Patent ID: 7389245

Claim:
A computer-implemented method, executed in a first computer operated by an incentive administrator that is coupled to a second computer operated by a payer and a third computer operated by a healthcare provider, of providing an apportioned monetary incentive upon completion of a course of treatment for a patient with a condition during an episode of care, the method comprising the steps of: identifying a responsible provider from among one or more healthcare providers involved in the course of treatment, based on performance of a defining procedure in the course of treatment; creating an initial baseline value related to the course of treatment; receiving over the computer network from the payers a diagnosis of the patient performed by a healthcare provider and provided to the payer, along with an associated cost quantified by the initial baseline value; creating an episode of care based upon the diagnosis of the healthcare provider and the course of treatment for the condition; verifying that the episode of care is not an outlier case representing an extreme condition that costs significantly more than the cost associated with the initial baseline value; summing a plurality of claims processed during the episode of care to obtain a total treatment cost; adjusting the initial baseline value by factoring in any effects due to comorbidity to derive an adjusted baseline value; determining if the total treatment cost is less than the adjusted baseline value, thus resulting in a cost savings for the decided course of treatment; representing the cost savings as an incentive payment that is to be apportioned among the responsible provider, the payer and the incentive administrator; causing a first portion of the cost savings to be sent to the responsible provider in the form of a monetary incentive that is individually calculated based on the episode of care, and correlated to the total treatment cost; causing a second portion of the cost savings to be sent to the payer, the second portion constituting a savings in the amount paid out for the course of treatment; and causing a third portion of the cost savings to be retained by the incentive administrator, wherein the responsible provider, the payer, and the incentive administrator are independent entities.