presentation by a business analysis consultant. The performance criteria may be retrieved from a performance capability criteria database or other information source.
FIG. 10 also shows an example of a database implementation 1024 of a portion of a reference table. In particular, the database implementation 1024 includes records (e.g., the records 1026, 1028, 1030) that establish each PCC 1012. In the example shown, each record includes a PCC field 1032, a category specifier field 1034, and a KAA specifier field 1036. Other fields may be provided, such as a reference table assignment field or reference set assignment field. The records categorize each PCC into a specific category (e.g., ‘Basic’), into a specific KAA, and, optionally, into a specific reference table in a specific reference set for any particular HPCA model.
FIG. 11 shows a high-performance capability assessment system (“system”) 1100. The system 1100 includes a processor 1102 and a memory 1104. Several databases support the operation of the system 1100, including a performance capability database 1106, a performance measured database 1108, a capability detail pool database 1110, and an assessment results database 1126. The system 1100 may include a local display 1112 and input/output interfaces 1117 (e.g., including a keyboard, mouse, microphone, speakers, or other device), and, through the communication interface 1114 and networks 1116, may communicate with remote devices 1118 and remote displays 1120. The networks 1116 may be any combination of external networks (e.g., the Internet) and internal networks (e.g., corporate LANs). The displays 1112 and 1120 may, for example, present performance capability assessment models 1122 that the system 1100 retrieves from the capability detail pool database 1110 for review, modification, and application by process engineers or other individuals. With regard to local access or access by the remote devices 1118, the system 1100 may include a login processing program 1124 to authenticate and/or authorize access to the system 1100. To that end, the login processing program 1124 may include username/password verification, private/public key encryption, or other validation and data protection capabilities.
In one implementation, the capability performance database 1106 stores performance criteria. As will be described in more detail below, the system 1100 may populate performance capability assessment models with performance capability criteria suited to any particular platform or sub-platform (e.g., a perform health care management sub-platform 220), and business capability at one or more capability levels across one or more key assessment areas. The performance measured database 1108 may store the determined, measured, or otherwise ascertained characteristics, criteria, and other measured data of a particular key assessment area as representative practice data 1148. The representative practice data 1148 may be obtained through interviews with business consultants and industrial engineers, through online questionnaires, through manual or automated analysis of business data (e.g., year-end operating reports), or in other manners. The capability detail pool database 1110 stores the capability detail pool 1000, which includes pre-defined performance capability assessment models 1122. The assessment results database 1126 stores determined capability levels for specific capabilities that have been analyzed.
The system 1100 facilitates the review, modification, creation, and application of performance capability assessment models. In that role, performance capability assessment model manipulation logic (“manipulation logic”) 1146 within the system 1100 creates, retrieves, and stores capability assessment data 1128 in the memory 1104. The manipulation logic 1146 may establish capability assessment data 1128 in the memory 1104, including a capability assessment data structure 1130 with multiple capability levels (“CL”) 1132 organized along a scale of mastery dimension, multiple key assessment areas (“KAA”) 1134 organized along a key factor dimension, and performance criteria (“PCC”) 1136 that populates the performance capability assessment model 1130. The manipulation logic 1146 may vary widely in implementation, and, as one example, may include data storage logic 1152 that saves data in memory and user interface logic that accepts capability level specifications, key assessment area specifications, and performance capability criteria inputs to create new performance capability assessment models, to modify existing performance capability assessment models, to delete performance capability assessment models, or to retrieve performance capability assessment models for review.
In one implementation, the manipulation logic 1146 establishes the capability assessment data structure 1130 to include a multidimensional health and life sciences industry performance reference set that includes multiple key assessment performance reference tables in which the key assessment performance reference tables include a ‘Basic’ capability performance level, a ‘Competitive’ capability performance level, and a ‘Market Leading’ capability performance level.
The capability assessment data 1128 may also include a capability position specifier 1138. The capability position specifier 1138 may record the capability level along the scale of mastery 146, as determined for any particular capability. Thus, the system 1100 may store the performance level in the assessment results database 1126 or elsewhere for future retrieval and review.
In one implementation, the data population logic 1140 may be a data population program executed by the processor 1102 that populates template performance capability assessment models. For example, the data population logic 1140 may include input logic 1150 that accepts input specifying a capability of interest that indicates a particular performance capability assessment model. The data population logic 1140 may include query logic 1145 that executes database queries and prompts a user for input to obtain the corresponding performance capability criteria for the capability of interest.
In another implementation, for example, the query logic 1145 may receive an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis. The query logic 1145 searches the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area, and retrieves the matching key assessment performance reference table.
The data population logic 1140 may further include storage logic that adds the retrieved performance capability criteria to the template performance capability assessment model. The data population logic 1140 produces populated performance capability assessment structures 1142 that may be stored in the capability detail pool database 1110.
In addition to the analysis process described above, the system 1100 may provide an automated analysis of representative practice data 1148 that identifies relevant performance capability criteria and determines the position on the scale of mastery 146 of each key assessment area corresponding to the performance capability criteria for the representative practice data 1148. As one example, the system 1100 may implement capability assessment logic 1144 that includes comparison and/or matching logic that analyzes the representative practice data 1148 with respect to performance capability criteria to locate key assessment areas for which the system 1100 can determine capability levels to obtain a resultant performance level for each key assessment area.
Furthermore, the capability assessment logic 1144 may determine an overall position on the scale of mastery 146 as the capability position specifier 1138 for a capability under examination given the knowledge of where the key assessment areas corresponding to the capability under examination fall in each capability level. Thus, for example, the capability assessment logic 1144 may determine an overall capability level for a capability corresponding to the capability level for the majority of the key assessment areas, or it may apply a weighted analysis technique to give more emphasis to some key assessment areas than others in determining the overall position on the scale of mastery 146 for a capability. As another example, the capability assessment logic 1144 may implement an expert system (e.g., based on a neural network trained on prior determinations) that analyzes the determined characteristics with respect to the performance capability criteria and ascertains where the capability under examination falls along the scale of mastery 146 for each of the key assessment areas, or overall on the scale of mastery.
FIG. 12 shows a flow diagram 1200 for creating performance capability assessment models. The performance capability assessment model creator (e.g., the manipulation logic 1146) establishes a key factor dimension for the performance capability assessment model (1202). The performance capability assessment model creator also establishes a capability scale dimension for the performance capability assessment model (1204). The capability scale dimension may define a scale of increasing organizational capability. For example, the structure creator may create the ‘Basic’ level 140, the ‘Competitive’ level 142, and the ‘Market Leading’ level 144. The performance capability assessment model creator also populates the performance capability assessment model with capability performance criteria (1206). A capability detail pool 1000 may be formed to hold multiple tailored key assessment performance reference tables (1208). The performance capability assessment model creator may store the populated assessment structure in the capability detail pool for subsequent retrieval and analysis (1210).
FIG. 13 shows a flow diagram 1300 for retrieving and applying performance capability assessment models. A selection of a capability to be analyzed is obtained (1302). In one implementation, the system 1100 receives input data that specifies a health and life sciences industry area and a health and life sciences industry key assessment area for analysis. For example, the system 1100 may accept input from a business consultant that specifies a capability for analysis. The system 1100 may query the capability detail pool 1000 for a corresponding performance capability assessment model (1304). The corresponding performance capability assessment model may be pre-defined in the capability detail pool 1000, or the data population logic 1140 (or other actor) may populate a performance capability assessment model template that the system 1100 newly creates, or that the system 1100 retrieves from a data store, such as the capability detail pool database 1110.
In another example, the system 1100 searches the multidimensional health and life sciences industry performance reference set in the capability detail pool 1000 for a matching key assessment performance reference table based on the input data that specifies a health and life sciences industry platform and a health and life sciences industry key assessment area. The system 1100 retrieves the matching key assessment performance reference table and initiates analysis of the matching key assessment performance reference table to obtain a resultant performance level for the health and life sciences industry key assessment area.
The system 1100 obtains representative practice data 1148 for the capability under examination in the specific business under review (1306). For example, a business consultant may interview the business to determine how the business currently executes the capability under review. As another example, a representative from the business may complete a questionnaire, submit business data for analysis and parameter extraction, or otherwise provide the characteristics of their current capability execution. As a further example, the system 1100 may retrieve the representative practice data 1148 from a database of previously obtained representative practice data.
The system 1100 compares the representative practice data 1148 to the performance criteria in the performance capability assessment model (1308). For example, a business consultant may use his or her expertise to arrive at a determination of level for the business and the capability under examination (1310). Alternatively or additionally, the capability assessment logic 1144 may perform an automated analysis of the assessment results data in the assessment results database 1126 and ascertain the performance level on the scale of mastery 146. The system 1100 may store the assessment results, including the determined performance level, for future reference in the assessment results database 1126 or other location (1312).
FIG. 14 shows a flow diagram 1400 for analyzing representative practice data 1148 to determine a health and life sciences industry and a health and life sciences key assessment area to which the representative practice data applies. The system 1100 receives representative practice data 1148 as input data (1402). The system 1100 may receive the representative practice data 1148 from a database query performed by the query logic 1145 that the query logic executes periodically, when instructed by an operator, and/or automatically against any number of available database sources that store representative practice data 1148. The capability assessment logic 1144 analyzes the representative practice data 1148 to identify performance capability criteria in the capability detail pool 1000 that the capability assessment logic 1144 determines relevant to the representative practice data 1148 (1404). For example, the capability assessment logic 1144 may compare and/or match the content of the representative practice data 1148 with the performance capability criteria using natural language processing (NLP), text string, and/or substring matching, by comparing tags linked to the representative practice data 1148 and that specify that any portion of the representative practice data 1148 is applicable to a specific PCC, by querying for a manual classification of the representative practice data 1148 to a PCC, or other matching technique. The capability assessment logic 1144 may score and/or weight a performance capability criteria and compare the score and/or weight to a user specified relevance threshold to rank the relevance of the performance capability criteria to the representative practice data 1148 (1406). The user may specify particular terms and/or phrases to search and match between the performance capability criteria and the representative practice data 1148, in order to score the performance capability criteria.
The capability assessment logic 1144 may determine, based on the number of performance capability criteria that meet or exceed the relevance threshold, that the capability assessment logic 1144 has identified a sufficient number of performance capability criteria for a specific key assessment area in order to determine a performance level for the capability as a whole or any key assessment area within the capability (1408). As one example, where at least 51% of the performance capability criteria for a particular key assessment area meet or exceed the relevance threshold, the capability assessment logic 1144 applies the performance capability criteria to the representative practice data 1148. In another example, the performance capability criteria for a particular key assessment area may be ranked in importance and/or designated as mandatory in order to assess the key assessment area. In the event the capability assessment logic 1144 identifies the mandatory performance capability criteria for a key assessment area, the capability assessment logic 1144 applies the performance capability criteria to the representative practice data 1148.
The capability assessment logic 1144 may apply the performance capability criteria meeting or exceeding the relevance threshold to the representative practice data 1148 to determine whether any particular PCC is met. Accordingly, as the capability assessment logic 1144 analyzes the PCC, the system 1100 tracks the best fit of the representative practice data 1148 to the PCCs in the key assessment performance reference tables. In other words, the system 1100 determines how the representative practice data 1148 meets (or does not meet) each PCC, thereby gaining insight into whether the representative practice data 1148 is indicative of ‘Basic,’ ‘Competitive,’ or ‘Market Leading’ practices.
The system 1100 may also gauge the position on the scale of mastery 146 of each key assessment area corresponding to the performance capability criteria (1410). The capability assessment logic 1144 may further determine an overall position on the scale of mastery 146 for a capability (1412). The capability assessment logic 1144 may establish that a desired number and/or designated mandatory performance capability criteria for the key assessment areas have been identified as relevant to a capability and sufficient to determine the position on the scale of mastery 146 for the capability. For example, the capability assessment logic 1144 may determine an overall performance level for the capability based on the performance level determined for the majority of the key assessment areas. The capability assessment logic 1144 may apply a weighted analysis technique to give more emphasis to some key assessment areas than others in determining the overall position on the scale of mastery 146 for the capability. Although selected aspects, features, or components of the implementations are depicted as being stored in computer-readable memories (e.g., as computer-executable instructions or performance capability assessment models), all or part of the systems and structures may be stored on, distributed across, or read from other computer-readable media. The computer-readable media may include, for example, secondary storage devices such as hard disks, floppy disks, and CD-ROMs; a signal, such as a signal received from a network or received at an antenna; or other forms of memory, including ROM or RAM, either currently known or later developed.
Various implementations of the system 1100 may include additional or different components. A processor may be implemented as a microprocessor, a microcontroller, a DSP, an application specific integrated circuit (ASIC), discrete logic, or a combination of other types of circuits or logic. Similarly, memories may be DRAM, SRAM, Flash or any other type of memory. The processing capability of the system may be distributed among multiple system components, such as among multiple processors and memories, optionally including multiple distributed processing systems. Parameters, databases, and other data structures may be separately stored and managed, may be incorporated into a single memory or database, may be logically and physically organized in many different ways, and may be implemented in many ways, including data structures such as linked lists, hash tables, or implicit storage mechanisms. Programs may be combined or split among multiple programs, or distributed across several memories and processors.
The HPCA 100 model provides unexpectedly good results for a performance capability assessment model, particularly in the health and life sciences industry. In particular, the combinations of key assessment areas and particular assessment criteria of the HPCA model, including the criteria noted in the Appendix of Tables, provide significant advantages over other assessment models. The unexpectedly good results include clearly identifying and delineating from among multiple related complex processes the specific processes to improve, how to improve the process, and identifying concrete and measurable improvement goals.
While various embodiments of the invention have been described, it will be apparent to those of ordinary skill in the art that many more embodiments and implementations are possible within the scope of the invention. Accordingly, the invention is not to be restricted except in light of the attached claims and their equivalents.
APPENDIX OF TABLES







TABLE 1







Capability Assessment Model


Payer - Coordinate Healthcare Services


Design Innovative Products








Sub-Platform: Perform Health Management
Capability: Design and Incent









Basic
Competitive
Market Leading





Medical product design at group and
Medical product design at group and
Medical, pharmacy, and wellness product


subscriber level provides preventive service
subscriber level includes high deductible
design includes dynamic consumer-level


coverage for minimal out-of-pocket cost
health plan options and provides preventive
benefits and market segmented benefits


Pharmacy product design channels use of
service coverage
Service design includes strategies to engage


mail-order and appropriate benefit tiers
Pharmacy product design supports mail-
consumers and measure effectiveness


When applicable medical and/or pharmacy
order, generic drug incentives (e.g. coupons, 
More robust incentives offered: Aligned


product is supported by a type of health
reward points, co-paying waiving, etc.), and
incentives to medication adherence


spending account
specialty pharmacy
More robust incentives offered: Consumer


Traditional Utilization Management is an
Product design includes wellness
selected incentives


optional feature
components with minimal healthy lifestyle
More robust incentives offered: Increased


Traditional, episodic Case Management
incentives
incentives for healthy lifestyle


Disease Management offered for defined list
Product features include access to Affinity
More robust incentives offered: Incentives


of conditions
networks and product discounts
aligned to disease condition goals


Inconsistent and fragmented sourcing
Products are supported by tax advantaged
More robust incentives offered:


strategy
spending accounts, when applicable
Incentive/reward tracker tools


Product design and pricing driven by Sales
Ease of administration of health spending
Tiered products for wellness based on


and Marketing team(s)
accounts includes batch cross-over payment
intensity



Tiered products for Case Management and
Expansion of services offered within Affinity



Disease Management based on intensity
networks and product discounts (e.g. spa



Majority of programs and services are
services, chiropractic, acupuncture, etc.)



insourced providing a more integrated
Option to buy-up concierge services



experience. Limited outsourced services
Ease of administration of health spending



with continued fragmentation
accounts includes real time cross-over



Collaborative product design and pricing
payment



effort between Sales, Marketing, and Health
Investment and credit products supporting



Management
spending accounts and high-deductible




product design




Minimal outsourcing, when necessary, with




high degree of integration




Pricing completed using sophisticated




models that have been market tested




Pricing based on lifestyles, accurate staffing




models, dynamic premium pricing




Health Management continually introduces




differentiating product design as part of




market dynamics and the consultative sales




process driven by analytics
















TABLE 2







Capability Assessment Model


Payer - Coordinate Healthcare Services


Design Services








Sub-Platform: Perform Health Management
Capability: Design and Incent









Basic
Competitive
Market Leading





Focus on episodic and chronic segments of
Focus on healthy, at risk, episodic, and
Focus across entire health care continuum


health care continuum
chronic segments of health care continuum
Integrated service model, which includes all


Core traditional Health Management services
Services evolving to integrated health
consumer and provider facing services


driven by the purchasers (i.e. UM, CM, DM)
advocate model
Personalized assessments and scripting


Standard services across all market segments
Market segment specific services (e.g. senior
which include consumer engagement


Static assessments and scripting
segment, etc.)
approaches


Condition oriented services
Dynamic assessments and scripting
Proactive anticipation of consumer needs


Metrics tied to operational processes
Whole person oriented services
Actionable high performance metrics tied to


Segmented service units that support specific
Metrics tied to health and financial outcomes
results with defined accountabilities and


functions
Coordinated services with some
action plans



consolidation of service units
Integrated service units
















TABLE 3







Capability Assessment Model


Payer - Coordinate Healthcare Services


Design Campaigns








Sub-Platform: Perform Health Management
Capability: Design and Incent









Basic
Competitive
Market Leading





Population based campaigns targeted to
Timely population based campaigns tailored 
Personalized campaigns targeted to


specific conditions or disease states
to specific segments
individual opportunities and preferences


Limited metrics defined to measure impact
Purchaser driven campaign identification and
during optimal impact period


and value of campaign
design
Segment specific outreach channels (e.g.


Campaign channels limited to mail or phone 
Specific metrics defined to measure impact
satellite radio, magazine, online TV, etc.)


Condition based content
and value of campaigns
Personalized and consumer preferred



Addition of web-based channels (e.g. portal,
channels for outreach



email, etc.) for campaign outreach and
Specific metrics defined to measure impact



content distribution
and value of campaigns



Use of a campaign management solution
Integrated campaign management solution



Prevention, condition, and segment based
for enterprise



content
Personalized, prevention, condition, and




segment based content
















TABLE 4







Capability Assessment Model


Payer - Coordinate Healthcare Services


Project Population Health and Wealth Indicators








Sub-Platform: Perform Health Management
Capability: Segment and Target









Basic
Competitive
Market Leading





Identify consumers based on defined criteria,
Leverage multiple traditional data sources
Utilize data from varying data sources to


historical data, and available reports
(e.g. claims, health assessment, etc.) and
segment consumer population and design and



basic analytics to segment consumer
execute trajectory predictors



population
Traditional - claims, health assessment, labs,



Integrates data sources into single, unified
pharmacy, etc.



view across Health Management functions
Non-traditional - behavioral marketing data,



Population based financial and clinical
3rd party consumer data, etc.



impacts are incorporated into segmentation
Integrates data sources into single, unified



and algorithms
view across the enterprise (e.g. customer



Dedicated team that systematically reviews
service, provider relations, Health



segmentation and algorithms to identify and
Management, etc.)



implement improvements
Comprehensive consumer insight capabilities




to identify consumer during their impact




period




Consumer level financial and clinical impact




analysis




Integrated informatics capabilities across the




enterprise (e.g. actuarial, marketing, clinical,




etc.)
















TABLE 5







Capability Assessment Model


Payer - Coordinate Healthcare Services


Identify Individual Intervention Opportunities








Sub-Platform: Perform Health Management
Capability: Segment and Target









Basic
Competitive
Market Leading





Interventions identified based on program
Intervention opportunities identified using
Intervention opportunities identified based on


definition and clinical guidelines (e.g. risk
evidence-based medical (EBM) guidelines
consumer's individual clinical, financial, and


level, diagnoses, procedures, etc.)
Prioritized intervention opportunities based
lifestyle data


Individual clinical judgment determines
on defined clinical pathways which
Systematically prioritized health and wealth


priority of interventions and consumers for
incorporate co-morbidities
intervention opportunities based on predicted


outreach
Adherence to standardized quality measures
level of clinical and financial impact for the



for the highest level of accreditation (e.g.
specific consumer



URAC/NCQA)
Real time active monitoring and execution



Population based financial and clinical
Actual consumer level financial and clinical



impacts are incorporated into opportunity
outcomes are utilized for ongoing



identification
improvements to opportunity identification
















TABLE 6







Capability Assessment Model


Payer - Coordinate Healthcare Services


Perform Proactive Outreach








Sub-Platform: Perform Health Management
Capability: Reach and Engage









Basic
Competitive
Market Leading





Mail and telephone outreach channels
Addition of web-based channels (e.g. portal,
Segment specific outreach channels (e.g.


Static assessments and scripting
email, chat, etc.)
satellite radio, magazine, online TV, etc.)


Limited measurement of impact and value of
Use of customer service/provider service as a
Personalized and consumer preferred


campaigns
channel for outreach
channels for outreach


Use of high-cost, high-skilled resources for
Dynamic assessments and scripting
Personalized, intervention-specific


outreach
Channel consumer to network providers and
assessments and scripting



facilities
Offer provider cost and quality data to



Measurement and analysis of campaign
empower and influence consumer 



outcome
decision-making



Use of non-clinical resources for outreach as
Active discussion with providers regarding



appropriate
comparative utilization data (e.g. cost and




quality) to improve outcomes




Use of measurement and analysis of




campaign outcomes to refine future




campaigns




Use of law cost, high yield, non-clinical




resources for outreach as appropriate
















TABLE 7







Capability Assessment Model


Payer - Coordinate Healthcare Services


Coordinate Care








Sub-Platform: Perform Health Management
Capability: Reach and Engage









Basic
Competitive
Market Leading





Execute authorization review: Authorization
Execute authorization review: Shift to
Execute authorization review: Focused


policies are broadly applied
automated notifications
authorization on high impact opportunities


Execute authorization review: Manual entry
Execute authorization review: Use of IVR,
Execute authorization review: Use of


of fax and phone data
web and EDI to automate authorization data
automated notifications to trigger programs


Execute authorization review: Multiple
entry
and services


clinical criteria sets applied inconsistently 
Execute authorization review: Consistent
Execute authorization review: Use of


(e.g. Interqual, Milliman, etc.)
clinical criteria set
clinical workflow tools and rules engine to


Execute authorization review: Use of a non-
Execute authorization review: Leveraged
support automated adjudication and


leveraged clinical/non-clinical resource
model with mix of clinical and non-clinical
distribution of authorizations/notifications


model for non-clinical transactions
resources for non-clinical transactions
Execute authorization review: Non-clinical


Perform inpatient concurrent review and
Perform inpatient concurrent review and
transactions supported by low cost, high


discharge planning: Onsite, intensive
discharge planning: Primarily telephonic
yield, non-clinical resources as appropriate


concurrent review with duplicative steps (e.g.
concurrent review model
Perform inpatient concurrent review and


manual, paper-based charting that is then
Perform inpatient concurrent review and
discharge planning: Shift to technology-


typed into a system)
discharge planning: Discharge planning is
based concurrent review transactions


Perform inpatient concurrent review and
proactive with limited integration with other 
Perform inpatient concurrent review and


discharge planning: Discharge planning is
services
discharge planning: Focused telephonic


manual, reactionary, and silo'd
Manage appeals and grievances:
concurrent review model (e.g. LOS outliers,


Manage appeals and grievances: Simple
Coordinated processes with customer
facility outliers, etc.) with onsite for high


processes and systems (e.g. Access
service, provider service and claims
volume facilities and specific cases


databases) to support resolution (typically
processing; multiple systems to support
Perform inpatient concurrent review and


fragmented with multiple handoffs)
appeals and grievances which are typically
discharge planning: Discharge planning is


Evaluate opportunities for programs/services:
not integrated
proactive, targeted, integrated with other


Opportunities identified based on chronic or
Evaluate opportunities for programs/services:
services, and supported by automated tools


episodic condition
Intervention opportunities identified using
Manage appeals and grievances: Integrated


Evaluate opportunities for programs/services:
evidence-based medical (EBM) guidelines
processes and systems for coordination with


Opportunities driven by health plan business
Evaluate opportunities for programs/services:
customer service, provider service, and


objectives
Prioritized intervention opportunities based
claims processing


Develop care plan - Care plan is created
on defined clinical pathways which
Evaluate opportunities for programs/services:


based on chronic or episodic condition
incorporate co-morbidities
Intervention opportunities identified based on


Develop care plan - Care plan is driven by
Evaluate opportunities for programs/services:
consumer's individual clinical, financial and


health plan business objectives
Obtain consumer understanding and consent
lifestyle data


Coordinate and manage care plan - Simple
regarding intervention opportunities driven
Evaluate opportunities for programs/services:


processes and systems to support care plans
by EBM guidelines
Systematically prioritized health and wealth


which are stand-alone and segregated
Develop care plan - Care plan is created
intervention opportunities based on predicted


Coordinate and manage care plan -
based on intervention opportunities and
level of clinical and financial impact for the


Engagement, disengagement, graduation or
clinical guidelines
specific consumer


step-down criteria for consumers based
Develop care plan - Obtain consumer
Evaluate opportunities for programs/services:


primarily on clinical judgment
understanding and consent regarding care
Collaboration with consumer to personalize


Coordinate and manage care plan - Clinician
plan driven by EBM guidelines
intervention opportunities


access to providers to collect information and
Coordinate and manage care plan -
Develop care plan - Individualized, iterative


vendors/partners to provide services
Coordinated processes within Health
care plan is created based on prioritized


Coordinate and manage care plan - Services
Management services; shared access to
health and wealth intervention opportunities


conducted primarily via telephone and mail
multiple systems to support care plan
Develop care plan - Collaboration with



Coordinate and manage care plan 
consumer to personalize care plan goals and



Standardized criteria used to determine
activities



engagement, disengagement, graduation or
Coordinate and manage care plan - Integrated



step-down criteria
processes within Health Management



Coordinate and manage care plan - Integrated
services; access to integrated system to



care plan that defines and tracks goals and
support care plan which includes both health



action items
and wealth intervention opportunities



Coordinate and manage care plan - Clinician
Coordinate and manage care plan -



access to subject matter advisors, providers,
Reputable, research based theories and



and vendors/partners to provide support
models (TTM, PAM, motivational



according to consumer need
interviewing, etc.) are used as a foundation to



Coordinate and manage care plan - Provide
determine engagement, disengagement,



interactive tools and content for consumer
graduation and step-down criteria



self-management
Coordinate and manage care plan -



Coordinate and manage care plan - Ability to
Interactive care plan with ability to track



distribute care plan to consumer and provider
goals and action items accessible via multiple



Coordinate and manage care plan - Addition
channels with customized views for



of web-based channels (e.g. portal, email,
consumer and approved care team (e.g. Care



etc.)
Navigator, provider, designated caregiver,




etc.)




Coordinate and manage care plan - Online




Personal Health Record (PHR) maintained




utilizing multiple data sources (e.g. claims,




pharmacy, biometric data, lab data, etc.) and




integrated with care plan




Coordinate and manage care plan - Single




point of contact (e.g. primary care navigator)




that coordinates with interdisciplinary team,




enterprise functions (customer service,




provider service, etc.) providers, and




vendors/partners to provide support activities




Coordinate and manage care plan - Access to




robust, integrated coaching tools that include




trending capabilities, goal tracking and




modeling




Coordinate and manage care plan - Multi-




channel, personalized, interactive coaching




customized to consumer and provider needs,




objectives and preferences with broader




access to person to person coaching, support




groups, online chat, etc.




Coordinate and manage care plan -




Collaboration with consumer to personalize




care plan goals and activities
















TABLE 8







Capability Assessment Model


Payer - Coordinate Healthcare Services


Promote Optimal Lifestyle








Sub-Platform: Perform Health Management
Capability: Reach and Engage









Basic
Competitive
Market Leading





Lifestyle promotion limited to consumer
Typical wellness programs offered include 
Optimal lifestyle programs evolving to


health education (usually CM/DM nurses)
tobacco cessation, weight management, and
include sleep, nutrition, exercise, and wealth


Engagement, disengagement, graduation or
stress management
management aligned with personalized


step-down criteria for consumers based
Tiered program options include buy-up to
reward programs and incentives


primarily on clinical judgment
coaching performed by licensed or certified
Multi-channel, personalized, interactive


Interventions with consumers based
professionals (i.e. registered dietician,
coaching customized to consumer and


primarily on episodic events or chronic
exercise physiologist, certified wellness
provider needs, objectives and preferences


condition
coach, etc.)
with broader access to person to person


Optional general health assessment is used to 
Basic behavior modification methods are
coaching, support groups, online chat


provide consumer's individual report and
used to determine engagement,
Reputable, research based theories and


relevant content
disengagement, graduation and step-down
models (TTM, PAM, motivational



criteria; includes creation of personalized
interviewing, etc.) are used as a foundation to



action plan and coordinated goal setting
determine engagement, disengagement,



Interventions with consumers based on
graduation and step-down criteria



triggers from general health assessments in
Behavior modification skills and approach



addition to chronic conditions or episodic
integrate into all Health Management



events
services



Provide interactive tools and content for
Interventions with consumers based on



consumer self-management (sustainability)
triggers from all available data sources (e.g.



Offer optional purchaser sponsored health
biometrics, lab data, health fair data, kiosk



and wellness fairs
devices, genomics, etc.




Pursue pilots/opportunities to leverage




relationships, with other vendors/partners




(e.g. pharmaceutical companies, PBM, etc.)




Access to robust, integrated coaching tools




that include trending capabilities, goal




tracking and modeling
















TABLE 9







Capability Assessment Model


Payer - Coordinate Healthcare Services


Engage Provider








Sub-Platform: Perform Health Management
Capability: Collaborate and Support









Basic
Competitive
Market Leading





Collaboration on Health Management
Collaboration on Health Management
Treatment Opportunities and Care Plans -


Program Design - Medical Directors meet
Program Design - Physicians are paid to
Near real time, online notification of


with Professional Organizations to promote
participate in facilitated design sessions
treatment opportunities (care gaps) and


programs
Treatment Opportunities - Notify provider, in
health risks of patients. Leverage provider


Treatment Opportunities - Disease
timely manner, of treatment opportunities
connectivity channels


management programs notify physician of
(i.e., care gaps) and health risks of patients 
Treatment Opportunities and Care Plans -


patient participation in program
Treatment Opportunities - Paper based and
Provide access to web based care plan tool


Treatment Opportunities quarterly
usually monthly or quarterly
and reward physician for creation of care


Provider Payment Strategies - Limited to
Provider Payment Strategies - Provider
plan that can be shared with broader care


provider contracts focused on fee schedules
payment strategies aligned with health
team


Decision Support - Paper based decision
outcomes, quality of care and interaction
Provider Payment Strategies - Providers are


support - mostly in the form of newsletters
with health management programs and tools.
incented to proactively manage their patient


and policy updates
Leverage this data to align fee schedules and
population (not just reactive medicine)



contracts
including payments for: (e.g. patient



Provider Connectivity - Support timely,
centered medical home concept)



online interaction
Provider Payment Strategies - Work



Provider Connectivity - Prior Authorizations
required to proactively review aggregate



Provider Connectivity - Referral network
population and individual information to



(specialist referrals)
identify risks



Provider Connectivity - Formulary
Provider Payment Strategies - Work that



information - cost, alternatives, drug-to-drug
falls outside of the face-to-face visit to



interactions
proactively care for patients



Provider Connectivity - Real time eligibility
Provider Payment Strategies - Payment



Provider Connectivity - Real time claim
for remote monitoring of clinical data using



adjudication to obtain near real time data for
technology



Care Management
Provider Payment Strategies - Online reports



Decision Support - Support clinical decision
to provider on status of incentive rewards



making with:
Provider Connectivity - Support channels



Access to evidence based guidelines
that provide near-real time patient



Patient-specific administrative
information that is both portable and



information (e.g., benefits information)
accessible to enable the provider (e.g.



Drug interaction and allergy warnings
Physicians, ER, retail clinics) to make



Identification of medication
decisions during a patient encounter



contraindications
Provider Connectivity - Support timely,



Provider Value Reports - Physicians receive
online interaction for:



yearly paper based reports that communicate:
Provider Connectivity - Personal health



Provider Value Reports - Annual report
Record information - with messages related



on number of patients that have participated
to care gaps and risks identified



in Health Management Programs
Provider Connectivity - Cost Calculator -



Provider Value Reports - Comparison of
estimate physician payment and member out-



utilization trends - from past years and
of-pocket expense



compared to peers
Decision Support - Support clinical decision



Provider Value Reports - Usage of
making with:



decision support tools
Patient-specific clinical information




Cost-effective treatment options




Identification of treatment adherence




issues




Provider Value Reports - Physicians receive




value reports, online, quarterly - or on




demand




Provider Value Reports - Enhancements to




quarterly reports that communicate:




Provider Value Reports - Health outcomes




achieved through Health Management




programs - for physician population




Provider Value Reports - Percentage




achievement of goals to achieve reward




dollars
















TABLE 10







Capability Assessment Model


Payer - Coordinate Healthcare Services


Engage Purchaser/Employer








Sub-Platform: Perform Health Management
Capability: Collaborate and Support









Basic
Competitive
Market Leading





Value Reporting - Paper based reports -
Value Reporting - Standard value-based
Value Reporting - Offer online reporting to


usually once a year during contract renewal
reports available on purchaser web site -
all accounts - regardless of size


Value Reporting - Standard reporting is only
target is large accounts
Value Reporting - Drill-down capability on


available to mid to large sized accounts
Value Reporting - Automated report process,
online reports to do ad hoc analysis.


Value Reporting - Operational/process
limited or no manual intervention
Parameter Driven Reports and Interactive


measures are reported (e.g. number of
Value Reporting - Value clearly articulated -
Reports that are created on demand


participants reached) - limited ROI reporting
clinical outcomes, financial outcomes and
Consultative Services - Automated purchaser


Value Reporting - Manually intensive
operational efficiencies
opportunity analysis with rules that create


process to analyze data and limited
Consultative Services - Conduct account-
recommendations for programs, metrics and


recommendations based on member
specific assessments to help clients improve
targets


experience
their business to obtain a better ROI from
Incentive Programs - Create employer


Value Reporting - Medical Director goes
their healthcare investments - target “A”
incentives for encouraging healthy behaviors


with Sales Rep to represent Health
Accounts
within employee population. Annually,


Management
Consultative Services - Establish baselines,
modify contracts/premiums based on percent


Consultative Services - Limited collaboration
identify employer specific opportunities to
of employee population that achieved agreed


between Sales force and Care Management
manage health, make recommendations for
upon goals


Worksite Programs - Small number of health
programs, set annual goals/targets
Worksite Programs - Collaborate with large


fairs conducted at time of open enrollment at
Consultative Services - Manual analysis
employers to set up onsite health clinics with


large employers
required
broad spectrum of non-urgent services (e.g.,



Consultative Services - Collaborate with the
symptom advice/treatment, condition



Account Manager to articulate care
coaching, etc.)



management solutions
Worksite Programs - Create new innovative



Incentive Programs - Collaborate with
employee health management services (e.g.,



employers to offer employer-funded
health concierge services, health/wealth



incentives to employees
retirement planning)



Incentive Programs - Report on employee




uptake of incentive programs and impact of




program on health outcomes




Worksite Programs - Collaborate with




Purchasers to support health fairs, lunch and




learns, and other wellness programs.




Prioritize accounts to optimize use of limited




resources




Worksite Programs - Develop Employer




“tool-kits” with example programs and




materials to initiate employer wellness




initiatives
















TABLE 11







Capability Assessment Model


Payer - Coordinate Healthcare Services


Manage Results








Sub-Platform: Perform Health Management
Capability: Evaluate and Improve









Basic
Competitive
Market Leading





Enterprise-wide measurement methodology
Engagement of stakeholders in determining
Collaboration with stakeholders to determine


defined by health plan
measurement methodology
measurement methodology leveraging


Paper-based report distribution
Electronic report distribution
industry standards


Manual reporting for regulatory compliance,
Annual reporting on outcomes and ROI for
Executive dashboard generated to understand


contractual obligations and operational
operational management, provider
high-level cost and utilization trends across


management
performance and purchaser value reporting
the enterprise



Vendor Data is included in reports
Dynamic, interactive, individualized reports



Ability to perform metrics evaluation
with drill-down capabilities and



compared to expected thresholds
identification of actionable items



Dedicated team to manage standard reports
On-demand reporting on outcomes and ROI



and ad hoc reports for root cause analysis
for operational management, provider



Leverage root cause analysis for internal
performance and purchaser value reporting



continuous improvement
Seamless, systematic incorporation of vendor




data




Executive accountability and ownership for




enterprise-wide healthcare informatics




Leverage real time predictive analysis for




trending and alerts with defined actionable




items




Leverage results management capabilities for




stakeholder continuous improvement
















TABLE 12







Capability Assessment Model


Payer - Coordinate Healthcare Services


Communicate Value to Stakeholders








Sub-Platform: Perform Health Management
Capability: Evaluate and Improve









Basic
Competitive
Market Leading





Paper-based explanation of benefits (EOB)
Paper-based personalized health statements
Electronic, dynamic, integrated personal




health statements with actionable targeted




messaging




Interactive modeling




Personalized ROI reports with ability to do




interactive modeling (i.e. ability for




consumers to adapt/change inputs)
















TABLE 13







Capability Assessment Model


Payer - Coordinate Healthcare Services


Provide Account Specific Consultative Services








Sub-Platform: Perform Health Management
Capability: Evaluate and Improve









Basic
Competitive
Market Leading





Utilize reports to monitor utilization and
Utilize reports to monitor utilization,
Comprehensive, interactive reports with in-


program efficiency to determine if services
program efficiency, and value to determine if
depth analysis and interpretation including


need to be added or modified
services need to be added or modified
productivity, absenteeism, and presenteeism


Basic set of reports handed off to account
Basic set of reports provided to account
Account representatives have the training


representative with limited analysis
representative with analysis and
and tools to perform interactive, dynamic


Ad hoc purchaser data generated upon
interpretation
opportunity assessment and program


purchaser request, limited by health plan
Customer understanding and relationship
planning


capability
development is data driven and fact-based
Health Management advisors involved in


Customer understanding and relationship
utilizing internal and external sources
consultative sales process


development is an “art” versus fact and data 
Defined delivery approach and processes
Customer understanding and relationship


driven
leveraging Health Management advisors on
development is trust-based, interactive, and


Basic delivery approach and processes driven 
an as needed basis
reflects the depth of knowledge on the


by reaction to purchaser requests (typically

customer obtained from personal


inconsistent, segmented and silo'd)

interactions, understanding of the customer's




strategic objectives and relevant data




Collaborative approach driven by insight to




proactively identify customer needs to




achieve strategic objectives
















TABLE 14







Capability Assessment Model


Payer - Coordinate Healthcare Services


Provide Decision Support








Sub-Platform: Perform Health Management
Capability: Research and Engage









Basic
Competitive
Market Leading





Focused on treatment option decisions for
Focused on health decisions for preference
Offer full spectrum of health and wealth


chronic or episodic conditions to support
sensitive conditions based on health plan
decision support based on consumer needs


CM/DM
ROI (e.g. pain management, surgery,
(e.g. provider selection, medication therapy,


Guidance on health care options provided
fertility, oncology decisions, etc.)
palliative care, medical tourism, etc.)


according to health plan guidelines and
Proactive identification of consumers
Proactive identification of consumers during


policy
through “trigger list” of diagnoses and
optimal impact period through predictive


Access to static information based on
procedures
analysis


medical policy
Access to static information based on
Multi-channel access to interactive,



evidence-based medical guidelines
customized content, messaging and tools



Coaching consumer to have appropriate
(e.g. cost calculators, decisions trees, etc.)



dialog with provider (e.g. developing list of
regarding health and wealth options,



questions, creating checklist, etc.)
including access to interactive personal



Access to clinical decision support content,
health and wealth advisor services



clinical care paths, basic cost and quality data 
Support consumer dialog with provider (e.g.



(e.g. Subimo, CMS, etc.)
coaching, joint conversation, etc.)



Access to subject matter advisors to provide
Ability for consumer to access health plan



decision support according to consumer need
and consumer rating information on




providers (e.g. quality, cost, consumer




satisfaction data, etc.)




Access to interdisciplinary team to provide




decision support according to consumer need

## Claims

1. A computer-implemented method for high-performance capability assessment of a health and life sciences business, comprising:
providing a processor operatively coupled to a communication network;
providing a database operatively coupled to the processor and accessible through the communication network;
coupling an interface to the processor for receiving input;
defining, by the processor coupled to a machine-readable memory in the database, a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market Leading’ performance assessment criteria;

establishing a coordinate care assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a first criteria for execution of authorization review where authorization policies are broadly applied;
wherein the ‘Competitive’ performance assessment criteria includes a first criteria for execution of authorization review where a shift to automated notifications occurs;
wherein the ‘Market Leading’ performance assessment criteria includes a first criteria for execution of authorization review where focused authorization on high impact opportunities exists;

receiving, through the communication network, an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
searching, by the processor, the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area;
retrieving, by the processor, the matching key assessment performance reference table;
analyzing, by the processor, the matching key assessment performance reference table; and
obtaining, by the processor, a resultant performance level for the health and life sciences industry key assessment area.

2. A computer-implemented method for high-performance capability assessment of a health and life sciences business, comprising:
providing a processor operatively coupled to a communication network;
providing a database operatively coupled to the processor and accessible through the communication network;
coupling an interface to the processor for receiving input;
defining, by the processor coupled to a machine-readable memory in the database, a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market Leading’ performance assessment criteria;

establishing a coordinate care assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes

a first criteria for execution authorization review where manual entry of fax and phone data exists;
wherein the ‘Competitive’ performance assessment criteria includes

a first criteria for execution authorization review where use of IVR, web and EDI exists to automate authorization data entry;
wherein the ‘Market Leading’ performance assessment criteria includes

a first criteria for execution authorization review where use of automated notifications triggers programs and services
receiving, through the communication network, an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
searching, by the processor, the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area
retrieving, by the processor, the matching key assessment performance reference table;
analyzing, by the processor, the matching key assessment performance reference table; and
obtaining, by the processor, a resultant performance level for the health and life sciences industry key assessment area.

3. A computer-implemented method for high-performance capability assessment of a health and life sciences business, comprising:
providing a processor operatively coupled to a communication network;
providing a database operatively coupled to the processor and accessible through the communication network;
coupling an interface to the processor for receiving input;
defining, by the processor coupled to a machine-readable memory in the database, a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market Leading’ performance assessment criteria;
establishing a promotion of optimal lifestyle assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes


a first criteria where engagement, disengagement, graduation or step-down criteria for consumers is based primarily on clinical judgment;
wherein the ‘Competitive’ performance assessment criteria includes
a first criteria where tiered program options include buy-up to coaching is performed by licensed or certified professionals;
wherein the ‘Market Leading’ performance assessment criteria includes

a first criteria where multi-channel, personalized interactive coaching is customized to consumer and provider needs, objectives and preferences, which provides broader access to person to person coaching, support groups, and online chat;

receiving, through the communication network, an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
searching, by the processor, the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area;
retrieving, by the processor, the matching key assessment performance reference table;
analyzing, by the processor, the matching key assessment performance reference table; and
obtaining, by the processor, a resultant performance level for the health and life sciences industry key assessment area.

4. The computer-implemented method of claim 1, further including establishing a provide decision support assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes
a second criteria where guidance on health care options are provided according to health plan guidelines and policy;
wherein the ‘Competitive’ performance assessment criteria includes
a second criteria where proactive identification of consumers through “trigger list” of diagnoses and procedures exists; and
wherein the ‘Market Leading’ performance assessment criteria includes
a second criteria where proactive identification of consumers during optimal impact period through predictive analysis exists.

5. The computer-implemented method of claim 1, further including establishing a design campaigns assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes
a second criteria where limited metrics are defined to measure impact and value of campaign;
wherein the ‘Competitive’ performance assessment criteria includes a second criteria where purchaser driven campaign identification and design exists; and
wherein the ‘Market Leading’ performance assessment criteria includes a second criteria where segment specific outreach channels exist.

6. The computer-implemented method of claim 1, further including establishing an identify individual intervention opportunities assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a second criteria where individual clinical judgment determines priority of interventions and consumers for outreach;
wherein the ‘Competitive’ performance assessment criteria includes a second criteria where prioritized intervention opportunities are based on defined clinical pathways which incorporate co-morbidities; and
wherein the ‘Market Leading’ performance assessment criteria includes a second criteria where systematic prioritized health and wealth intervention opportunities are based on predicted level of clinical and financial impact for the specific consumer.

7. A non-transient computer-readable memory or data storage means encoded with data representing a computer program for a high-performance capability assessment of a health and life sciences business, the computer-readable memory or data storage means causing the computer to perform the acts of:
operatively coupling a processor to a communication network;
operatively coupling a database to the processor, the database accessible through the communication network;
coupling an interface to the processor for receiving input;
establishing, by the processor, a machine-readable memory in said database, including a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market leading’ performance assessment criteria;

establishing a coordinate care assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a first criteria for execution of authorization review where authorization policies are broadly applied;
wherein the ‘Competitive’ performance assessment criteria includes a first criteria for execution of authorization review where a shift to automated notifications occurs;
wherein the ‘Market Leading’ performance assessment criteria includes a first criteria for execution of authorization review where focused authorization on high impact opportunities exists;

receiving, by the processor, an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
searching, by the processor, the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area;
retrieving, by the processor, the matching key assessment performance reference table;
analyzing, by the processor, the matching key assessment performance reference table; and
obtaining, by the processor, a resultant performance level for the health and life sciences industry key assessment area.

8. A non-transient computer-readable memory or data storage means encoded with data representing a computer program for a high-performance capability assessment of a health and life sciences business, the computer-readable memory or data storage means causing the computer to perform the acts of:
operatively coupling a processor to a communication network;
operatively coupling a database to the processor, the database accessible through the communication network;
coupling an interface to the processor for receiving input;
establishing, by the processor, a machine-readable memory in said database, including a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market leading’ performance assessment criteria;

establishing a coordinate care assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes:
a first criteria where execution of authorization review policies are broadly applied;
wherein the ‘Competitive’ performance assessment criteria includes a first criteria where execution authorization review shifts to automated notifications;
wherein the ‘Market Leading’ performance assessment criteria includes a first criteria where execution authorization review is focused on high impact opportunities;

receiving, by the processor, an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
searching, by the processor, the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area;
retrieving, by the processor, the matching key assessment performance reference table;
analyzing, by the processor, the matching key assessment performance reference table; and
obtaining, by the processor, a resultant performance level for the health and life sciences industry key assessment area.

9. A non-transient computer-readable memory or data storage means encoded with data representing a computer program for a high-performance capability assessment of a health and life sciences business, the computer-readable memory or data storage means causing the computer to perform the acts of:
operatively coupling a processor to a communication network;
operatively coupling a database to the processor, the database accessible through the communication network;
coupling an interface to the processor for receiving input;
establishing, by the processor, a machine-readable memory in said database, including a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market leading’ performance assessment criteria;

establishing a promote optimal lifestyle assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a first criteria where lifestyle promotion is limited to consumer health education
wherein the ‘Competitive’ performance assessment criteria includes a first criteria where typical wellness programs offered include tobacco cessation, weight management, and stress management;
wherein the ‘Market Leading’ performance assessment criteria includes a first criteria where optimal lifestyle programs evolving to include sleep, nutrition, exercise, and wealth management aligned with personalized reward programs and incentives;

receiving, by the processor, an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
searching, by the processor, the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area
retrieving, by the processor, the matching key assessment performance reference table;
analyzing, by the processor, the matching key assessment performance reference table; and
obtaining, by the processor, a resultant performance level for the health and life sciences industry key assessment area.

10. The non-transient computer-readable medium of claim 7 further comprising computer-readable content to cause a computer to perform acts of establishing a provide decision support assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a second criteria where guidance on health care options is provided according to health plan guidelines and policy;
wherein the ‘Competitive’ performance assessment criteria includes a second criteria where proactive identification of consumers through “trigger list” of diagnoses and procedures exist; and
wherein the ‘Market Leading’ performance assessment criteria includes a second criteria where proactive identification of consumers during optimal impact period is performed through predictive analysis.

11. The non-transient computer-readable medium of claim 7 further comprising computer-readable content to cause a computer to perform acts of establishing a design campaigns assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes
a second criteria where limited metrics are defined to measure impact and value of campaign;
wherein the ‘Competitive’ performance assessment criteria includes a second criteria where purchaser driven campaign identification and design exists; and
wherein the ‘Market Leading’ performance assessment criteria includes a second criteria where segment specific outreach channels exist.

12. The non-transient computer-readable medium of claim 7 further comprising computer-readable content to cause a computer to perform acts of establishing an identify individual intervention opportunities assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a second criteria where individual clinical judgment determines priority of interventions and consumers for outreach;
wherein the ‘Competitive’ performance assessment criteria includes a second criteria where prioritized intervention opportunities based on defined clinical pathways which incorporate co-morbidities, exist; and
wherein the ‘Market Leading’ performance assessment criteria includes a second criteria where systematic prioritized health and wealth intervention opportunities are based on predicted level of clinical and financial impact for the specific consumer.

13. A system for high-performance capability assessment of a health and life sciences business, comprising:
a processor operatively coupled to a communication network;
an interface coupled to the processor configured to receive input;
a database operatively coupled to the processor and accessible through the communication network;
a machine-readable memory operatively located in said database, said memory including a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market leading’ performance assessment criteria;

establishing a coordinate care assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a first criteria for execution of authorization review where authorization policies are broadly applied;
wherein the ‘Competitive’ performance assessment criteria includes a first criteria for execution of authorization review where a shift to automated notifications occurs;
wherein the ‘Market Leading’ performance assessment criteria includes a first criteria for execution of authorization review where focused authorization on high impact opportunities exists;

the interface receiving an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
wherein the processor searches the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area, and retrieves the matching key assessment performance reference table; and
wherein the processor performs analysis of the matching key assessment performance reference table; and obtains a resultant performance level for the health and life sciences industry key assessment area.

14. A system for high-performance capability assessment of a health and life sciences business, comprising:
a processor operatively coupled to a communication network;
an interface coupled to the processor configured to receive input;
a database operatively coupled to the processor and accessible through the communication network;
a machine-readable memory operatively located in said database, said memory including a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market leading’ performance assessment criteria;

the processor establishing a coordinate care assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a first criteria where authorization policies are broadly applied;
wherein the ‘Competitive’ performance assessment criteria includes a first criteria where execution authorization review shift to automated notifications;
wherein the ‘Market Leading’ performance assessment criteria includes a first criteria where execution of authorization review includes focused authorization on high impact opportunities;

the interface receiving an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
wherein the processor searches the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area, and retrieves the matching key assessment performance reference table; and
wherein the processor performs analysis of the matching key assessment performance reference table; and obtains a resultant performance level for the health and life sciences industry key assessment area.

15. A system for high-performance capability assessment of a health and life sciences business, comprising:
a processor operatively coupled to a communication network;
an interface coupled to the processor configured to receive input;
a database operatively coupled to the processor and accessible through the communication network;
a machine-readable memory operatively located in said database, said memory including a multidimensional health and life sciences industry performance reference set comprising multiple key assessment performance reference tables, at least one key assessment performance reference table defining a sub-platform for performing health care management, including:
a ‘Basic’ performance level specifying ‘Basic’ performance assessment criteria;
a ‘Competitive’ performance level specifying ‘Competitive’ performance assessment criteria;
a ‘Market Leading’ performance level specifying ‘Market leading’ performance assessment criteria;

the processor establishing a promotion of optimal lifestyle assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes a first criteria where lifestyle promotion is limited to consumer health education
wherein the ‘Competitive’ performance assessment criteria includes a first criteria where typical wellness programs offered include tobacco cessation, weight management, and stress management;
wherein the ‘Market Leading’ performance assessment criteria includes a first criteria where optimal lifestyle programs evolve to include sleep, nutrition, exercise, and wealth management aligned with personalized reward programs and incentives;

the interface receiving an input specifying a health and life sciences industry area and a health and life sciences industry key assessment area with the health and life sciences industry area for analysis;
wherein the processor searches the multidimensional health and life sciences industry performance reference set for a matching key assessment performance reference table that matches the health and life sciences industry area and the health and life sciences industry key assessment area, and retrieves the matching key assessment performance reference table; and
wherein the processor performs analysis of the matching key assessment performance reference table; and obtains a resultant performance level for the health and life sciences industry key assessment area.

16. The system of claim 13, wherein the processor establishes a provide decision support assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes
a second criteria where guidance on health care options are provided according to health plan guidelines and policy;
wherein the ‘Competitive’ performance assessment criteria includes
a second criteria where proactive identification of consumers through “trigger list” of diagnoses and procedures exist; and
wherein the ‘Market Leading’ performance assessment criteria includes
a second criteria where proactive identification of consumers during optimal impact period occurs through predictive analysis.

17. The system of claim 13, wherein the processor establishes a design campaigns assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes
a second criteria where limited metrics are defined to measure impact and value of campaign;
wherein the ‘Competitive’ performance assessment criteria includes
a second criteria where purchaser driven campaign identification and design exists;
wherein the ‘Market Leading’ performance assessment criteria includes
a second criteria where segment specific outreach channels exist.

18. The system of claim 13, wherein the processor establishes an identify individual intervention opportunities assessment criteria,
wherein the ‘Basic’ performance assessment criteria includes
a second criteria where individual clinical judgment determines priority of interventions and consumers for outreach;
wherein the ‘Competitive’ performance assessment criteria includes
a second criteria where prioritized intervention opportunities are based on defined clinical pathways which incorporate co-morbidities; and
wherein the ‘Market Leading’ performance assessment criteria includes
a second criteria where systematic prioritized health and wealth intervention opportunities are based on predicted level of clinical and financial impact for the specific consumer.