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 1):
A method of optimizing healthcare services consumption of patients in a healthcare plan comprising:\n A. providing at least one computing device maintaining one or more databases on a computer-readable media, the one or more databases being electronically coupled to one or more networks; B. the at least one computing device electronically receiving from a first external data source and storing in the one or more databases information comprising patient data, wherein the patient data comprises at least the names, ages, and genders of patients in the healthcare plan, C. the at least one computing device electronically receiving from a second external data source and storing in the one or more databases healthcare information comprising healthcare claims data relating to submitted medical claims, wherein the healthcare claims data relating to submitted medical claims comprises at least a procedure code and costs; D. the at least one computing device analyzing 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, wherein analyzing the accessed healthcare claims data is repeated by the at least one computing device at least once during a predetermined time period; E. accessing data representing a group of healthcare service providers who satisfy one or more predefined criteria including at least a quality-based criterion; F. determining, based on the patient data and associated healthcare claims data, whether an individual patient in the group of patients suffers from one or more medical conditions, wherein determining whether an individual patient in the group of patients suffers from one or more medical conditions is repeated by the at least one computing device at least once during the predetermined time period; G. storing in the one or more databases an identification of any such medical condition as part of the patient data associated with the individual patient, H. the at least one computing device associating a predetermined set of minimum annual care requirements (MACRs) with each individual patient's one or more medical conditions each time a patient in the group of patients is determined to suffer from a medical condition; I. the at least one computing device determining whether an individual patient determined to suffer from one or more medical conditions has obtained healthcare services that satisfy the predetermined set of MACRs associated with the one or more medical conditions, wherein determining whether an individual patient has satisfied the predetermined set of MACRs is performed repeatedly by the at least one computing device during an annual period; and J. transmitting, with an electronic communication device, an electronic message to an electronic device associated with a patient who has not obtained healthcare services that satisfy the predetermined set of MACRs to instruct the patient to obtain additional healthcare services to satisfy the predetermined set of MACRs from a healthcare service provider 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): 0.1395876989236209
- 35 USC 102 Novelty (BERT): 0.5940487012169985
- Combined Prediction Score: 0.1850337991529586
- Mean Citation Score: 462.20940999999993
- Max Citation Score: 527.3645
- Similarity Product: 449.386975487113

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

Dataset: test