Patent Document ID: 7657442
Application ID: 10615640
Patent Flag: 1

Claim One:
1. A method for administering health care to patients within a patient population such that utilization of health care resources available to care for said patients within said patient population are conserved, the method comprising the steps: a) generating said patient population, said generation of said patient population comprising the steps: i) receiving a request from an individual to become a patient within said patient population; ii) obtaining information from said individual in step (i), wherein said information is obtained by an in-person interview and wherein said information comprises demographic information related to said individual comprising the individual's age, sex, medical history and geographic vicinity pertaining to said individual's residence as well as the number of emergency room visits, number of hospitalizations and readmissions, patient pharmacy records, and medication compliance, storing such information in electronic medical records embodied on a computer readable medium; iii) evaluating said data submitted in step (ii) via a computer capable of interpreting said electronic medical records; iv) enrolling said individual as a patient within said patient population; and v) repeating steps (i)-(iv) for a multiplicity of individuals; b) receiving a request from a patient within said patient population generated in step a) for medical services; c) assessing said request made in step b) and determining whether said request substantiates a specified clinical event, wherein said assessment is made by a primary care physician; d) electronically submitting only a single CPT code corresponding to a single, specified medical service to be rendered in response to the clinical event specified in step (c) via a data communications network; e) evaluating the single code submitted in step (d) for clinical and financial appropriateness, wherein said evaluation is performed by a hospitalist or case manager that is other than the primary care physician, and wherein evaluating the single code submitted in step (d) comprises (i) evaluating the effectiveness or clinical importance of the service required to be rendered in relation to the code, (ii) evaluating whether the submitted code is applicable to those health care services that are covered by the patient's health care, and (iii) evaluating whether the code is susceptible to duplicative and/or unbundled billing practice or otherwise provides any financial interest to the primary care physician; f) electronically responding to said submission made in step (d) based upon said evaluation made in step (e), said response comprising either approval or disapproval to proceed with rendering the requested service corresponding to said code submitted in step (d) via a data communications network; g) assessing said request made in step (b) and determining whether said request substantiates the utilization of either in-patient services, out-patient services, referral to a specialist, or combinations thereof, wherein said assessment is made by a primary care physician and the in-patient services, out-patient services and services from the specialist are to be performed by a physician other than the primary care physician; h) electronically submitting only a single CPT code corresponding to a single, specified medical service to be rendered in response to the utilization requested in step (g) via a data communications network; i) evaluating the single code submitted in step (h) for clinical and financial appropriateness, wherein said evaluation is performed by a hospitalist or case manager that is other than the primary care physician, and wherein evaluating the single code submitted in step (h) comprises (i) evaluating the effectiveness or clinical importance of the service required to be rendered in relation to the code, (ii) evaluating whether the submitted code is applicable to those health care services that are covered by the patient's health care, and (iii) evaluating whether the code is susceptible to duplicative and/or unbundled billing practice or otherwise provides any financial interest to the primary care physician; j) electronically responding to said submission made in step (h) based upon said evaluation made in step (i), said response comprising either approval or disapproval to proceed with rendering the requested service corresponding to the code submitted in step (h) via a data communications network; and k) when the patient has a chronic condition, repeating steps (g)-(j) to continuously assess the utilization of the in-patient services, out-patient services, and services of the specialist to provide treatment of the chronic condition.