Patent Publication Number: US-2011071868-A1

Title: Systems and methods for tailoring the delivery of healthcare communications to patients

Description:
RELATED APPLICATIONS 
     This application claims the benefit of U.S. Patent Application No. 61/244,838 filed on Sep. 22, 2009, which is hereby incorporated herein by reference in its entirety. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     In a preferred embodiment, this application relates to systems and methods for communicating health or wellness information to clients, and more particularly to scheduling communications related to health and wellness information. 
     2. Description of the Related Art 
     Managing a population of patients to improve health and wellness may involve interacting with patients in that population through a series of conversations where a clinician, coach, or medical specialist guides a patient towards better decisions for the patient&#39;s overall health. In some cases these conversations are delivered via a telephone dialer system that prioritizes calls by maximizing the number of attempts to reach each patient. Successful connection rates for telephonic intervention using this type of system are often less than 10%, meaning that healthcare, and wellness services providers must do a significant amount of rework in order to deliver the promised service. Thus, it is desirable to have a method for predicting the best time and method to contact a patient in order to maximize the number of successful communications between a medical specialist and a patient. 
     SUMMARY OF THE INVENTION 
     In one embodiment, a computerized method of scheduling a plurality of patient communications comprises determining the available resources for communicating a plurality of patient communications, determining the clinical priority of each patient communication, determining the relative likelihood of receiving a response to each patient communication based on the time of the patient communication, organizing the plurality of patient communications into time slots based on the likelihood of receiving a response, the clinical priority of each patient communication, and the available resources, and outputting a schedule for performing patient communications based on the organized patient communications. The time of the communication may be a time of day, a day of the week, a particular date, or a week of a month. Determining the available resources for communicating a plurality of patient communications may comprise analyzing the skill set of each individual responsible for performing the communications. Determining the clinical priority of each patient communication may comprise categorizing the patient communication, assigning a priority based on the category of the communication, and adjusting the priority of the communication based on the length of time the communication has been scheduled but not completed. The method of scheduling a plurality of patient communications may further comprise determining the time and content of a future patient communication based on the response received from the patient communication. The method of scheduling a plurality of patient communications may further comprise determining a relative priority of the patient communications within a time slot and ordering the patient communications within the time slot based on the relative priority. Determining the relative likelihood of receiving a response to each patient communication my comprise analyzing a correlation between patient demographics and the likelihood for a patient to respond to a patient communication performed in a particular time slot. Patient demographics may be age and gender. Determining the relative likelihood of receiving a response to each patient communication may comprise analyzing communication preference information received from the patient. Determining the relative likelihood of receiving a response to each patient communication may comprise analyzing the patient&#39;s health status. A predictive model may be used to determine the relative likelihood of receiving a response to each patient communication. Organizing the patient communications may be performed by a computing device. The method of scheduling a plurality of patient communications may further comprise contacting a patient on the basis of the schedule. In one embodiment, the patient is contacted using an apparatus selected from the group consisting of a computer, a portable computing device, or a telephone. 
     In another embodiment, a computerized method of scheduling a plurality of patient communications comprises receiving information indicative of the available resources for communicating a plurality of patient communications, receiving information indicative of the clinical priority of each patient communication, receiving information indicative of the relative likelihood of receiving a response to each patient communication based on the time of the patient communication, organizing the plurality of patient communications into time slots based on the likelihood of receiving a response, the clinical priority of each patient communication, and the available resources, and outputting a schedule for performing patient communications based on the organized patient communications. The time of the communication may be a time of day, a day of the week, a particular date, or a week of a month. The method of scheduling a plurality of patient communications may further comprise determining the time and content of a future patient communication based on the response received from the patient communication. The method of scheduling a plurality of patient communications may also further comprise determining a relative priority of the patient communications within a time slot and ordering the patient communications within the time slot based on the relative priority. Organizing the patient communications may be performed by a computing device. In one embodiment, the method of scheduling a plurality of patient communications further comprises contacting a patient on the basis of the schedule. The patient may be contacted using an apparatus selected from the group consisting of a computer, a portable computing device and a telephone. 
     In another embodiment, a system for scheduling a plurality of patient communications, the system comprises a memory storing information associated with a plurality of patients and a processor to perform determining the available resources for communicating a plurality of patient communications, determining the clinical priority of each patient communication, determining the relative likelihood of receiving a response to each patient communication based on the time of the patient communication, organizing the plurality of patient communications into time slots based on the likelihood of receiving a response, the clinical priority of each patient communication, and the available resources, and outputting a schedule for performing patient communications based on the organized patient communications. The time of the communication may be a time of day, a day of the week, a particular date, or a week of a month. Determining the available resources for communicating a plurality of patient communications may comprise analyzing the skill set of each individual responsible for performing the communications. Determining the clinical priority of each patient communication may comprise categorizing the patient communication, assigning a priority based on the category of the communication, and adjusting the priority of the communication based on the length of time the communication has been scheduled but not completed. The processor may further perform determining the time and content of a future patient communication based on the response received from the patient communication. The processor may further perform determining a relative priority of the patient communications within a time slot and ordering the patient communications within the time slot based on the relative priority. Determining the relative likelihood of receiving a response to each patient communication may comprise analyzing a correlation between patient demographics and the likelihood for a patient to respond to a patient communication performed in a particular time slot. Patient demographics may comprise age and gender. Determining the relative likelihood of receiving a response to each patient communication may comprise analyzing communication preference information received from the patient. Determining the relative likelihood of receiving a response to each patient communication may comprise analyzing the patient&#39;s health status. A predictive model may be used to determine the relative likelihood of receiving a response to each patient communication. 
     In another embodiment, a computerized system for scheduling a plurality of patient communications, the system comprises a memory storing information indicative of the available resources for communicating a plurality of patient communications, information indicative of the clinical priority of each patient communication, and information indicative of the relative likelihood of receiving a response to each patient communication based on the time of the patient communication and a processor to perform organizing the plurality of patient communications into time slots based on the likelihood of receiving a response, the clinical priority of each patient communication, and the available resources and outputting a schedule for performing patient communications based on the organized patient communications. The time of the communication may be a time of day, a day of the week, a particular date, or a week of a month. The processor may further perform determining the time and content of a future patient communication based on the response received from the patient communication. The processor may further perform determining a relative priority of the patient communications within a time slot and ordering the patient communications within the time slot based on the relative priority. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a block diagram illustrating one embodiment of a communication tailoring system. 
         FIG. 2  is a flow chart illustrating one embodiment of a process for tailoring communications, such as using the system of  FIG. 1 . 
     
    
    
     DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS 
     The system, method, and devices of embodiments of the invention each have several aspects, no single one of which is solely responsible for its desirable attributes. Without limiting the scope of this invention as expressed by the claims which follow, its more prominent features will now be discussed briefly. After considering this discussion, and particularly after reading this section, one will understand how the features of this invention provide advantages that include providing more efficient methods and systems for communicating with patients. 
     The following detailed description of certain embodiments presents various descriptions of specific embodiments of the invention. However, the invention can be embodied in a multitude of different ways as defined and covered by the claims. For example, while this discussion describes the use of the invention in the context of patient communications, it will be appreciated that, in some embodiments, the inventions can be used in other contexts where it is desirable to contact an individual. In this description, reference is made to the drawings wherein like parts are designated with like numerals throughout. 
     The terminology used in the description presented herein is not intended to be interpreted in any limited or restrictive manner, simply because it is being utilized in conjunction with a detailed description of certain specific embodiments of the invention. Furthermore, embodiments of the invention may include several novel features, no single one of which is solely responsible for its desirable attributes or which is essential to practicing the inventions herein described. 
     The system is comprised of various modules, tools, and applications as discussed in detail below. As can be appreciated by one of ordinary skill in the art, each of the modules may comprise various sub-routines, procedures, definitional statements and macros. In some embodiments, each of the modules are typically separately compiled and linked into a single executable program. Therefore, the following description of each of the modules is used for convenience to describe the functionality of embodiments of the system. Thus, the processes that are undergone by each of the modules may be arbitrarily redistributed to one of the other modules, combined together in a single module, or made available in, for example, a shareable dynamic link library. 
     The system modules, tools, and applications may be written in any programming language. For example, in some embodiments, the applications may be written in C, C++, C#, BASIC, Visual Basic, Pascal, Ada, Java, HTML, XML, or FORTRAN, and executed on an operating system. In some embodiments, the operating system may be Windows, Macintosh, UNIX, Linux, VxWorks, or another variant of the foregoing operating system. C, C++, BASIC, Visual Basic, Pascal, Ada, Java, HTML, XML and FORTRAN are industry standard programming languages for which many commercial compilers can be used to create executable code. 
     Healthcare providers, insurance companies, and other healthcare entities must often contact patients, for example to deliver or request information, discuss healthcare options, or schedule appointments. A communication attempt made without an actual connection, such as an unanswered phone call, can result in the patient not receiving critical healthcare information. If a patient cannot be reached in the initial attempt, the provider must use additional resources to deliver the message and thus ensure that the service is delivered as promised. 
     In one embodiment, a communication tailoring systems permits a service provider to tailor the delivery of a communication or encounter to a patient in a way that maximizes the probability of actual communication with the patient. Maximizing the number of successful communications may decrease the resources and cost necessary to contact some patients. In one embodiment, the communication tailoring system maximizes successful communications for the most important communications rather than increasing the number of successful low priority communications. In one embodiment, in order to determine the best way to allocate communication resources, the communication tailoring system may weigh the available system resources, the likelihood of a communication with a patient being successful at a particular time through a particular method, and the clinical priority of the particular communication. 
       FIG. 1  is a block diagram illustrating one embodiment of a communication tailoring system  100 . In this embodiment, a mobile or fixed computing device  104  is operated by a user  102 . In some embodiments, the computing device  104  can be a handheld computing device or other portable computing device such as a Palm, Pocket personal computer (PC), Linux based handheld, PDA, smartphone, Tablet PC, or PC having a display. Alternatively, the computing device  104  may be a personal computer having a built in or separate display. The computing device  104  in certain embodiments operates in a stand-alone (independent) manner. In other embodiments, the computing device  104  is in communication with one or more computing devices  106 , such as a server, via a network  108 . The computing devices  106  include one or processors  122 , a data storage  120 , a rules engine  126 , and system software  124  executed by the processor(s)  122 . 
     In certain embodiments, the data storage  120  stores one or more databases used by the system, and stores patient medical records. The processor(s)  122  are in communication with the database(s) via a database interface, such as structured query language (SQL) or open database connectivity (ODBC). In certain embodiments, the data storage  120  is not included in computing device  106 , but is in data communication with the computing device  106  via the database interface. 
     The rules engine  126  establishes rules for tailoring communications with patients. The rules engine  126  may embodied in hardware, software, or both of these. In one embodiment, the rules executed by the rules engine  126  are related to relationships found in a study performed by Healthways, Inc. To improve real connectivity and to enhance the ability to achieve outcomes on the population, a study was performed to evaluate attributes that affect successful delivery of communications. The results of these studies yielded operational factors based on trial results that increase operational efficiency by maintaining consistently high productivity for internal providers while also maximizing for true connectivity instead of number of attempts. The processor  122  may leverage these results which may be accomplished by the addition of clinical and financial factors to the decision-making regarding communication delivery. The study was conducted using different types of communications, using regression analysis and a fit test against the regression analysis. For each hour state of a day, the rules engine  126  weights variables, such as age, gender, number of unsuccessful communications times, clinical relevance, and other factors. It will be appreciated that, in embodiments in which the claimed invention is used to contact individuals who are not patients, factors relevant to the demographics and criticality of contact of the desired group of individuals may be considered. 
     The healthcare system  100  may include a network  108 , which may represent a local area network (LAN), a wide area network (WAN), the Internet, or another connection service. The connection from the computing device  104  to the network  108  can be a wireless or a satellite connection or a wired or direct connection. In certain embodiments, the server(s) are part of a web site, such as on an intranet or the Internet. 
     The computing device  104  includes a processor  114 , an integral or separate display  118 , and one or more input devices  116 . The processor  114  is in data communication with a data storage  112  for storing one or more databases having data such as medical data used by the system. In certain embodiments, the data storage  112  stores data such as patient medical records. System software  110  is executed by the processor  114 . The system software  110  includes an application graphical user interface (GUI). The application GUI can include a database interface to the data storage  112  of the computing device. In certain embodiments, the software is loaded from the data storage  112 . In embodiments where the computing device  104  communicates with a web site, the processor utilizes browser software in place of or in addition to the software  110 . The network  108  may connect to a user computer  104 , for example, by use of a modem or by use of a network interface card. A user  102  at computer  104  may utilize a browser to remotely access the programs using a keyboard and/or pointing device and a visual display, such as a monitor. Alternatively, the browser is not utilized when the programs are executed in a local mode on computer  104 . A video camera may be optionally connected to the computer  104  to provide visual input. 
     In one embodiment, the methods discussed herein are executed on the processor  114 . In another embodiment, the methods are executed on the processor  122  with output sent via the network  108  to the computing device  104 . In one embodiment, the programs and databases reside on a group of servers that are interconnected by a LAN and a gateway to a network. Alternatively, the programs and databases reside on a single server that utilizes network interface hardware and software. The servers store the information described herein. 
     Various other devices may be used to communicate with the computing device  106 . If the servers are equipped with voice recognition or DTMF hardware, the user can communicate with the program by use of a telephone. Other connection devices for communicating with the computing device  106  include a portable personal computer with a modem or wireless connection interface, a wireless device such as a mobile telephone or a smart phone, a cable interface device connected to a visual display, or a satellite dish connected to a satellite receiver and a television. Other ways of allowing communication between the user  102  and the servers  106  are envisioned. 
     As used herein, actions such as the process described herein below, performed by the processor  122  may be performed by any suitable hardware or software, including the processor  114 , the processor  122 , and/or the rules engine  126 . 
       FIG. 2  is a flow chart illustrating a process  202  for tailoring communications. In one embodiment, the process  202  is executed on a computing device. Beginning at a state  203 , the process  202  receives information about a plurality of patient communications. The information may include information about necessary patient communications. In one embodiment, the process  202  determines which patient communications are necessary rather than receiving the information from another source. In one embodiment, the process  202  analyzes the patient&#39;s contract to determine which patient communications should be made. For example, a healthcare plan may authorize certain types of communications or a certain frequency of communications. Other criteria for determining whether a patient communication should be made include, for example, whether the patient has requested not to be contacted, whether new data is available (such as claims, lab information, or healthcare usage information), whether a reminder for a scheduled appointment is necessary, whether an inbound communication was received from a patient, and whether a healthcare provider has requested that a patient communication be made. 
     After the state  203 , the process  202  may advance to one of a state  204 ,  206 , or  208 . The process  202  may perform the states  204 ,  206 , and  208  in any order, and in one embodiment, the process  202  may also skip one or more of the states  204 ,  206 , and  208 . In one embodiment, the process  202  performs the states  204 ,  206 , and  208  simultaneously. 
     Continuing to a state  204 , the process  202  determines the available resources for communicating the plurality of patient communications. The process  202  may evaluate multiple factors when determining the available resources. For example, the process  202  may consider the number of service providers, the skill sets of the service providers, average time per communication, types of available resources, and the service provider staff idle time. The process  202  may further analyze the volume of the necessary patient communications and the objectives for the system. The process  202  may also consider the resources for multiple types of communications, such as telephone, web, email, and mail communications. In one embodiment, the process  202  executes one or more predictive models in order to determine the available resources. 
     In one embodiment, the process  202  also determines the available resources based on a particular delivery approach devoted to each communication. The delivery approaches may include, for example, a team, one to one, dedicated, group, limited team, and community approaches. A team approach may involve a team of providers (e.g., clinicians or coaches) where the team of providers interacts with an individual patient where communications are automatically distributed to one of the members of the particular team of providers based on heuristics designed to maximize outreach and balancing probability of success with priority of the communication. This is desirable because individuals are often not expecting to be contacted and interacting with different providers for each interaction. 
     In one embodiment, a one to one delivery approach occurs when a primary provider initiates interaction with an Individual through scheduled appointments. Individuals expect to be contacted at a scheduled time and with the same provider for each interaction. 
     In another embodiment, a dedicated delivery approach involves a primary provider interacting with a patient through the automatic distribution of encounters to that provider. Individuals are often not expecting to be contacted, but do expect to interact with the same provider for each interaction. 
     Other embodiments include a group delivery approach where a group of patients are serviced by one provider, a limited team delivery approach where a single provider manages the distribution to a set of other providers for an individual patient in a given population, and a community delivery approach where individuals interact with other patients often under the of a healthcare management system and channels provided by a healthcare management system, such as moderated forums. 
     After the state  203 , the process  202  may also continue to a state  206 , in which the process  202  determines the clinical priority of each patient communication. In one embodiment, the process  202  stores the clinical priority in the database  120  shown in  FIG. 1 . In another embodiment, the rules engine  126  determines the clinical priority based on multiple factors. The factors may be, for example, the health status of the patient, type of communication, clinical relevance of communication to be delivered, aging of communications never attempted, and number of failed attempts for the communication. In one embodiment, the rules engine  126  assigns a ranking to each communication that is indicative of the relative priority of the communication. 
     In one embodiment, the communication has a priority based on the type of communication. The type of communications may be, for example, base, immediate, remote monitoring, and specialty communications. Base communications may represent typical communications delivered by an internal provider such as care or follow up communications. Immediate communications may represent any communications that must be delivered in a short time frame, such as on the particular day. Remote monitoring communications may represent communications that are specialized, such as communications from resources that can manage alerts from equipment managed in a patient&#39;s home. Specialty communications may be communications that have been separated out for treatment independent of operational factors listed previously. 
     In one embodiment, the process  202  places each communication in one of the four categories, or buckets, mentioned above and prioritizes it within the category. This priority forms the base clinical priority. The process  202  then adjusts the base clinical priority based on how long the communication has been waiting for delivery, either because it was never attempted or because there was not a successful communication resulting from an attempt. 
     Table 1 below shows one embodiment of an example chart of communication types, communication names along with the communication category and priority based on the type of communication. It will be appreciated that other communication types may also be utilized. The process  202  could further adjust the priority based on conditions relevant to the particular communication. 
     
       
         
           
               
               
               
               
             
               
                 TABLE 1 
               
               
                   
               
               
                 Communication 
                   
                   
                   
               
               
                 Type 
                 Communication Name 
                 Priority 
                 Category 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                 Care 
                 Condition Management 
                 70 
                 Base 
               
               
                 Care 
                 High Risk Management 
                 70 
                 Base 
               
               
                 Care 
                 Final - Disease Management 
                 65 
                 Base 
               
               
                   
                 Lite 
               
               
                 Care 
                 Final - Lifestyle Management 
                 65 
                 Base 
               
               
                 Care 
                 Disease Management Lite 
                 60 
                 Base 
               
               
                 Care 
                 Lifestyle Management 
                 60 
                 Base 
               
               
                 Discharge- 
                 Disease Management Lite 
                 60 
                 Base 
               
               
                 Conclusion 
               
               
                 Discharge- 
                 Lifestyle Management 
                 60 
                 Base 
               
               
                 Conclusion 
               
               
                 Engagement 
                 Disease Management Lite 
                 60 
                 Base 
               
               
                   
                 Engagement 
               
               
                 Engagement 
                 Initial-Patient 
                 60 
                 Base 
               
               
                 Engagement 
                 Lifestyle Management 
                 60 
                 Base 
               
               
                 Engagement 
                 NewTo 
                 60 
                 Base 
               
               
                 Engagement 
                 ReEngagement 
                 60 
                 Base 
               
               
                 HealthUpdate 
                 Depression Screening Results 
                 60 
                 Base 
               
               
                 Followup 
                 Behavior Quit Date 
                 50 
                 Base 
               
               
                 Followup 
                 Behavior Start Date 
                 50 
                 Base 
               
               
                 Followup 
                 Engagement 
                 50 
                 Base 
               
               
                 Followup 
                 Engagement - Pregnancy 
                 45 
                 Base 
               
               
                 Followup 
                 AppointmentVisit 
                 40 
                 Base 
               
               
                 Followup 
                 Remove Engagement 
                 40 
                 Base 
               
               
                 Followup 
                 Engagement - Weight 
                 40 
                 Base 
               
               
                   
                 Complications 
               
               
                 Engagement 
                 Research Confirmation 
                 30 
                 Base 
               
               
                 HealthUpdate 
                 Provider 
                 30 
                 Base 
               
               
                 Reminder 
                 Appointment Visit 
                 30 
                 Base 
               
               
                 Reminder 
                 Flu-Pneumonia Vaccination 
                 30 
                 Base 
               
               
                 Reminder 
                 Standard Of Care 
                 30 
                 Base 
               
               
                 Referral 
                 Case Management 
                 25 
                 Base 
               
               
                 Referral 
                 Coaching 
                 25 
                 Base 
               
               
                 Referral 
                 Dietary 
                 25 
                 Base 
               
               
                 Referral 
                 External Provider 
                 25 
                 Base 
               
               
                 Referral 
                 Mental or Behavioral Health 
                 25 
                 Base 
               
               
                 Referral 
                 Nursing 
                 25 
                 Base 
               
               
                 Referral 
                 Oncology 
                 25 
                 Base 
               
               
                 Referral 
                 Pharmacy 
                 25 
                 Base 
               
               
                 Referral 
                 Provider Services Manager 
                 25 
                 Base 
               
               
                 Referral 
                 Psychiatry 
                 25 
                 Base 
               
               
                 Referral 
                 Respiratory Therapy 
                 25 
                 Base 
               
               
                 Referral 
                 Social Work 
                 25 
                 Base 
               
               
                 Information 
                 Benefits 
                 20 
                 Base 
               
               
                 Information 
                 Complaint-Patient 
                 20 
                 Base 
               
               
                 Information 
                 Complaint-Provider 
                 20 
                 Base 
               
               
                 Information 
                 Miscellaneous 
                 20 
                 Base 
               
               
                 CriticalRiskEvent 
                 Initial - General 
                 90 
                 Immediate 
               
               
                 CriticalRiskEvent 
                 Initial - Medication Possession 
                 90 
                 Immediate 
               
               
                   
                 Ratio 
               
               
                 CriticalRiskEvent 
                 Initial - Pregnancy 
                 90 
                 Immediate 
               
               
                 Followup 
                 Discharge 
                 90 
                 Immediate 
               
               
                 Followup 
                 Discharge Re-Engagement 
                 90 
                 Immediate 
               
               
                 Any 
                 Inbound - Any 
                 85 
                 Immediate 
               
               
                 CriticalRiskEvent 
                 Followup - General 
                 80 
                 Immediate 
               
               
                 CriticalRiskEvent 
                 Followup - Medication 
                 80 
                 Immediate 
               
               
                   
                 Possession Ratio 
               
               
                 CriticalRiskEvent 
                 Followup - Pregnancy 
                 80 
                 Immediate 
               
               
                 Alert 
                 Heart Failure Remote Monitoring 
                 80 
                 Remote 
               
               
                   
                   
                   
                 Monitoring 
               
               
                 Engagement 
                 Heart Failure Remote Monitoring- 
                 70 
                 Remote 
               
               
                   
                 Patient 
                   
                 Monitoring 
               
               
                 Followup 
                 Heart Failure Remote 
                 65 
                 Remote 
               
               
                   
                 Monitoring-Patient Engagement 
                   
                 Monitoring 
               
               
                 HealthUpdate 
                 Heart Failure Remote Monitoring - 
                 65 
                 Remote 
               
               
                   
                 Provider 
                   
                 Monitoring 
               
               
                 Discharge- 
                 Heart Failure Remote Monitoring - 
                 60 
                 Remote 
               
               
                 Conclusion 
                 Delnstall 
                   
                 Monitoring 
               
               
                 Engagement 
                 Heart Failure Remote Monitoring - Provider 
                 60 
                 Remote 
               
               
                   
                   
                   
                 Monitoring 
               
               
                 Followup 
                 Heart Failure Remote Monitoring - 
                 50 
                 Remote 
               
               
                   
                 Patient Troubleshooting 
                   
                 Monitoring 
               
               
                 Followup 
                 Heart Failure Remote Monitoring - Vendor 
                 45 
                 Remote 
               
               
                   
                   
                   
                 Monitoring 
               
               
                 One-Time 
                 Used for Speciality Campaigns - 
                 50 
                 Speciality 
               
               
                   
                 names to be standardized 
               
               
                 Referral 
                 Home Pulmonary Education 
               
               
                   
               
            
           
         
       
     
     In one embodiment, the process  202  receives information about the clinical priority of each communication rather than itself performing the calculations. In one embodiment, a predictive model is used to determine the clinical priority of each communication. 
     After the state  203 , the process  202  may also move to a state  208  to determine the relative likelihood of receiving a response to each patient communication based on the time and method of the communication. The time may be for example, a time of day, a day of the week, a particular date, or a particular week of a month. The method may be, for example, email, mail, voice mail, or telephone conversation. The process  202  may execute a predictive model that estimates the likelihood of a person responding to a communication from the service provider based on factors such as the patient&#39;s gender, location, age, preference data collected from the patient, and clinical picture. In one embodiment, whether the patient is an employee of the service provider is also a factor. Any suitable factors may be used. The rules engine  126 , shown in  FIG. 1 , may use the rules determined from a study, such as the Healthways study mentioned above, in order to predict the probability of a successful communication delivered by a particular method at a particular time. In one embodiment, the determination as to whether a communication will be successful may be refined as additional information is gained from the patient. In one embodiment, the process  202  also analyzes a patient&#39;s response to previous communications in order to predict whether a future communication is likely to be successful. 
     In one embodiment, the process  202  determines the best time to contact a patient by assessing whether the recipient for that communication has a preference to be called during a specific block of time and the probability of success at any hour of the day. In certain embodiments, the process  202  determines the probability of success for any hour by the formula e x /1+e x  where x is equal to regression values determined by multiple factors indicative of the likelihood of a successful communication. The factors may include, for example, the patient&#39;s gender, age, and other characteristics, the day of week, the number of delivery sessions previously attempted, occupation, importance of faith, and historical successful attempts. Any suitable factors may be used. 
     The process  202  may perform the steps illustrated in the states  204 ,  206 , and  208  in any order. In one embodiment, the process  202  does not perform the steps in each of the states  204 ,  206 , and  208 . Instead, the process  202  may receive information indicative of the clinical priority, likelihood of success, and available resources. 
     At the completion of one or more states  204 ,  206 , and  208 , process  202  proceeds to a state  210  to organize the plurality of patient communications into time slots based on one or more of the likelihood of receiving a response, the clinical priority of each patient communication, and available resources. The process  202  may determine the earliest time that a communication should be scheduled and optionally, a date for which the communication should be cancelled if not delivered. 
     The process  202  may partition communications into timeslots based on the determined probability of success for delivering the communication to the patient for each hour of the day, the available resources, and the clinical priority of the communication. In some embodiments, the process  202  may order the communications within each timeslot based on the highest probability of success such that the first communication attempted in each time slot is the one that is most likely to result in actual communication. The process  202  may also prioritize the communications based on their clinical priority. In one embodiment, if the patient has provided a time preference, timeslots that correspond to the time preference are ranked first in order of probability of success followed by any other non-preferred hours in order of probability of success. 
     After completion of the state  210 , the process  202  advances a state  212  and outputs a schedule for performing the patient communications based on the organized patient communications. The service provider may initiate communications based on the schedule. 
     Moving to a state  214 , the process  202  determines a future time to reinitiate communication with the patient. In one embodiment, any communications not performed during the scheduled time slot are moved to the next time slot and reprioritized. This may occur because more communications are scheduled than can be completed in the time slot. In one embodiment, any remaining unperformed communications at the end of a day are scheduled for the next day. In one embodiment, the process  202  determines a reason for a failed communication and schedules a follow-up communication based on the reason for the failed communication. In one embodiment, a follow up communication is automatically scheduled for a particular time in the future, for example, for communications that should be delivered at regular intervals. In one embodiment, the follow up communications determined by the process  202  may be overridden by a clinician. 
     In one embodiment, the communication tailoring system determines if the previous communication was successful in order to determine whether a follow up communication is necessary. For example, in some cases a voice message may be considered a successful communication depending on the type of communication. Table 2 below shows types of communications and whether the particular communication type is considered successful if a voice message is left, but there is no communication with the patient. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 2 
               
               
                   
                   
               
               
                   
                   
                 Consider Communication 
               
               
                   
                 Communication 
                 Successful If Leave a 
               
               
                   
                 Type 
                 Message 
               
               
                   
                   
               
             
            
               
                   
                 Engagement 
                 No 
               
               
                   
                 Care 
                 No 
               
               
                   
                 Critical Risk Event 
                 No 
               
               
                   
                 FollowUp 
                 No 
               
               
                   
                 DischargeConclusion 
                 No 
               
               
                   
                 HealthUpdate 
                 Yes 
               
               
                   
                 Information 
                 Yes 
               
               
                   
                 Alert 
                 No 
               
               
                   
                 OneTime 
                 No 
               
               
                   
                   
               
            
           
         
       
     
     In one embodiment, the process  202  redials a patient when a call is aborted or the patient hangs up. In one embodiment, the redialing is done within 15 minutes of the ended phone call. In other embodiments, other times are used. In one embodiment, the process  202  attempts to call the same patient up to three times in one day, but other frequencies are contemplated in other embodiments. In one embodiment, the process  202  redials a patient based on a time that the patient requests that he or she be called back. 
     In one embodiment, if the process  202  determines that a follow up communication is necessary, the follow up communication is also scheduled. To do this, the process  202  repeats itself and begins to perform at least one of  204 ,  206 , and  208 . 
     In one embodiment, the process  202  dynamically alters the workflow. For example, changes could include reassigned workflow based on a new clinical situation, new patient preferences, or a change in the provider&#39;s employees. The rules engine  126  can also be updated so that the relative rankings results are altered based on the same data. The process  202  may adjust the rules engine  126  based on changes in resources, spikes in certain types of communications, or addition of work. This allows for “real-time” re-evaluation of priority of attempts, and, therefore, improvement in the number of successful communications. The process  202  may update the preferences for communications as a patient&#39;s preferences or clinical situation changes. 
     Certain embodiments of the system and method as described herein may be part of a product such as Embrace™, soon to be available from Healthways, Inc. In one embodiment, the process  202  may be used to prioritize and schedule other types of communications that are not patient healthcare communications. 
     Healthways conducted a study to determine the effectiveness of some of the systems and methods used by the communication tailoring methods described above. The study found that the successful communication rate was 22.8% using the communication tailoring methods versus a 9.8% successful communication rate using traditional communication prioritization methods. 
     Those of skill in the art will recognize that the various illustrative logical states, modules, circuits, and algorithm steps described in connection with the embodiments disclosed herein may be implemented as electronic hardware, computer software, or combinations of both. To clearly illustrate this interchangeability of hardware and software, various illustrative components, states, modules, circuits, and steps have been described above generally in terms of their functionality. Whether such functionality is implemented as hardware or software depends upon the particular application and design constraints imposed on the overall system. Skilled artisans may implement the described functionality in varying ways for each particular application, but such implementation decisions should not be interpreted as causing a departure from the scope of the present invention. 
     The various illustrative logical states, modules, and circuits described in connection with the embodiments disclosed herein may be implemented or performed with a general purpose processor, a digital signal processor (DSP), an application specific integrated circuit (ASIC), a field programmable gate array (FPGA) or other programmable logic device, discrete gate or transistor logic, discrete hardware components, or any combination thereof designed to perform the functions described herein. A general purpose processor may be a microprocessor, but in the alternative, the processor may be any conventional processor, controller, microcontroller, or state machine. A processor may also be implemented as a combination of computing devices, e.g., a combination of a DSP and a microprocessor, a plurality of microprocessors, one or more microprocessors in conjunction with a DSP core, or any other such configuration. 
     The steps of a method or algorithm described in connection with the embodiments disclosed herein may be embodied directly in hardware, in a software module executed by a processor, or in a combination of the two. A software module may reside in RAM memory, flash memory, ROM memory, EPROM memory, EEPROM memory, registers, hard disk, a removable disk, a CD-ROM, or any other form of storage medium known in the art. An exemplary storage medium is coupled to the processor such the processor can read information from, and write information to, the storage medium. In the alternative, the storage medium may be integral to the processor. The processor and the storage medium may reside in an ASIC. The ASIC may reside in a user terminal. In the alternative, the processor and the storage medium may reside as discrete components in a user terminal. 
     While the above detailed description has shown, described, and pointed out novel features of the invention as applied to various embodiments, it will be understood that various omissions, substitutions, and changes in the form and details of the device or process illustrated may be made by those skilled in the art without departing from the intent of the invention. As will be recognized, the present invention may be embodied within a form that does not provide all of the features and benefits set forth herein, as some features may be used or practiced separately from others. The scope of the invention is indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.