PATENT CLAIM ANALYSIS

Application Number: 16405408
Application Type: Utility
Filing Date: 2019-05
Publication Date: 2019-08
Patent Classification: ["705", "002000"]

Abstract:
A method of optimizing healthcare services consumption according to the invention includes the steps of assessing the healthcare situation of an employer providing healthcare benefits to a population, identifying a first group of patients from the population likely to generate expensive healthcare claims based on data representing past claims, periodically determining whether patients in the first group have satisfied certain predetermined healthcare requirements, identifying a first group of providers who provide high quality, cost efficient healthcare services based on the practice patterns of the providers, prompting patients who have not satisfied the predetermined healthcare requirements to obtain services from providers in the first group, and responding to healthcare requests from patients by determining whether the requesting patient is seeking services from a provider in the first group, and, if not, urging the patient to obtain such services from a provider in the first group.

Claim (Index 17):
A system for optimizing healthcare services consumption of patients in a healthcare plan comprising:\n a first computing device including a database coupled with the first computing device, and one or more second computing devices electronically coupled with the first computing device via a network; wherein the first computing device is configured to: A. electronically receive from the one or more second computing devices and store in the database information comprising patient data and healthcare claims data; B. analyze the healthcare claims data to determine a group of patients who are likely to consume healthcare services at a higher cost relative to other patients in the healthcare plan; C. access via the network data representing a group of healthcare service providers who satisfy one or more predefined criteria; D. determine, based on the patient data and the healthcare claims data, whether patients in the group of patients suffer from one or more medical conditions; E. store in the database as part of the patient data a set of predetermined care requirements associated with each patient's one or more medical conditions; and F. determine whether patients determined to suffer from one or more medical conditions have obtained healthcare services that satisfy the set of predetermined care requirements associated with the one or more medical conditions; and an electronic communication device that is used to transmit an electronic message to an electronic device associated with a patient who has not obtained healthcare services that satisfy the set of predetermined care requirements to instruct the patient to obtain additional healthcare services to satisfy the set of predetermined care requirements from one or more providers in the group of healthcare service providers.

Metadata:
- Claim Count in Document: 6.0
- Percentile: 100.0
- Lexical Diversity: 2.2
- Patent Class: 705.0
- Transitional Phrase Type: open
- Component Type: 1
- Foreign Priority: False
- Related Applications: ['10313370', '12773334', '13178174', '15584664', '11447627']

Analysis Scores:
- 35 USC 101 Eligibility (BERT): 0.1409727793772004
- 35 USC 102 Novelty (BERT): 0.5872076544819826
- Combined Prediction Score: 0.1855962668876787
- Mean Citation Score: 462.20940999999993
- Max Citation Score: 527.3645
- Similarity Product: 418.4995051983297

Labels:
- Claim Label 101: 0
- Claim Label 102: 1
- Claim Label 103: 0
- Claim Label 112: 1
- Combined Label: 0
- Label 101 Adjusted: 0

Dataset: test