U.S. patent application number 13/962199 was filed with the patent office on 2013-12-05 for identification of health risks and suggested treatment actions.
The applicant listed for this patent is Roy Schoenberg. Invention is credited to Roy Schoenberg.
Application Number | 20130325500 13/962199 |
Document ID | / |
Family ID | 40509401 |
Filed Date | 2013-12-05 |
United States Patent
Application |
20130325500 |
Kind Code |
A1 |
Schoenberg; Roy |
December 5, 2013 |
Identification of Health Risks and Suggested Treatment Actions
Abstract
Using a brokerage system, a consumer of services is matched with
a service provider and a comprehensive health management plan is
generated for the consumer during the consumer's interaction with
the brokerage system. The brokerage system uses a rules engine to
identify one or more conditions of the consumer's health and
generate one or more follow-up actions based at least in part on
the consumer's identified health condition. The consumer is
notified of at least one of the identified conditions and the
generated follow-up actions.
Inventors: |
Schoenberg; Roy; (Boston,
MA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Schoenberg; Roy |
Boston |
MA |
US |
|
|
Family ID: |
40509401 |
Appl. No.: |
13/962199 |
Filed: |
August 8, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12098720 |
Apr 7, 2008 |
8521553 |
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13962199 |
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60997230 |
Oct 2, 2007 |
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60997263 |
Oct 2, 2007 |
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Current U.S.
Class: |
705/2 |
Current CPC
Class: |
G16H 50/30 20180101;
G16H 70/20 20180101; G06F 19/00 20130101; G16H 50/20 20180101; G16H
40/67 20180101 |
Class at
Publication: |
705/2 |
International
Class: |
G06F 19/00 20060101
G06F019/00 |
Claims
1-30. (canceled)
31. A computer-implemented method comprises: accessing, over a
network by a computing system, health data for a consumer of
medical services from one or more health data repositories;
producing, based on the accessed health data, one or more medical
topics to cover during a consultation between the consumer of
medical services and a provider of medical services; accessing a
database storing information indicative of medical service
providers and associated medical service qualifications of the
medical service providers; analyzing, by the computing system, the
accessed health data and the medical service qualifications of the
medical service providers to find one or more medical service
providers that are presently available for the consultation and
that have at least one medical service qualification that qualify
the one or more medical service providers to advise the consumer on
at least one of the one or more medical topics during the
consultation; sending, by the computer system over the network,
information indicative of the one or more medical service
providers; and receiving, over the network, information indicative
of a selection of one of the one or more medical service providers
to establish a communication channel between a computer system
associated with the selected one of the one or more medical service
providers and a computer system associated with the consumer of
medical services.
32. The computer-implemented method of claim 31, further
comprising: generating, by the computing system, information for a
graphical user interface that when rendered on a display device,
renders: a visual representation of at least one of the one or more
medical topics to notify the consumer of the at least one of the
one or more medical topics, with the at least one of the one or
more medical topics juxtaposed to a link, which causes
establishment of the communication channel between the computer
system associated with the selected one of the one or more medical
service providers and the computer system associated the consumer
of medical services.
33. The computer-implemented method of claim 32, further
comprising: receiving, over the network, a selection of the link to
establish the communication channel between the selected one of the
one or more medical service providers and the consumer of medical
services.
34. The method of claim 31, wherein at least one of the one or more
medical topics comprise at least one of recommendations to consult
with one or more service providers, follow-up actions for the
consumer to complete, and follow-up actions that are added to a
consumer's profile.
35. The method of claim 31, wherein the communication channel
comprises one or more of an audio communication channel, a
telephony communication channel, a text-based communication
channel, and a network-based communication channel.
36. The computer-implemented method of claim 31, further
comprising: generating, by the computing system, information for a
graphical user interface that when rendered on a display device,
renders: a first visual representation of a particular medical
topic that is included in the one or more medical topics; a second
visual representation of a medical service provider who is
qualified to address the particular medical topic with the
consumer, with the first visual representation juxtaposed in the
graphical user interface to the second visual representation; a
selectable portion that is associated with the one or more of the
first visual representation and the second visual representation,
with a selection of the selectable portion establishing a
communication channel between the computer system of the consumer
and a computer system of the medical service provider who is
qualified to address the particular medical topic with the
consumer.
37. The computer-implemented method of claim 36, wherein the
medical service provider who is qualified to address the particular
medical topic with the consumer is the selected one of the one or
more medical service providers, and wherein receiving the
information indicative of the selection of one of the one or more
medical service providers comprises: receiving information
indicative of the selection of the selectable portion.
38. A computer program product residing on a computer readable
hardware storage device, the computer program product comprising
instructions for causing a computing system to perform operations
comprising: accessing, over a network, health data for a consumer
of medical services from one or more health data repositories;
producing, based on the accessed health data, one or more medical
topics to cover during a consultation between the consumer of
medical services and a provider of medical services; accessing a
database storing information indicative of medical service
providers and associated medical service qualifications of the
medical service providers; analyzing the accessed health data and
the medical service qualifications of the medical service providers
to find one or more medical service providers that are presently
available for the consultation and that have at least one medical
service qualification that qualify the one or more medical service
providers to advise the consumer on at least one of the one or more
medical topics during the consultation; sending, over the network,
information indicative of the one or more medical service
providers; and receiving, over the network, information indicative
of a selection of one of the one or more medical service providers
to establish a communication channel between a computer system
associated with the selected one of the one or more medical service
providers and a computer system associated with the consumer of
medical services.
39. The computer program product of claim 38, wherein the
operations further comprise: generating information for a graphical
user interface that when rendered on a display device, renders: a
visual representation of at least one of the one or more medical
topics to notify the consumer of the at least one of the one or
more medical topics, with the at least one of the one or more
medical topics juxtaposed to a link, which causes establishment of
the communication channel between the computer system associated
with the selected one of the one or more medical service providers
and the computer system associated the consumer of medical
services.
40. The computer program product of claim 39, wherein the
operations further comprise: receiving, over the network, a
selection of the link to establish the communication channel
between the selected one of the one or more medical service
providers and the consumer of medical services.
41. The computer program product of claim 38, wherein at least one
of the one or more medical topics comprise at least one of
recommendations to consult with one or more service providers,
follow-up actions for the consumer to complete, and follow-up
actions that are added to a consumer's profile.
42. The computer program product of claim 38, wherein the
communication channel comprises one or more of an audio
communication channel, a telephony communication channel, a
text-based communication channel, and a network-based communication
channel.
43. The computer program product of claim 38, wherein the
operations further comprise: generating information for a graphical
user interface that when rendered on a display device, renders: a
first visual representation of a particular medical topic that is
included in the one or more medical topics; a second visual
representation of a medical service provider who is qualified to
address the particular medical topic with the consumer, with the
first visual representation juxtaposed in the graphical user
interface to the second visual representation; a selectable portion
that is associated with the one or more of the first visual
representation and the second visual representation, with a
selection of the selectable portion establishing a communication
channel between the computer system of the consumer and a computer
system of the medical service provider who is qualified to address
the particular medical topic with the consumer.
44. The computer program product of claim 43, wherein the medical
service provider who is qualified to address the particular medical
topic with the consumer is the selected one of the one or more
medical service providers, and wherein receiving the information
indicative of the selection of one of the one or more medical
service providers comprises: receiving information indicative of
the selection of the selectable portion.
45. A computer system comprising: one or more processing devices;
and a computer program product residing on a computer readable
hardware storage device, the computer program product comprising
instructions for causing the one or more processing devices to
perform operations comprising: accessing, over a network, health
data for a consumer of medical services from one or more health
data repositories; producing, based on the accessed health data,
one or more medical topics to cover during a consultation between
the consumer of medical services and a provider of medical
services; accessing a database storing information indicative of
medical service providers and associated medical service
qualifications of the medical service providers; analyzing the
accessed health data and the medical service qualifications of the
medical service providers to find one or more medical service
providers that are presently available for the consultation and
that have at least one medical service qualification that qualify
the one or more medical service providers to advise the consumer on
at least one of the one or more medical topics during the
consultation; sending, over the network, information indicative of
the one or more medical service providers; and receiving, over the
network, information indicative of a selection of one of the one or
more medical service providers to establish a communication channel
between a computer system associated with the selected one of the
one or more medical service providers and a computer system
associated with the consumer of medical services.
46. The computer system of claim 45, wherein the operations further
comprise: generating information for a graphical user interface
that when rendered on a display device, renders: a visual
representation of at least one of the one or more medical topics to
notify the consumer of the at least one of the one or more medical
topics, with the at least one of the one or more medical topics
juxtaposed to a link, which causes establishment of the
communication channel between the computer system associated with
the selected one of the one or more medical service providers and
the computer system associated the consumer of medical
services.
47. The computer system of claim 46, wherein the operations further
comprise: receiving, over the network, a selection of the link to
establish the communication channel between the selected one of the
one or more medical service providers and the consumer of medical
services.
48. The computer system of claim 45, wherein at least one of the
one or more medical topics comprise at least one of recommendations
to consult with one or more service providers, follow-up actions
for the consumer to complete, and follow-up actions that are added
to a consumer's profile.
49. The computer system of claim 45, wherein the communication
channel comprises one or more of an audio communication channel, a
telephony communication channel, a text-based communication
channel, and a network-based communication channel.
50. The computer system of claim 45, wherein the operations further
comprise: generating information for a graphical user interface
that when rendered on a display device, renders: a first visual
representation of a particular medical topic that is included in
the one or more medical topics; a second visual representation of a
medical service provider who is qualified to address the particular
medical topic with the consumer, with the first visual
representation juxtaposed in the graphical user interface to the
second visual representation; a selectable portion that is
associated with the one or more of the first visual representation
and the second visual representation, with a selection of the
selectable portion establishing a communication channel between the
computer system of the consumer and a computer system of the
medical service provider who is qualified to address the particular
medical topic with the consumer.
51. The computer system of claim 45, wherein the medical service
provider who is qualified to address the particular medical topic
with the consumer is the selected one of the one or more medical
service providers, and wherein receiving the information indicative
of the selection of one of the one or more medical service
providers comprises: receiving information indicative of the
selection of the selectable portion.
Description
CLAIM OF PRIORITY
[0001] This application is a continuation of U.S. patent
application Ser. No. 12/098,720, filed Apr. 7, 2008, which claims
priority under 35 U.S.C. .sctn.119(e) to provisional U.S. Patent
Applications 60/997,230, filed on Oct. 2, 2007, and 60/997,263,
filed on Oct. 2, 2007, the entire contents of each of which are
hereby incorporated by reference.
BACKGROUND
[0002] The present disclosure is directed to connecting consumers
with service providers.
[0003] Systems have been developed to connect consumers and their
providers over the Internet and the World Wide Web. Some systems
use e-mail messaging and web-based forms to increase the level of
connectivity between a member of a health plan and his assigned
health care provider. The consumer sends an e-mail or goes to a
website that generates and sends a message (typically an e-mail or
an e-mail type message) to a local provider.
[0004] These types of services have been broadly referred to as
"e-visits." While generally viewed as an addition to the spectrum
of services that may be desired by consumers, the benefits of such
services are not clear. One of the concerns associated with
offering additional communication channels, such as e-mail, is that
it can result in over consumption of services, rather than provide
for better coordination.
[0005] Until recently, the notion of an electronic encounter was
not even coded in the standard financial coding schemes used for
submitting medical claims, preventing proper reimbursement of
providers for such encounters. This gap has been recently corrected
by the introduction of CPT (current procedural terminology) code
0074T, allowing providers to submit a reimbursement claim for an
electronic encounter (e.g., e-visit) with their patients. Most
plans at this time, however, do not include this service code as a
covered service (i.e., a benefit) making it an out-of-pocket
expense for members and an unattractive offering for providers (who
need to charge members directly for such encounters).
[0006] Recently, a number of health plans announced their intention
to begin remunerating providers for electronic visits (i.e., paying
a certain consideration for claims submitted with a CPT 0074T
code). While limited to pilot projects, plans are embracing the
notion of consumerism by offering advanced tools for consumers to
become informed and acquire medical services. Facilitating timely
and more organized communication between the member and their
provider is perceived as a natural investment in the new
consumer-driven healthcare world. While still at an early stage,
interest in e-visits has picked up both in the commercial world as
well as in the strategic planning sessions of health plans around
the country. Vendors offering health portals for health plans
typically now describe their roadmap for the incorporation (or
interfacing with) e-visit platforms.
SUMMARY
[0007] In general in one aspect, using a brokerage system, a
consumer of services is matched with a service provider and a
comprehensive health management plan is generated for the consumer
during the consumer's interaction with the brokerage system. The
brokerage system uses a rules engine to identify one or more
conditions of the consumer's health and generate one or more
follow-up actions based at least in part on the consumer's
identified health condition. The consumer is notified of at least
one of the identified conditions and the generated follow-up
actions.
[0008] Implementation may include one or more of the following
features. Generation of the comprehensive health management plan
includes collecting the consumer's health care information and
classifying the consumer's collected health care information. In
some examples, a graphical user interface is provided that when
rendered on a display displays for the service provider one or more
proposed health conditions. The system receives a notification of
the provider's acceptance of the one or more proposed health
conditions and consolidates the provider's accepted one or more
health conditions with prior health conditions. In some examples,
the system notifies the consumer of the consolidated health
conditions through a consumer identified communication channel or a
consumer's preferred communication channel.
[0009] In some examples, a graphical user interface is provided
that when rendered on a display displays for the service provider
one or more proposed follow-up actions. The system receives a
notification of the provider's acceptance of the one or more
proposed follow-up actions and consolidates the provider's accepted
one or more follow-up actions with prior follow-up actions. The
system notifies the consumer of the consolidated follow-up
actions.
[0010] In some examples, follow-up actions include recommendations
to consult with one or more service providers, follow-up actions
for the consumer to complete, and follow-up actions that are added
to a consumer's profile.
BRIEF DESCRIPTION OF THE FIGURES
[0011] FIG. 1 is a diagrammatic view of an engagement brokerage
service.
[0012] FIGS. 2A, 5A-5D, 7, 8, and 10 are screen images of a user
interface for an engagement brokerage service.
[0013] FIG. 2B is a flow chart for an interactive voice response
system interface for an engagement brokerage service.
[0014] FIGS. 3, 4A-4D, 6 are flow charts of processes used in an
engagement brokerage system.
[0015] FIG. 9 is a table of sample criteria used in an engagement
brokerage system.
[0016] FIG. 10 is an example of a provider interface.
[0017] FIG. 11 is a diagram illustrating data collection from
multiple sources.
[0018] FIG. 12 is a flow chart of data collection and a rules
engine.
[0019] FIGS. 13A, 13B, and 13C are flow charts of comprehensive
health management plans.
[0020] FIG. 14 is a flowchart of using a rules engine to provide
comprehensive health management.
[0021] FIG. 15 is an example rule set.
[0022] FIG. 16 is an example health directives interface.
[0023] FIG. 17A is an example past engagements interface.
[0024] FIG. 17B is an example interface.
[0025] FIG. 18 is a flowchart of provider implemented comprehensive
health management.
[0026] FIGS. 19A, 19B are example trackers.
DETAILED DESCRIPTION
[0027] Overview
[0028] The system described below provides an integrated
information and communication platform that enables consumers of
services to identify and prioritize service providers with whom
they should consult and to carry out consultations with such
service providers in an efficient manner. Consumers are able to
consult on-line with an expert service provider, at a mutually
convenient time and place, even when the two parties are
geographically separated. This integrated platform is referred to
herein as an engagement brokerage service (brokerage).
[0029] FIG. 1 shows an example system 100 implementing the
brokerage service. The system 100 includes a computerized system or
server 110 for making connections between consumers 120, at client
systems 122, and service providers 130, at client systems 132, over
a network 140, e.g., the Internet or other types of networks. The
computerized system 110 may operate as a service running on a web
server 102.
[0030] The computerized system 110 includes an availability or
presence tracking module 112 for tracking the availability of the
service providers 130. Availability or presence is tracked actively
or passively. In an active system, one or more of the service
providers 130 provides an indication to the computerized system 110
that the one or more service providers are available to be
contacted by consumers 120 and an indication of the mode by which
the provider may be contacted. In some examples of an active
system, the provider's computer, phone, or other terminal device
periodically provides an indication of the provider's availability
(e.g., available, online, idle, busy) to the system 110 and a mode
(e.g., text, voice, video, etc.) by which he can be engaged. In a
passive system, the computerized system 110 presumes that the
service provider 130 is available by the service provider's
actions, including connecting to the computerized system 110 or
registering the provider's local phone number with the system. In
some examples of a passive system, the system 110 indicates the
provider 130 to be available at all times until the provider logs
off, except when the provider is actively engaged with a consumer
120.
[0031] The computerized system 110 also includes one or more
processes such as the tracking module 112 and a scheduling module
116. The system 110 accesses one or more databases 118. The
components of the system 110 and the web server 102 may be
integrated or distributed in various combinations as is commonly
known in the art.
[0032] Using the system 100, a consumer 120 communicates with a
provider 130. The consumers 120 and providers 130 connect to the
computerized system 110 through a website or other interface on the
web server 102 using client devices 122 and 132, respectively.
Client devices 122 and 132 can be any combination of, e.g.,
personal digital assistants, land-line telephones, cell phones,
computer systems, media-player-type devices, and so forth. The
client devices 122 and 132 enable the consumers 120 to input and
receive information as well as to communicate via video, audio,
and/or text with the providers 130.
[0033] Limited by office hours and other patients, providers
struggle with the idea of adding another service commitment to
their existing workload. Patients sending queries to their
providers can not expect an immediate response and are often asked
to schedule an appointment for further evaluation. Providers are,
however, often available at times that are not convenient for their
patients, for example, in the event of a last-minute cancellation.
Providers also may be available for e-visits during otherwise idle
times, such as when home, during their commute, and so forth. The
brokerage supplements existing provider availability to allow
whichever providers are available at any given time to provide
e-Visits to whichever consumers need a consultation at that time.
Instead of relying on the unlikely availability of a specific
provider for any given consumer, the brokerage connects the
consumer to all online providers capable of addressing the
consumer's needs. The brokerage has distinct features including the
ability to engage in live communication with a suitable, selectable
provider and the ability to do so on-demand.
[0034] One advantage that the brokerage provides is that the
brokerage constantly monitors the availability of a provider for an
engagement and thus, consumers receive immediate attention to
address their questions or concerns, since the brokerage will
connect them to available service providers. In order to achieve
such a level of availability, the system assimilates the
discretionary or fractional availability windows of time offered by
individual providers into a continuous availability perception by
consumers. Since many of the services offered to consumers are
on-demand, consumers have little expectation that the same provider
will be constantly available, rather, they expect that some
provider will be available.
[0035] The computerized system 110 provides information and
services to the consumers 120 in addition to connecting them with
providers 130. The computerized system 110 includes an access
control facility 114, which manages and controls whether a given
consumer 120 may access the system 110 and what level or scope of
access to the features, functions, and services the system 110 will
provide.
[0036] The consumer 120 use the system 100 to find out more
information about a topic of interest or, for example, a potential
medical condition. The computerized system 110 identifies service
providers 130 that are available at any given moment to communicate
with a consumer about a particular product, service, or related
topic or subject, for example, a medical condition. The
computerized system 110 facilitates communication between the
consumer 120 and provider 130, enabling them to communicate, for
example, via a data-network-facilitated video or voice
communication channel (such as Voice over IP), land and mobile
telephone network channels, and instant messaging or chat. In some
examples, the availability of one or more providers 130 is tracked,
and at the instant a consumer 120 desires to connect and
communicate with a provider, the system 110 determines whether a
provider is available. If a particular provider 130 is available,
the system 110 assesses the various modes of communication that are
available and connects the consumer 120 and the provider 130
through one or more common modes of communication.
[0037] The system selects a mode of communication to use based in
part on the relative utility of the various modes. The preferred
mode for an engagement is for both the consumer 120 and the
provider 130 to use web-based consoles, as this allows each of the
other modes to be used as needed. For example, consumers and
providers may launch chat sessions, voice calls, or video chats
from within a web-based console like that shown in FIG. 2A, below.
A web based console also provides on-demand access to records, such
as the consumer's medical history, and other information. If only
one of the participants in an engagement has access to a web
console, the system 110 connects that participant's console to
whatever form of communication the other party has available. For
example, if the consumer is on the phone and the provider is using
a web browser, the system 110 may connect the consumer's phone call
to a VoIP session that the provider can access through the web.
[0038] If the provider 130 is not available, the system 110
identifies other available providers 130 that would meet the
consumer 120's needs. The system 110 enables the consumer 120 to
send a message to the consumer's chosen provider. The consumer can
also have the system 110 contact the consumer in the future when
the chosen provider is available.
[0039] By way of illustration, the system 100 connects members of
healthcare plans with providers of healthcare products and
services. For example, the service providers 130 may be physicians,
and the service consumers 120 may be patients. The service
providers and service consumers may also be lawyers and clients,
contractors and homeowners, or any other combination of a provider
of services and a consumer of services.
[0040] The system enables the consumer to search for providers that
are available at the time the consumer is searching and enables the
consumer to engage a provider on a transactional basis or for a
one-time consultation. A consumer is able to engage a
world-renowned specialist for a consultation or second opinion,
even though the specialist is located too far away from the
consumer to become a regular client, patient, or consumer. The
consumer can use that specialist's advice when considering services
by a local service provider. For example, a patient in a suburban
town with a rare condition may consult with a specialist in a
distant city, and then, based on that consultation, select a local
physician for treatment.
[0041] FIG. 2A shows a page 134 of the main user interface to the
brokerage. Many of the web-based functions are also provided by an
Interactive Voice Response (IVR) system, as discussed below. As
noted the server 110 sends web pages like the page 134 to the
consumer 120 and the provider 130 and receives responses from the
consumer 120 and the provider 130. In some examples, the
application server provides a predefined sequence of web pages or
voice prompts to the consumer 120 or the provider 130. FIG. 2 shows
an interface intended for the consumer 120. A similar interface is
provided for providers 130, as shown in FIG. 10.
[0042] The web page 134 includes various elements to enable the
consumer 120 (to input information. These interface elements
include buttons 136a and text 136b to enable the consumer 120 to
select information and to navigate the website Other standard
elements (not shown) can include text boxes to receive textual
information and menus (such as drop-down menus) to enable the
consumer 120 to select information from a menu or list.
[0043] Referring now to FIG. 2B, an example of logic for use in an
IVR system is shown. It is not intended that FIG. 2B be described
in detail, since it is one of many possible logic flows for such a
system and the exact details on questions and sequences is not
important to an understanding of the concepts disclosed herein. In
the IVR system, the voice prompts include questions or statements
that elicit information from the consumer 120 and the provider 130
as shown. The consumer 120 and the provider 130 input information
by speaking into the microphone of the telephone or other terminal
device and their speech is stored as received or converted to text
using voice recognition. In some examples, the questions are
multiple choice questions and the consumer 120 or the provider 130
responds with spoken responses or by pressing buttons on the keypad
of their phone or other terminal device. The IVR system follows a
series of flow charts like the flowchart 138 in FIG. 2B and can
include a menu system, in which case the consumer 120 or provider
130 moves forward or backward, or exits the system by pressing
certain keys.
[0044] Referring now to FIG. 3, the computerized system 110 tracks
142 the availability of providers 130 and consumers 120. When a
provider 130 logs 144 into the system 100, the provider 130
indicates 146 (such as by setting a check box or selecting a menu
entry or by responding to a voice prompt) to the tracking module
112 that he or she is available to interact with consumers 120. The
provider 130 can also indicate 148 to the tracking module 112 (such
as by setting a check box or selecting a menu entry or by
responding to a voice prompt) the modes (e.g., telephone, chat,
video conference) by which a consumer 120 can be connected to the
provider 130. Alternatively, the tracking module 114 determines 150
the capabilities of the terminals 122 and 132 the consumer 120 and
the provider 130 use to connect to the system (for example, by
using a terminal-based program to analyze the hardware
configuration of each terminal). Thus, if a provider 130 connects
to the system 100 by a desktop computer and the provider has a
video camera connected to that computer, the tracking module 112
determines 150 that the provider 130 can be engaged by text (e.g.,
chat or instant messenger), voice (e.g., VoIP) or video conference.
Similarly, if a provider 130 connects to the system using a
handheld device such as a PDA, the tracking module 112 determines
152 that the provider 130 can be engaged by text or voice. The
tracking module 112 can also infer 152 a provider's availability
and modes of engagement by the provider's previously provided
profile information and the terminal device through which the
provider connects to the system.
[0045] Providers participating in the brokerage network can have
several states of availability over time. States in which the
provider may be available may include on-line, in which the
provider is logged-in and can accept new engagements in any mode,
on-line (busy), in which the provider is logged-in but is currently
occupied in a video or telephonic engagement, and scheduled, in
which the provider is offline but is scheduled to be online at a
designated time-point and can pre-schedule engagements for it.
While not online, the provider can take messages as in offline
state. Other states may include off-line, in which the provider is
not logged in but can take message-based engagements (i.e.,
asynchronous engagements), out-of-office, in which the provider is
not accepting engagements or messages, and standby, in which the
provider is offline and can be paged to Online status by the
brokerage network if traffic load demands it (in some examples,
consumers see this state as offline).
[0046] The operating business model for the provider network
employs a remuneration scheme for providers that helps assure that
the consumers can find providers in designated professional domains
(e.g., pediatrics) in the online mode. For example, selected
providers can be remunerated for being in the standby mode to
encourage their on-line availability in case of low discretionary
availability by other-providers in their professional domain.
Standby providers are also called into the on-line state when the
fraction of on-line (busy) providers in their professional domain
exceeds a certain threshold. In some examples, the transition of
providers from standby to online and back to standby (in case of
over capacity or idle capacity) is an automated function of the
system.
[0047] The tracking module 112 transfers 154 information about the
availability and the communication capability of the consumers 120
and the providers 130 to the scheduling module 116 using, for
example, one or more well-known presence protocols, such as Instant
Messaging and Presence Service (IMPS), Session Initiation Protocol
(SIP) for Instant Messaging and Presence Leveraging Extensions
(SIMPLE), and the Extensible Messaging and Presence Protocol
(XMPP).
[0048] As noted, the system 100 includes access control facilities
114 that control how consumers 120 access the system and to what
extent or level the services provided by the system are made
available to consumers. The system 100 also stores and provides
access to consumer information (e.g., contact information, credit
and financial information, credit card information, health
information, and other information related to the consumer and the
services purchased or otherwise used by the consumer) and provider
information (e.g., physician biographies, product and service
information, health related content and information and any
information the provider or the health plan wants to make available
to members) and the access control facility 114 can prevent
unauthorized access to this information. In some examples, the
system 100 exports the consumer information for use in a provider's
office or other facility.
[0049] The system 100 interacts with consumers and available data
sources to position and direct their health matters to appropriate
care providers. Consumers can use various tools of physician and
provider profiling to exercise choice in selecting the providers
they wish to interact with. The brokerage facilitates the
communication between the consumer and his selected providers,
allowing the consumer to follow-up as needed to establish a comfort
level in his care. The brokerage supports transfer of these
communications and any other results of the eVisit to non-virtual
care points if such escalation is needed.
[0050] The brokerage can be considered as a first tier of medical
care that is made available to consumers at home or at other
locations. This first tier precedes typical entry points into a
medical care setting, e.g., a physician's office or an emergency
room. The brokerage enables consumers to explore concerns on, new
or existing medical issues without the need to incur the time,
cost, and emotional burden typically associated with the office
visits or trips to the emergency room. To deliver such a comfort
level, the system provides immediate access to tools that help
define health issues, as well as, access to the appropriate
automated and human mediated interventions. Consumers can
discretionally engage (or escalate) the level of care they need to
gain confidence in their management of such issues. The consumers'
choices in this area span both the type of credentials of the
provider they interact with (e.g., a nurse versus a board certified
specialist), as well as the level of intensity (mode and frequency)
of their communications (e.g., messages versus full video
dialogue). The brokerage can export the information and workup
gained during an encounter to a subsequent tier of services, such
as a specific medical office or the ER (as well as care management
services if offered by the consumer's health plan, hospitals and so
forth). As such, the brokerage manages more costly medical service
consumption (demand management) and serves as a pervasive tool for
impacting basic medical care and follow-up and encourages
appropriate health behaviors for the customer population at
large.
[0051] There are various models for how consumers may gain access
to the system. Consumers may purchase access to the system through
a variety of models, including direct payment or as part of their
insurance coverage. Health plans may provide access to their
members as part of their service or as an optional added benefit.
In some examples, health plans may receive information about their
members' use of the brokerage to allow, for example, better
allocation of resources and overall management of member's health
care consumption. Employers may purchase access to the brokerage
for their employees through whichever health plans the employer
offers. Self-insured employers may purchase access for their
employees directly with the brokerage. Providers may be compensated
in several ways and may offer their services to the brokerage
either independently or as part of a framework such as a provider
network.
[0052] Similarly, there are numerous ways the brokerage can be
packaged. As a health plan benefit, the brokerage expands a health
plans ability to manage health care service consumption by their
members. A health plan may provide access to the brokerage through
an existing web portal through which members access benefit
information and interact with their health plan. As an employee
benefit, the brokerage supplements the employee's health coverage
and may be presented, for example, through a human resources web
site. In a direct-to-consumer situation, consumers may access the
brokerage directly through its own web page. In some examples, the
brokerage is implemented as an enterprise software system for a
call center, such as one operated by a health care provider. Linked
to other institutional users of the system (e.g., other
participating providers), this can allow the provider to provide
services to its patients that it cannot offer itself, such as
24-hour specialty consultations. The brokerage may also be used by
a provider practice to allows its practitioners to provide care to
the brokerage's members (and generate revenue) during off-hours or
as a preliminary stage to office visits. This may also eliminate
the need for an office visit with a primary care physician just to
get a referral to a specialist.
[0053] The brokerage provides compensation for products and
services provided. Access to the system 100 may be provided on a
subscription basis, with consumers paying a fee (either directly or
indirectly through another party, such as a healthcare plan or
health insurance provider) to be provided with a particular level
of access to the system. In exchange for providing products or
services, the service provider may receive compensation from the
consumer or from an organization that pays for the products or
services on behalf of the consumer, such as a health plan or a
health insurance company. In instances in which the consumer pays
directly, the operator of the interface to the system that
connected the consumer to the service provider may be compensated.
In one embodiment, the consumer pays the operator, which keeps a
portion (e.g., a percentage, a flat fee, or a co-pay) and pays the
remainder to the service provider. In another embodiment, the
consumer or the service provider pays a flat fee or percentage of
the fee for the engagement to the operator. Where the service
provider's compensation is paid by a health plan or insurance
company, the operator may be paid a flat fee or a percentage of the
fee for the engagement transaction by the health plan or insurance
company. Alternatively, the consumer or the service provider or
both may pay a fee (a co-pay or service fee) to the operator for
providing the connection.
The Consumer Interface
[0054] Initiation of an Engagement
[0055] A consumer 120 engages with the brokerage system 100 to
access a service provider 130. Several types of engagements may
exist. Examples of these are described with respect to flowcharts
in FIGS. 4A to 4D and user interface screens in FIGS. 5A to 5D.
[0056] Referring now to FIG. 4A, a process 160 for establishing a
consumer-initiated engagement is shown. In a consumer-initiated
engagement, a consumer logs in 162 and communicates 164 a new
matter he desires assistance or guidance on to the brokerage, for
example, a health concern. For example, this is done on a web page
166, as shown in FIG. 5A. A component of the brokerage system 100,
such as the consumer advisor discussed below, assists the consumer
in consolidating 168 his questions and helps select 170 the
appropriate providers to answer them. The web page 166 includes
some initial questions 172, and another web page 174, in FIG. 5B,
provides a user interface for entering additional criteria 176 to
find a provider. A results page 178, in FIG. 5C, allows the
consumer to select a specific provider 180 from a list 182 of
providers identified based on the search criteria. Once a provider
is selected and a mode of engagement is chosen 184 (see below), the
scheduling module 116 establishes 186 the new engagement. In some
examples, the brokerage associates 188 a unique identifier with
participating consumers which can be used in subsequent
interactions with the brokerage, such as associating records from
multiple engagements. The consumer's health plan membership number
or other similar, pre-existing identification can be used 190. If
the consumer does not already have 192 a number, one is generated
194. The unique identifier can be used by the consumers to save
their planned engagement for later retrieval.
[0057] Referring now to FIG. 4B, a process 196 for establishing a
follow-up or prescheduled engagement is shown. Once an engagement
is established 186 as in FIG. 4A or as one is completed 198, the
two parties can instruct 200 a component of the system 100, such as
the scheduling module 116, to pursue the established engagement or
a follow-up engagement at pre-defined schedules or at future time
points. The system uses 202 e-mail, automated telephone
communication, or any other method of communication to establish a
convenient time for both parties to accomplish the follow-up and
then prompts 204 them to do so 206.
[0058] Referring now to FIG. 4C, a process 208 for a standby
engagement is shown, with a user interface on a web page 210 in
FIG. 5D. A standby engagement is similar to a consumer-initialized
engagement. In a standby engagement, the consumer selects 212 a
provider 180 or type of provider and requests 214 that a component
of the system 100, such as the scheduling module 116, to notify the
consumer by an appropriate communication, for example, e-mail, text
message, or an automated phone call, when the selected provider is
online and accepting engagements. In the example of FIG. 5D, the
user has chosen to be called and input a phone number 216 and a
limit 218 as to how long she will wait. The consumer request is
placed 220 in a queue for the specific requested provider who is
off-line (or for a type of provider for which all qualified
providers are off-line). When the system determines 222 that the
provider is available, the system notifies 224 the consumer. When
notified, the consumer logs in 226 and is connected 228 to the
provider.
[0059] As an option, a standby list for a provider may provide
preferential queuing for some consumers. For example, preferential
queuing may be provided based on prior engagements with the
provider (e.g., preference is given to follow-up engagements) or
based on a service tier (e.g., frequent user status) of that
consumer. The brokerage can be configured such that it collects
information about the consumer (e.g., answers to initial intake
questions) and provides the collected information to the specific
service provider prior to initiating any further engagements. For
example, a consumer can store information during a
consumer-initiated engagement as described above, park the
information, and wait to be contacted when the specific selected
provider is available.
[0060] Referring now to FIG. 4D, a process 230 for an
interventional engagement is shown. In addition to
consumer-initiated engagements, a health plan (or another
authorized entity) automatically instructs 232 the system to
schedule 234 an engagement with one of its members. This scenario
may be employed, for example, when a health plan member is
consuming 236 costly charges or exhibits a high risk score. The
system may also be authorized to automatically pursue 238 a
low-intensity telephonic follow-up with members that would
otherwise not be contacted for follow-up (e.g., Medicare or
Medicaid patients).
[0061] Provider Selection
[0062] One capability of the brokerage is to extend a retail-like
experience to the consumer. Consumers are able to spend time on the
system to explore its participating providers whether they are
currently available or are expected to be available at some other
time. While the system can assist the consumer in identifying the
most appropriate providers (see the consumer advisor function,
below), it also allows the consumer to filter the provider list
based on his preference and access a view of a provider
availability matrix that changes as providers go on and off
line.
[0063] An example of an interface by which consumers can select
providers in a variety of ways is shown in FIG. 5B, mentioned
above. In the health-care based example of the illustrated page
174, various criteria 176 can be used to filter the available
physicians. Basic details 240 indicate the consumer's preference
for the type 240a and gender 240b of the provider and what modes of
communication 240c the consumer wants to be able to use. The user
can also specify demographics 242 including location 242a and
languages spoken 242b. Qualifications 244 may include education
244a, years of experience 244b, and various other criteria 244c.
The consumer's health plan may offer additional searching criteria
246, such as whether a provider "must be in-network" 246a or
whether the consumer can consult with an out-of-network provider
246b. A consumer can also use a search box 248 to search for a
provider by name.
[0064] Consumers may select providers according to attributes of
the provider, such as a geographical area where the provider is
located or which professional organizations have accredited the
provider (e.g., whether a doctor has board certification in
cardiology). Any metrics within the provider profile (discussed
below) can be used to define a list of providers that meet the
consumer's preferences.
[0065] Once the consumer enters her search criteria 176, the
results are shown on the web page 178 in FIG. 5C. As mentioned, a
list 182 of providers is presented. This list may indicate each
providers name 250 and rating 252 and whether the provider is
available 254. For the selected provider 180, additional details
are shown, including her picture 256, specialty 258, demographic
information 260, what types 262 of connections she can use for an
engagement, and personal information 264. Tools 266 allow the
consumer to initiate or schedule an engagement.
[0066] Providers already associated with the consumer may appear on
the consumers' short list. Association may be based on historical
engagements and may extend to the health plan's feed of claims
(i.e., all providers that submitted claims for the consumer). When
reviewing the list of historical engagements, consumers are able to
access the engagement audit and the ranking they have attributed to
any engagements in the past.
[0067] In certain modes of deployment, there are functional
attributes that may impact the consumer's selection. In most
health-plan distribution modes, consumers may opt (or be limited)
to see only providers that are "in-network" according to their
insurance coverage product. Selecting an "out-of-network" provider
may incur higher out-of-pocket costs. Another example relates to a
deployment of the system in disease management and health coaching
settings (e.g., a call center). In this case, the plan may require
that the consumer can select only nurses that are associated with
the disease management program with which the consumer is
associated.
[0068] Regulations introduced by the federal government in August,
2006, require all federal bodies offering medical coverage
(including Medicare, Medicaid, and military, and federal employee
plans) to publish their ratings of health service providers
(physicians and hospitals) to the general public. The system can
allow the consumer to search such sites automatically for a
selected provider prior to an engagement. Other sources of
reference data may include state publications on morbidity,
mortality, and legal actions against providers, or databases
maintained by third parties.
[0069] Once a consumer has defined a collection of criteria to
filter and find a provider, the system can offer tools to shorten
the process in the future. Consumers may be able to save
criteria-sets as named searches and benefit from notifications when
a search list surpasses a certain level of availability that may
encourage the consumer to log in and communicate with a
provider.
[0070] Modes of Engagement
[0071] The brokerage allows consumers to engage provider's e.g.,
health professionals "on demand" based on provider availability.
Engagements can be established in various ways, including: [0072]
1. Passive browsing--Reference health content is accessed on the
brokerage's website. The website can support the use of licensed
content packages from other vendors to meet the variable
preferences of health plans. For example, key content vendors
include Healthwise.TM., ADAM.TM., Mayo Clinic.TM. and
HealthDay.TM.. Content libraries provided by such vendors offer a
combination of articles, imagery, interactive tutorials and related
tools that allow consumers to access content relevant for their
health issues. Many health plans and major employers already
possess a license for the use of one of these content packages.
[0073] 2. Health Risk Assessments--The system acquires information
from consumers through automated interaction (e.g., rules-based
interaction) in order to crystallize their needs (e.g., medical
risks) and better direct them. Assessments span from general health
to very specific medical conditions and follow a path of
questioning that dynamically tailors itself based on information
already retrieved (e.g., using predefined rules). As assessments
progress, the system constructs engagement suggestions that the
consumer can exercise. Each suggestion represents both the question
to the provider and the type of provider appropriate to answer it.
Consumers may choose to simply launch such engagements or apply
their own discretion as to the phrasing and the selection of the
recipient provider. This is discussed in more detail below in the
context of the consumer advisor. [0074] 3. Asynchronous
correspondence--The lowest level of true provider interaction is by
way of secure messaging. The question or topic of the engagement is
sent to a selected provider (whether online or not) and can be
answered by this provider at her leisure. Turnaround times are
monitored by the system and are part of the credentials of the
provider used for her selection by consumers. The system informs
the consumer once a response has been received and can allow the
consumer to redirect the question if he needs more urgent response
time. For example, typical types of asynchronous correspondence
include e-mail, instant messaging, text-messaging, voice mail
messaging, VoIP messaging (i.e., leaving a message using VoIP), and
paper letters (e.g., via the U.S. Postal Service). [0075] 4.
Synchronous correspondence--Several forms of synchronous
correspondence allow the consumer and the provider to engage in
real-time discussions. [0076] 5. Synchronous text
correspondence--This may be referred to as a "Chat" module where
both sides of the engagement type their entries in response to each
others' entries. The form of communication may be entirely text
based but is still a live communication. Examples include instant
messaging and SMS messaging. [0077] 6. Web-based
teleconferencing--The use of broadband network connections allows
for real-time voice transmission over the Internet in what is
referred to as full duplex (i.e., both voice channels are open at
the same time). Consumers can opt to have a voice conversation with
their providers using, for example, their computer's speakers and
microphone. Web-based teleconferencing may use VoIP, SIP, and other
standard or proprietary technologies. [0078] 7. Telephonic
conferencing--Consumers who wish for a direct telephonic
communication with a provider or who are not comfortable using
their computer may use a traditional telephone for interaction with
a provider. The consumer may use a dial-in number and an access
code that connects him to the brokerage's servers. Providers are
linked to the servers via VoIP, other data-network-based voice
systems, or their own telephones. Telephonic conferencing may also
allow consumers to request "call me now" functions, in which the
provider calls the consumer (directly or through the brokerage).
[0079] 8. Video conferencing--The system can support video
conferencing to allow consumers to exhibit physical findings to
providers if such disclosure is needed. Consumers and providers may
also simply prefer face-to-face communication, even if remote.
Small digital cameras, referred to as webcams, attached to or built
in to personal computers or laptops can be used for this purpose.
Video conferencing can be provided by standard software or by
custom software provided by the brokerage. Alternatively, dedicated
video conferencing communication equipment or telephones with
built-in video capabilities can be used. [0080] 9. Semi synchronous
correspondence--Some engagements of a consumer with an online
provider include both synchronous and asynchronous interactions.
Part of the engagement takes place by immediate messaging between
the two, but the provider may ask the consumer to take occasional
asynchronous assessments if, for example, a generic line of
question is desired. This allows the provider to operate more than
one consumer engagement at a time while each consumer is constantly
engaged. For example, semi-synchronous correspondence includes a
combination of e-mail, instant messaging, test messaging, voice
calls and mail messaging, and VoIP calls and VoIP messaging.
[0081] Interactive Voice Response Engagements
[0082] Interactive Voice Response (IVR) systems allow for the
deployment of interactive audio menus over the phone. The caller
can navigate between options, listen to data-driven information,
provide meaningful input, and engage system functions. IVR
engagements extend the reach of the system to the telephone as a
portable consumer interface to launch an engagement in addition to
the Web-based interface. Consumers select a pin code on the
application to authenticate their identity if they call in. Several
types of engagements can be carried out through an IVR system using
logic like that shown in FIG. 2B. For dial-in engagements, the
consumer calls in and invokes a telephonic engagement with an
available provider. The IVR system extends the consumer's ability
to select a provider to the phone so that the consumer's
interaction resembles one carried out on the Web.
[0083] The IVR system can also be used proactively to pursue
consumers who need a follow-up. At the time of a follow-up, the
system recalls the provider with whom the follow-up is desired (or
the type of provider in case the follow-up is not restricted to a
specific provider), identifies that the provider is available for
an engagement, and attempts to contact the consumer over the phone
to establish a connection for the engagement. Once contacted, the
consumer can decline or ask postpone the call. If the consumer
takes the call, the connection is made. When consumers are pursuing
an engagement with a provider that is either busy or currently
offline (e.g., a specific provider or a type of provider with few
participants), the IVR system allows the consumer to park in a
standby mode until the provider is available. When the provider is
available, the system calls the consumer, identifies the provider
to the consumer, and verifies that the consumer is still interested
in pursuing the call with the provider. If the consumer is still
interested, an engagement is connected.
[0084] In addition to launching engagements, the IVR interface
allows consumers to interact with other services offered by the
brokerage. For example, consumers can instruct the system to fax a
transcript of their information to a fax machine that the consumer
identifies by keying in or speaking its phone number. Using such a
function, a consumer makes key information available to, e.g.,
emergency room personnel or to a provider in an office visit.
without the need to plan, collect, print, and carry the information
to that encounter.
[0085] IVR hardware is readily available from telecommunication
vendors and can be programmed to operate in the context of the
brokerage framework. Authentication is provided through a PIN
number or by other standard methods.
[0086] Engagement Auditing
[0087] In some examples, material elements of an engagement are
audited by the brokerage to establish a work-up record of the
consumer. Such a record of consumer entries, recordings, and
provider notes, together with time stamps and identification of
registrars, is available to the consumer at any time for future
reference. A consumer may choose to share this record with other
providers within the brokerage or to export it to an external
point-of-care such as a provider office, an emergency room, a care
manager, or an external record management system such as a regional
health information organization (RHIO) (and to similar entities in
non-medical implementations). Auditing may also include various
degrees of automated entry of standardized coding to allow
effective rule-based moderation of the system based on clinical
(for example) insights captured during the engagement. In some
examples, the manners of auditing and coding are compliant with the
Health Insurance Portability and Accountability Act (HIPAA).
[0088] Engagement Recording and Transcription
[0089] The system 110 allows an engagement conducted using a voice
technology, such as telephone, VoIP, or a video call over the web,
to be recorded. As the system generates an audio file, it offers
consumers services associated with the file. Based on a consumer
request or setting to produce a transcript, the system forwards the
file to a third party vendor to perform transcription of the file
and return a textual representation of the engagement. Such text is
incorporated into the consumer's record, communicated to an
external party, or used as the basis for future engagements. In
some examples, the transcription may be performed by voice
recognition software. Transcription services can be bundled with
encoding and translation services. The consumer may also request
that the audio recording be made available over the phone or as a
data file to a third party (e.g., the consumer's personal
provider). In some examples, consumers are able to replay the
recording from either the web client or a telephone as part of the
IVR system.
[0090] Engagement Redirection
[0091] In some examples, a consumer redirects an active engagement
to another provider or provider type. A consumer may also redirect
an engagement to employ a different mode of communication with the
current provider (e.g., move from a text chat to a phone
conversation). The audit of the information and work up established
before the redirection becomes the basis for the new engagement. In
some examples, a consumer redirects an engagement that concluded in
the past as a way to continue follow-up on the same issue.
Consumer Advisor
[0092] Another utility in the brokerage, the consumer advisor,
assists consumers in determining what actions to take, for example,
which types of providers to consult. The consumer advisor acts as a
facilitator of engagements between consumers and providers,
similarly to the way a nurse might interact with a patient in a
health care system. In some examples, the consumer advisor is
operated using a rule-driven engine embedded in the system 110 that
draws from both consumer intake data and programmed clinical
knowledge. The consumer advisor helps the consumer identify issues
that the consumer should discuss with a provider in the system,
collects data to contextualize and shorten the time needed for the
discussion, and helps orchestrate engagements with the appropriate
type of providers, presenting the collected intake information to
the providers prior to the commencement of the engagement
itself.
[0093] The consumer advisor walks the consumer through the process
of using the brokerage and helps the consumer acquire the
appropriate services, minimizing the time spent and cost to the
consumer in determining which services to use. In some examples,
the consumer advisor packages or formats the information it has
collected to export it to a non-virtual provider (e.g., a
consumer's primary care physician) for further follow-up, even if
the consumer did not end up in an engagement. The consumer advisor
operates as an assistant to the provider during an engagement,
working directly with the consumer.
[0094] FIG. 6 shows an example process 280 used to implement the
consumer advisor. An intake stage 282 asks 284 the consumer a
series of questions that either pin-point the area of concern or
capture relevant information about the needs (for example, the
health) of the consumer in that area. In some examples, this
process is equivalent to what the healthcare industry calls a
Health Risk Assessment (HRA). The intake stage 282 identifies or
defines 286 one or more of a consumer's needs or problems. The
result of the intake stage 282 include a list or a narrative
summary of the issues that should be presented to the provider. The
intake stage enables the consumer to exclude topics he prefers not
to discuss or to add topics manually. The result of the process is
what physicians or lawyers call intake, a desired step in a
first-time office visit or client engagement. This relieves
providers from performing the typical extensive intake process
during an engagement. Because the information the provider would
collect has already been gathered by the intake stage 282. In the
health care example, the intake stage 282 covers topics that extend
to both medical conditions and issues (e.g., pain in left shoulder,
not associated with exercise) as well as general health and
wellness assessment profiling (e.g., the patient is a female over
40 and had not had a mammogram, the patient is overweight, the
patient is having trouble sleeping).
[0095] The information obtained from the intake stage 282 is
analyzed 288 in an analysis stage 286 to determine a list of topics
concerning health issues. The consumer advisor presents 290 the
list of topics about the consumer's needs to the consumer and
allows the consumer to further refine 292 the list by adding or
removing topics. In the health care example, generating the list
includes codifying the conditions, issues and general state of
health and wellness of the patient to allow internal profiling of
the patient and to facilitate future engagements. Once a list of
topics is defined, the analysis stage 286 determines 294 an
engagement action plan or agenda for the consumer, suggesting the
type of providers most appropriate to discuss each topic and the
relative priorities of such discussions. A web page 296 presenting
an example agenda 298 is shown in FIG. 7. The consumer advisor may
supplement 300 the agenda with links to consumer content
information to educate the consumer about the condition or issue
prior to his engagement with the provider. The action plan is
output 302 in several ways. In some cases, a consumer prints (or
downloads and saves) the action plan and takes it to his live
provider. In some cases, the action plan is transmitted to the
consumer's live or primary provider automatically.
[0096] The action plan is also output 302 to the scheduler module
116, which locates providers and establishes engagements, as
discussed above with regard to FIG. 4A, for the most appropriate
provider(s) available for each of the action plan's item(s). The
consumer uses the system 100 to engage such provider(s) or to find
other available providers, and to sequentially engage providers
appropriate for each of the topics on the consumer's engagement
action plan. The consumer can also re-prioritize the items in the
action plan and save the action plan to use at some point in the
future. A consumer may use the list as basis for entering into
multiple engagements (with multiple providers) or allow the first
provider engaged (or the consumer's personal provider, such as a
primary care physician) to review and orchestrate the management of
all issues in the list. The scheduler module 116 allows the
consumer to use the system 100 to engage available providers in any
suitable mode (for example, by chat, by video conference, or by
voice communication) or to enter the standby list for providers
currently not online.
[0097] In certain engagements, the provider enhances interaction
with the consumer by using a re-assessment process 304 to acquire
further information about the consumer's condition. During an
engagement 306, the provider invokes 308 the re-assessment process
304 to cause the consumer advisor to interact 310 with the consumer
on one or more specific intake assessments or assessment forms. For
example, where the initial intake did not determine the possibility
of a specific issue or condition, a treating physician, after
consultation with the consumer, can ask for a specific intake
process to be given or taken again (for example, where the consumer
omitted an important symptom). Once the re-assessment is completed,
the treating physician or a new physician (in the health care
example) can have 306 a new live engagement with the consumer.
[0098] This assessment process 304 may be repeated, with the
consumer undergoing further assessment or repeating assessments to
collect further information for the provider. In some examples, the
intake stage 282 determines, based on information provided by a
previous provider, for example, that the consumer needs a
re-assessment and the nature of the re-assessment, such that when
the consumer returns to the intake stage 282, the consumer is
prompted as to whether the consumer wants to proceed with the
re-assessment or perform intake for a new engagement or different
condition or disease.
[0099] In some examples, the consumer advisor includes a health
improvement function to assess a consumer patient's current overall
health and wellness state, a specific area of the health and
wellness state, or treatment for a specific condition, issue or
symptom. A profiling operation 312 is performed using the data
collected by the intake stage 282 to form a profile of the patient.
This data include the consumer's goals, where the consumer wants
the consumer's health state to be in the future, and desired
changes in the consumer's overall health and wellness state or in a
specific area of the consumer's health and wellness state (e.g.,
body weight, BMI, cholesterol level, etc.), or treatment for a
specific condition, issue or symptom. After developing 314 the
profile and analyzing 316 it, the consumer advisor lists 318 the
actions that the consumer should take to achieve these goals and
incorporates 320 the actions into the consumer's action plan. In
addition to recommending treatment, the health improvement function
also promotes actions in the area of education, including static
content and active engagements.
[0100] The health improvement function also determines a regimen
for the consumer to follow to achieve the goals. Where necessary,
the consumer can be directed to the scheduler module 116 to connect
the consumer with a provider to assist in developing the regimen.
For example, the consumer can meet with dietician to assist in the
development of a dietary regimen or a personal trainer for the
development of an exercise regimen. The consumer can periodically
interact with the health improvement function to track her progress
toward her goal. The information about the consumer's progress and
updates as to the consumer's profile information are collected
using the intake stage 282.
[0101] The steps of the process 280 may be implemented in a single
module or in several functional components or modules including an
intake module and an advisor module. The consumer advisor may be
implemented as a module within the server 110, similarly to the
tracking module 112 or the scheduling module 116, or it may be a
self-contained module. The scheduling may be carried out by the
scheduling module 116 through an interface to the modules carrying
out the advisor process. To provide continuity to consumers, the
interface may be implemented as part of the interface shown in
FIGS. 5A-D.
[0102] The consumer information collected by the intake process may
be stored in the databases 118 as part of the overall brokerage. In
some examples, the consumer information is protected and secured
from unauthorized access and in compliance with the various legal
requirements for storing private consumer information (for example,
HIPPA governs access to an individual's health care information).
The database 118 may also the process logic and rules data
including the business logic of an application or rules for a rules
engine that implements the consumer advisor module.
[0103] The system 110 keeps track of where the consumer 120 is in
any of the processes so that the consumer 120 can log out and, upon
his return, be taken to the same point where he left. After the
consumer 120 has completed a section of his action plan, for
example, after a patient has been successfully treated for a
condition, the system 110 archives the related data and stores it
as part of a virtual consumer record system in the databases 118.
In some examples, a virtual patient record system is used as a
source of data for various health assessment and health risk
studies. Patient data can be accessed anonymously, for example, so
that researchers can study patient data without obtaining the
identify of any of the patients.
[0104] Auxiliary Services
[0105] Other services can be incorporated into the overall
brokerage. Such auxiliary services extend the completeness of the
service's offering or allow for advanced functions that can improve
the end-user experience in a substantial way. The brokerage
architecture allows incorporation of such auxiliary services either
as part of the brokerage framework or as plug-ins using 3.sup.rd
party vendor components. Such auxiliary services may be positioned
inside the brokerage console to facilitate a consolidated user
experience independently of who ultimately provides them.
[0106] A consumer data repository includes collection of parametric
and non-parametric data. In addition, the repository holds consumer
information, such as health and wellness information. For
prescription filling, a provider prescribes medications to a
patient over the web and submits the prescription to a local
pharmacy for pick up. Such services may include components of
prescription clearinghouses like SureScript.TM. or RxHub.TM.. Where
appropriate, the system is designed to interface with such
services. There are, of course, legal constraints on such
offerings.
[0107] In targeted self-help programs, a provider may advise a
consumer to engage in a certain action plan that uses only
intermittent provider involvement and is primarily focused on
ongoing interaction by the consumer with computerized modules. The
brokerage may offer information regarding a consumer's current
eligibility for services or benefits as well as general information
on offerings, programs, and enrollment in special products offered
by, for example, a health plan that is providing the brokerage to
its members. This information may also come from employer-operated
benefit services. If consumers are enrolled in health-related
financial products like health spending accounts, various updates
on current standing are be presented through the console. This
information is updated, linked to, or summarized by the plan, the
employer, or an affiliated financial institution managing the
consumer's account. Similarly, retirement plans or brokerage
accounts might be linked, for example, if the brokerage is provided
by the consumer's employer or bank to provide financial planning
advice. Consumers may be given access to relevant and targeted
clinical content from packages that are included in a specific
service subscribed to by or on behalf of the consumer. These may
include packages related to clinical, health, wellness (e.g. diet
and exercise), preventive medicine, medication, coaching, mental
health, and other disciplines.
[0108] Information Portability
[0109] The brokerage extends the result of any engagement to a
physical point of care or service provider to allow continuation or
escalation of services beyond those provided in the electronic
encounter. For example, a textual transcript of an engagement is
forwarded to a desired provider. If the provider is a participant
in the brokerage, the provider accesses the transcript directly. If
the provider is not a participant, other modes of access to the
transcripts may be used, such as e-mail or fax or temporary access
may be given to the non-subscribing provider. In some examples, the
service may compensate a provider for reviewing a summary of his
client's on-line engagement with another provider. This keeps the
primary provider informed, leading to better service for the
consumer, and making the eVisit system more palatable to the
primary provider.
[0110] The brokerage may also supplement the record of the
engagement with additional information, such as pointing out to a
physician what treatment options the patient's health plan would
prioritize for an illness noted in the record, or what preventative
treatments the patient may be due for.
[0111] A consumer may opt to receive or forward his entire record
on the brokerage's system for either safekeeping or as part of a
record transfer to another service, for example, if the consumer
changes health plans. In some examples, the brokerage allows
consumers to request such a transcript to be transmitted in
electronic form or to be loaded onto a selected medium. Outbound
communications can be explicitly approved by the consumer, for
example, to conform to HIPAA requirements for managing protected
health information (PHI) or other consumer privacy policies or
regulations.
[0112] Assuring Treatment Continuity
[0113] Consumers are more likely to use the brokerage if they
perceive it as a valid tier in their relationships with their
service providers, which is more likely if there is continuity
between engagements, whether live or on-line. The workup performed
on the brokerage facilitates the consumer's non-virtual
relationship (rather than being redundant or contradictory) and
thus encourages participation by both consumers and providers. The
brokerage provides several features to achieve this goal. In some
examples, the brokerage engages concierge practices in key
geographic locations to provide non-virtual care to consumers who
are otherwise managed only through brokerage-based engagements.
[0114] A service guarantee is provided to the consumer that any
workup performed on the system is made available to his local
service provider (e.g., his primary care physician) or requested
point of care within a set number of business days electronically
and another number of business days by paper statement. The
consumer can also receive, for his own safekeeping, an assurance in
the form of transcripts of each transaction. In some examples, upon
the completion of the workup with the system, the consumer selects
a conversation wrap-up whereby he sends the results of the workup
to his local service provider.
[0115] For providers who do not participate in the brokerage, a
referral guarantee is provided to the consumer's local service
provider (e.g., his primary care physician) that her role in
coordinating the care to the consumer will not be harmed. As such,
the system acknowledges the local service provider's role visually
to both the consumer (e.g., while in engagement with another
provider) and to any participating providers with whom the consumer
interacts. The designation of a certain local service provider as,
for example, the PCP of the consumer, automatically triggers a
behavior in the system that continues to update that local provider
on the activity around "her" consumer. Another function that can
further cement the role of the local service provider is an
automated referral in which the participating provider can refer
the consumer to an office visit only with that local service
provider if additional workup is needed. This allows the local
service provider to increase her visibility and receive more
traffic merely by cooperating in her customers' use of the
brokerage.
[0116] In some examples, a quid-pro-quo feature extends the
treatment continuity offered to the consumer beyond forwarding
engagement information to a non-virtual service provider. It allows
consumers to continue a virtual engagement (or follow up on one)
with a participating provider operating a real-world practice.
Because participating providers have access to the brokerage's
online interface, transitions between on-line and live providers
are more informed. The consumer benefits from being able to pick up
where he left off in the on-line engagement and assure continued
documentation of his non-virtual visit in his service-based
records.
[0117] Consumer Incentives
[0118] In some examples, health plans or other entities offering
the brokerage to their customers incorporate automated incentives.
Such incentives reward consumers for activities that yield
favorable health outcomes (in the example of a health-plan-provided
service). Incentives are provided to encourage consumers to, for
example, become educated about the nature of a chronic condition
with which the consumer has been diagnosed, engage in a
conversation that yields advanced detection of a major health
issue, perform online follow-up on conditions that warrant it
(e.g., coronary artery disease or Diabetes), and participate in
engagements that yield higher drug regimen compliance in select
medical conditions. The system allows such incentives to be
distributed automatically and promoted to appropriate consumers to
encourage, for example, desired health behavior and medical
management.
[0119] Interface with External Data Sources
[0120] To facilitate engagements between the consumer and the
provider, the system acquires information from available systems
automatically and uses the information to prepare providers at the
beginning of an engagement. Such interfaces include both
synchronous (e.g., web services) and batch updates from, in the
example of health care, eligibility data, claims data, Pharmacy
Benefit Management (PBM) information, predictive modeling, provider
feeds relevant for consumer referrals, other standard-coding feeds
using, e.g., ICD, CPT, HCPCS, NDC, SNOMED, or LOINC, formulary
information relevant for Rx drug choice determination and
preference, Customer Relations Management systems (CRM), and
external messaging systems and queues (e.g., My Yahoo!,
personalized RSS feeds).
[0121] Management and Analysis of Raw Data Inputs
[0122] In some examples, the brokerage accepts raw data inputs such
as claims, pharmacy data, and lab data, from a variety of sources
typically used by large clients (e.g., health plans, care
management companies). The system validates the correlation between
incidental entries in the raw data and the profile of the consumer.
To do this, the system applies customizable analytic rules that tag
a consumer as diabetic, for example, based on lab results, rather
than flagging a consumer as a diabetic merely because he had a test
to exclude diabetes (e.g., where the ICD code for the text doesn't
indicate its outcome).
Service Providers
[0123] Provider Enrollment
[0124] Service providers are the individuals responding to
consumers queries and participating in engagements. For example, in
a health care setting, service providers include doctors, nurses,
and other medical professionals. Such providers participate in the
brokerage while maintaining their affiliations they may have with
any sort of professional engagement in the non-virtual world (e.g.,
a hospital appointment, a clinic or a private practice, partnership
in a law firm). Providers on the brokerage network are verified to
hold their claimed credentials prior to being permitted to accept
engagements with consumers. Once verified, providers agree to the
terms of the brokerage, such as payment for their time in
performing engagements, the protocol of conduct desired, and the
ramification and distribution of liability in case of violations of
that protocol. These are similar to the agreements providers would
make when joining a group practice or a hospital in the non-virtual
world. An example web page 330 for one stage in the enrollment
process is shown in FIG. 8.
[0125] Prior to joining the brokerage network, a provider
establishes a profile that allows consumers to select him as the
target service provider of an engagement. Providers are profiled
using verifiable information from provider registries (e.g., the
American Medical Association (AMA) for physicians or the American
Bar Association (ABA) for lawyers) as well as by a self-statement.
The profile is used for several purposes, including determining the
relative cost of the provider's time to either the consumer or the
brokerage sponsor (e.g. a health plan that is paying for the
service), and providing consumers with information that may be
relevant to their choice to engage one provider versus another.
Some information about the provider is verified by the brokerage
(e.g., Tax ID, education, professional certification, demographics,
and contact information), and some is acquired during the
provider's participation on the brokerage. Such data may include
length of service, number of engagements, consumer satisfaction,
projected availability, etc. A provider may also provide a general
introductory note, a picture, and voice and video welcome snippets.
Providers may also add other information they deem relevant for
consumers (e.g., a list of publications and honorary appointments)
A table 340 in FIG. 9 lists example profiling criteria that can be
populated during enrollment in a medical context. The table 340
includes example criteria 342, specific examples 344 of each
criterion 342, and an indication 346 of whether that criterion
would have an impact on engagement cost.
[0126] Providers participating in the brokerage may come from one
or more networks of service providers. Individual service providers
are also able to register and enroll with the system. Individual
service providers may be independent service providers not
affiliated with a provider network, or service providers affiliated
with a provider network that is not itself affiliated with the
brokerage. This allows service providers (or other service provider
networks) outside of a selected service provider network to
participate in the system.
[0127] Provider Introduction
[0128] As part of the provider selection process described above,
consumers benefit from access to introductory material from the
provider. As consumers search for providers to meet their needs,
they can select to view only providers where such material is
available, producing an incentive for providers to take advantage
of such capability. The example page 330 in FIG. 8 allows a
provider to upload such information. Introductory material may
include the provider's picture 332, a text welcome 334, a welcome
recording 336, a video introduction 338, or a link (not shown) to
the provider's home page in a clinic or hospital. The introductory
material may also include an Internet link (not shown) provided by
the brokerage that shows the provider's credentialing on a
recognized public site (e.g. The American Medical Association).
[0129] Provider Certification
[0130] In some examples, the system certifies service providers (or
networks of service providers) to enroll and participate in the
system. This may use certification standards established by outside
agencies, such as the AMA or ABA. A provider wishing to become
enrolled in the system registers with the system and provides his
credentials, such as board certifications, years in practice,
employment history, residencies, and education. The system confirms
this information and evaluates the provider as a potential provider
in the system. In addition, the system may also contact existing
providers in the system, such as those with the same specialty or
board certification or who have worked with or attended school with
the candidate provider, and ask them to provide a peer review
rating of the candidate provider. In some examples, the
certification process is provided by a third party organization or
by the same organization that provides the system for connecting
service providers and consumers.
[0131] In some examples, the certification process considers load
balancing of available or participating service providers in order
to encourage service providers of specialties that have low average
availability or are in high demand with respect to the consumer
marketplace to enroll and participate in the brokerage. The
brokerage may also limit the enrollment of service providers in
specialties that have high average availability or are in
relatively low demand to service providers with credentials that
meet or exceed the credentials of service providers already
participating in the system. The system maintains information about
the specific needs of the consumers and the availability of service
providers specializing in areas that can meet the needs of the
consumers. Using this information, the system identifies which
areas of specialization would benefit from additional service
providers and which areas are underutilized and possibly in need of
reducing the number of service providers or adding additional
consumers. Because the system can connect service providers and
consumers who are separated by great distances and who may not
normally interact in person, the system allows service providers
who are underutilized in their current location to make up for a
shortage in another location.
Provider Ratings
[0132] To further improve the ability of consumers to choose
appropriate service providers, the brokerage includes a utility for
rating the products and services provided by the service providers
or by a service provider network. The consumers provide feedback
(positive and negative) to the system about the products and
services provided by a particular service provider. For example, in
a healthcare system, the patients can provide an evaluation of the
quality of treatment or bedside manner provided by a physician. In
addition, the service providers provide feedback and evaluations of
the products and services provided by other service providers. For
example, a primary care physician can provide an evaluation of the
products and services provided by a specialist to which he referred
one of his patients.
[0133] In some examples, this information is used to reconsider the
certification of service providers participating in the system.
Periodically, the system perform a re-evaluation process on each of
the service providers participating in the system and eliminates or
locks out service providers that do not meet certain criteria or a
minimum level of performance with respect to consumer and peer
evaluations. Newer service providers are enrolled to participate in
the system for a probationary period where they are allowed to
continue only if the evaluations of their products and services are
satisfactory or are above a predefined threshold for
performance.
[0134] As part of the provider profile (and as a way for consumers
to limit their search), the system continuously updates each
provider's profile with metrics reflecting the quality of his or
her interaction with consumers. The metrics are updated at the
conclusion of every engagement to allow providers immediate
feedback as to their level of service. In some examples, all
searches for providers on the system are sorted by provider rating
by default, promoting higher-quality providers. Example parameters
to be updated and taken into account in setting the rating include
consumers' overall ranking of the provider's engagement quality,
the number of engagements made by this provider in the last 30 days
or overall, the number of returning engagements as a fraction of
all engagements for that provider, the number of redirected
engagements from this provider to another, and the average
turnaround time for messaging while not "out-of-office." In
addition to the ratings each provider on the system has a Provider
Statistic Manifest stating operational statistics that may interest
consumers, such as that provider's availability for phone
conferences over the last 30 days.
[0135] Consumers are asked to rank a provider at the end of the
engagement as part of the process of disconnecting. To encourage
consumers to provide such feedback, charges for the engagement
continue to accrue until the consumer completes the ranking. Such a
process helps encourage provider engagements to end with a ranking
entry, promoting a higher quality of service to the brokerage's
consumers.
[0136] The Provider Console
[0137] Providers interact with consumers through a provider console
web page 350, shown in FIG. 10. This interface is similar to that
used by the consumers. The provider console provides access to the
various tools used by providers. A window shows a live image 352 of
the consumer, with tools 354a, 354b to control or disable the video
feed. A phone control 356 allows the provider to initiate a phone
call with the consumer. A log of an ongoing chat 358 is displayed
above an input 360 for the provider's next comment. Other tools are
available in tabs 362 on the side, such as accesses to the terms of
operation and the legal policies of the brokerage, such as
disclaimers. State setting allows the providers to change his
availability state between states such as off-line, on-line and
out-of-office. Scheduling allows providers to update their
availability calendar with future times they expect to be available
on the system, which can in turn result in consumers seeing a
"scheduled" state for such providers.
[0138] Messaging tools allow providers correspond with consumers in
message-based engagements. The console also allows the provider to
participate in chat engagements where the consumer and the provider
communicate back-and-forth in real-time by typing, such as the chat
358 in FIG. 10. The brokerage allows a single provider to engage in
more than one chat at a time to maximize his yield while consumers
are typing their entries. The chat feature also allows the provider
to forward specific lists of questions to further reduce the need
for his time in acquiring information from the consumer at the
beginning of an engagement. Tools available to assist the provider
in chat or messaging may include a thread viewer, a clinical
summary of the consumer, the consumer's engagement history, a
communication timeline chart, and a library of built-in and
self-produced message templates for quick response. Such templates
may also include references, links, and embedded graphical
educational content on prevalent topics. In some examples, the
brokerage scans outbound messages for inappropriate language based
on the sponsor's preferences.
[0139] The console allows the provider to hold a voice conference
engagement with the consumer when the consumer is using either her
computer or a telephone. The provider can use the console to
redirect his end of the conference to a phone, for example, if
bandwidth or other considerations indicate it or simply based on
personal preference. The console also allows the provider to engage
in video conferences with consumers. Audio may be served via the
console or be may redirected to a telephone. To verify a provider's
identity when using the telephone for a voice engagement, the
system provides the provider with a PIN number through the provider
console. When the provider calls into the system, or answers the
phone when called by the system, the provider enters the PIN to
confirm that the person on the phone is the same person who is
logged into the console. This method is also used to leave secure
voice message. When a provider wants to leave a message for a
consumer, the provider tells the console and receive a PIN. The
provider then receives a call from the system, enters the PIN, and
leaves a message. The message is then delivered to the consumer
with assurances that it was left by the provider.
[0140] At any time during an engagement, the provider may add notes
to either the consumer engagement audit (consumer record) or to his
own audit of the engagement. The audit trail allows the provider to
review a complete audit of his consumer interactions via the
console. This audit may include the content and timing of past
engagements and related credits that the provider is due for the
engagements.
[0141] In versions of the brokerage for fields, such as health
care, that rely on detailed coding of work performed or analyses
made, an encoder feature is provided throughout the engagement. The
encoder allows the provider to add clinical codes describing the
findings of the engagement. The codes can be used to further
characterize the consumer as well as the basis for outbound
communication to the follow-on points of care or interfaced
clinical systems. The encoder can support, for example, coverage
for disease, drug and procedure classifications.
[0142] The system may allow provider to provider interaction either
in the context of a consumer (e.g., consultation or referral) or
without a consumer context (e.g., provider forums, discussion
boards, etc.). In a health care context, depending on the license
of the provider to prescribe medications to an engaged consumer,
the console allows the provider to use electronic prescription and
refill services. Assuming it is authorized, the provider may
instruct the system to forward transcripts of engagements or other
information to another recipient outside the brokerage. Such
exporting may include various modes of communication, such as
electronic (e.g., fax, e-mail, SMS) or non-electronic (e.g., print,
mail).
[0143] The provider is able to review his account status, system
settings, and preferences. The provider can also access his profile
and user satisfaction and statistics as they are available to
consumers. The console also connects to financial services
associated with the provider's participation in the brokerage. This
includes status of charges, submission of plan claims (e.g., for
CPT code 0074T for eVisits in a health care setting) and claim
processing status. In some examples, depending on the mode of
deployment of the brokerage from the health plan standpoint,
real-time claim information may be available.
[0144] The brokerage offers providers the ability to redirect
messages or requests for appointment to SMS-compatible cellular
phones. In this mode, the provider associates a cell phone number
with his account and establishes the type of information that the
system can send to the mobile device. Such information may include
engagement-related notifications as well as system-related
notifications (e.g., an announcement about a high-traffic state
asking providers to make themselves available and offering a higher
fee to do so).
Open Access Forum
[0145] In some examples, the system includes an open forum that
supports freeform engagements on different topics between all
constituents. The open forum allows a consumer to anonymously post
any of the issues identified by the consumer advisor or to manually
post questions into a publicly-accessible forum. While the consumer
posts his issues anonymously, responses or threads developing as
other users provide answers or discuss the issues are forwarded to
the consumer that posted the original issue. In some examples, the
system monitors the identity of those who respond to a posting and
differentially informs the consumer if a user known to be a
provider posts a response. In some examples, the brokerage pays
providers to post responses to entries they think are significant
on the open forum. Unlike consumer entries, provider entries are
identified and allow a consumer to start engagements with providers
whose answers he finds informative or beneficial. The open forum
also serves as a vehicle for providers to publicize themselves to
consumers.
[0146] In some examples, a consumer posts the audit of one or more
engagements onto the open forum for the benefit of other consumers.
The brokerage strips any data that identifies the participants
(i.e., it anonymizes the data) and offers the consumer the ability
to review the anonymized data prior to posting it.
The Rules Engine
[0147] Referring to FIG. 11, the system receives health care
information associated with a consumer 120 from multiple sources,
such as a provider of services 130 using a device 366a, the
consumer 120 using a device 366b and information that the system
generates 364. The database 118 collects the information and the
rules engine 368 located on the server 110 analyzes the
information. The system collects consumer health care information
from numerous sources. A rules engine uses the collected
information to identify health risks and produce follow-up actions.
The collected information includes the consumer's current intake
data, engagement information, provider's notes, information
included in the consumer's profile and so forth. A consumer's
health care information also includes assessments conducted by
other systems and usage history.
[0148] Referring to FIG. 12, the rules engine 368 includes defines
a rule or a set of rules 380. In some embodiments, other server
modules, such as the scheduling module, define the rules or the
rules are input into the system by an administrator or other user
of the system (not shown).
[0149] Various types of rules are defined including rules that
identify health conditions and health risks and rules that generate
follow-up actions. Through the application of the rules 382 to
ascertain if the health information meets the criterion specified
in the rule 384, the system identifies health risks and generates
follow-up actions for the identified health risks 386. If
additional rules exist 388, the rules are also applied to the
health information. If a rule's criterion is not met 384, the rules
engine 368 determines if the set of rules has more rules to apply
388 to the health care information. If the set of rules contains
additional rules, the rules engine 368 applies the additional rules
to the information 382.
[0150] The sequence continues until the rules engine 368 has
applied all of the rules in the rule set. In the case that the rule
set has no additional rules and the information fails to meet any
of the criteria specified in the rules 384, the rules engine 368
defines a second action to take and this action is also performed
390.
[0151] Referring to FIG. 13A, a comprehensive plan of managing
health risks 400 includes classifying health care information 402,
identifying health risks or medical conditions 404, producing
follow-up actions for the identified health risks or conditions 406
and providing notification of the health risks and follow-up
actions 408. The plan 400 also includes any combination of these
actions.
[0152] Referring to FIG. 13B, in another example, managing health
risks 400 includes providing notification 408 after identifying a
health risk 404 or after producing follow-up actions 406 or any
combination thereof. In some examples, a follow-up action is
produced prior to identifying a health risk 404.
[0153] Referring to FIG. 13C, the system's rules engine 368 and a
provider of services using the rules engine 412 both identify
health risks 404 and produce follow-up actions 406. Health risks
are identified and suggested follow-up actions are produce in a
number of different manners. Health risks that are unrelated to the
purpose of the consumer's interaction with the system may be
identified, even while those risks may not be present during system
routine interactions.
[0154] System Management of Health Risks
[0155] Referring to FIG. 14, the system generates a comprehensive
plan 400 by using the rules engine 368 to classify patient data
402. Additionally, the rules engine 368 identifies health risks 404
and generates follow-up actions 406. As was discussed in FIG. 12,
the rules engine 368 includes defining rules 380. Therefore, the
plan 400 defines classification, identification and follow-up
rules.
[0156] In the particular example illustrated in FIG. 15, the rules
set includes two classification rules 420, Rule 1 (422) and Rule 2
(424), and one identification and follow-up rule 426, Rule 3 (428).
In other examples, the rules include clinical health plan
guidelines, such as a woman of 35 years of age should have a
mammogram every two years or a consumer under the age of 22 should
have the hepatitis vaccine.
[0157] Classification
[0158] A provider consultation or system interaction produces
additional health care information, such as a diagnosis, procedures
performed and the type of engagement, as shown below:
Diagnosis=ICD-9 100
[0159] Procedure equals CPT 322
Engagement Type=ER Visit
Example Health Care Information
[0160] This new information is stored in the system and associated
with the consumer's prior health care information. The system is
capable of classifying the data into groups and categories.
Classification rules refine the consumer's profile and classify
consumer claims. As shown in FIG. 14, classification is done prior
to identification of health risks 404 and production of follow-up
actions 406. However, the system is capable of classifying the data
independent of any further identification or generation of
follow-up actions. Classification of health care information is
triggered when a change occurs in a consumer's associated health
care information, because the change signals the additional of new
or different information.
[0161] Referring to FIG. 12 and Rule 1 (422), if a consumer meets
Rule 1's criterion 384 of being associated with a diagnosis of
ICD-9 100 (422a), then two actions are performed 386. First, the
consumer is classified as diabetic 422b. Second, a "Diabetes"
diagnosis is added to the consumer's system profile 422c. In this
case, the consumer is classified as diabetic 422b and a diabetes
diagnosis is added to the member's profile 422c, because the
consumer's diagnosis is "ICD-9:100."
[0162] After this first classification, the rules engine 368
determines that the rule set contains two additional rules,
Classification Rule 2 (424) and Identification and Follow-up Rule 3
(428). Classification Rule 2 (424) classifies a consumer's diabetes
management as poor 424b if the consumer is a diabetic and has
visited the emergency room more than once 424a. In this case, upon
Rule 2's application 382 to the above health care information, the
consumer is classified as poorly managing the consumer's diabetes,
because the consumer's diagnosis is diabetic and the "engagement
type" equals "ER visit."
[0163] Identification
[0164] Referring to FIG. 14, the rules engine 368 is used to
identify health risks 404 through the application of rules defining
health risks. For example, Rule 3 (428) identifies a consumer as
having a health risk when the consumer is a diabetic 428a and the
consumer has poor diabetes management 428b. The rules engine 368 is
also capable of identifying consumer conditions, such as whether a
consumer is pregnant or is due for an annual colonoscopy.
[0165] Referring back to the above example and FIG. 14, health
risks are identified 404 after the classification of the consumer's
health care information 402. After the application of
Classification Rule 2 (424), the rules engine 368 determines that
the rule set includes an unapplied rule 388, the Identification and
Follow-up Rule 3 (428). In this case, the system identifies the
consumer as having a health risk, because the consumer meets Rule
3's criterion of being a diabetic 428a with poor diabetes
management 428b.
[0166] As previously discussed with reference to FIGS. 13a and 13b,
in some instances after identification of a health risk, the system
notifies the consumer of the risk. The system can use various
channels of communication in notifying consumers. Examples of
channels include email and automated phone calls. In some examples,
the consumer specifies preferred channels of communication. In
other examples, the system tracks the channels of communications
the consumer is most responsive to upon receiving a system
notification. For example, if the consumer always reads a system
sent email but never answers system initiated notification phone
calls, then the system is capable of tracking this responsiveness
and emailing the consumer with further notifications.
[0167] System Created Follow-Up Actions
[0168] Referring to FIG. 14, the comprehensive plan 400 includes
producing follow-up actions 406. These are actions to assist the
consumer in managing health risks and preventing future additional
health risks. The system is capable of generating numerous types of
follow-up actions. Examples of such follow-up actions include
recommending the consumer consult with a service provider
associated with the system, recommending the consumer consult with
the consumer's primary care physician, recommending reading
materials pertaining to the consumer's health risk or creating
health directives. The system provides notification 408 of the
follow-up actions to the consumer 120 and other, e.g., service
providers associated with the consumer, such as those service
providers that are also associated with the system 130 and those
service providers that are not associated with the system 410, but
still associated with the consumer.
[0169] In addition to generating follow-up actions 406, the system
is also capable of further classifying the consumer to further
refine the consumer's profile and group the consumer. For example,
based on the identified health risks, the system may classify the
consumer as a high risk consumer with a high potential for using
the system consistently.
[0170] Referring to FIG. 15, Rule 3 (428) generates three follow-up
actions: a health directive 428c, a notification 428d, and an
agenda item 428e. For this example, involving diabetes, the system
produces a health directive 428c that recommends the consumer
enroll in a diabetes program. Generally, the content of the health
directives is a list of recommendations for the service providers
to follow, such as referring a consumer to mammography if a
mammography is past due or suggesting a colonoscopy for a consumer
because the consumer received one recently and the colonoscopy was
inconclusive.
[0171] Referring to FIG. 16, in another example, health directives
434 include notes to a consumer's physician 432. In this example,
because the system has identified the consumer as pregnant 430, the
system generates a health directive 434 recommending that the
consumer's physician provide the consumer with an ultrasound
examination 436. In some examples, the system notifies 408 the
consumer's physician 410 of the health directives. Upon the
conclusion of an engagement, an engagement summary includes the
health directives and the consumer is capable of viewing the
engagement summary as part of the "past engagement record" of the
consumer.
[0172] Referring to FIG. 17a, the system exports the engagement
summary to the consumer's other service providers. The consumers
typically authorize this transfer. The information maybe sent
through secure or non-secure channels such as email. These health
plan directives are available as part of the "past engagement
record" 440 of the consumer. The system is also capable of sending
a feed of these directives to the consumer's sponsoring health
plan. This enables the health plan to ascertain if the service
provider, either associated or not associated with the system, has
taken action within the directive's suggested period of time and to
reward service providers' timely action.
[0173] Upon identifying a consumer's health risk, the system
provides follow-up actions directly to the consumer. The system
notifies the consumer of the recommendation to enroll in a diabetes
program 428d. The system also adds an agenda item to the consumer's
agenda, such as "Conversation with Endocrinologist" 428e. When the
system recommends that the consumer consult with additional
providers of services, the consumer is able to directly connect
with those providers or schedule an appointment with those
providers from the consumer's agenda.
[0174] Referring to FIG. 17b, the follow-up actions also include
adding trackers to a consumer's agenda. In this example, the rules
engine inserts a blood pressure tracker 470 into a consumer's
agenda 298 (FIG. 7) when the consumer's profile indicates that the
consumer is hypertensive.
[0175] Referring to FIG. 14, after generation of the follow-up
actions 408, the system notifies 408 the consumer 120 of the
action. The system uses the consumer's profile to identify
effective communication channels of informing the patient of health
risks and suggested follow-up actions. For example, a consumer who
frequently uses the system's on-line interface is notified with a
system message the next time the consumer logs on. However, a
consumer who rarely uses the on-line system is notified by postal
mail or by an automated phone call. The system is not limited to
notifying consumers and is capable of notifying other recipients,
including service providers associated with the system 130 and
service providers not associated with the system 410.
[0176] Rule 3 (428) also provides for further classification of the
health care information. For example, based on the identified risks
of being a diabetic 428a with poor diabetes management 424b, the
system further classifies the consumer as a high clinical profile
risk 428f and as potentially frequently using the system 428g.
Based on this further classification, the system makes further
suggestions and follow-up actions to the consumer. For example, the
system generates a number of follow-up actions for the consumer to
consult with service providers specializing in the consumer's type
of clinical profile risk. In other examples, the system lowers the
cost for high clinical profile consumer to consult with a service
provider, reflecting the system's assessment due to the consumer's
high risk of disease the consumer should consult with a service
provider quickly.
[0177] Provider Identification of Health Risks and Suggested
Actions
[0178] Referring to FIG. 18, a service provider is capable of
identifying health risks or conditions 480 during the provider's
consultation with the consumer. Based on the identified health
risks or conditions, the provider suggests follow-up actions 482.
In some examples, the rules engine 368 provides the service
provider with proposed health risks 484, applying the processes
previously discussed to health care information obtained during the
consultation between the consumer and the provider. In this
example, the service provider has the option of accepting or
rejecting the proposed health risks. If the proposed health risks
are accepted, they are incorporated with the service provider's
other identified health risks.
[0179] Analogously, the rules engine is capable of generating for
the provider's approval proposed follow-up actions 486, applying
the processes previously discussed to health care information
obtained during the consultation between the consumer and the
provider. In either scenario, the system allows the provider to
override the rules engine's proposal and input the service
provider's own identified health risk or follow-up actions.
[0180] Additionally, the system sends notification of the
identified health risks or the follow-up actions, or any
combination therefore, to the consumers 120, other service
providers associated with the system 130, and service providers not
associated with the system 410. Referring to FIG. 17, in producing
follow-up suggestions, the provider selects from a list of
suggestions and produces entries for the consumer to execute.
[0181] Entries include reading materials, articles about the
consumer's area of concern or issue, and self care tools such as
trackers which allow the consumer to track their weight, glucose
levels and so forth. Entries also include assessments to further
assess a consumer's conditions, concerns or symptoms. For example,
based on a consultation, a generalist may suggest the consumer take
an allergy assessment and then come back for a second consultation,
allowing the generalist to review the details of the
assessment.
[0182] This list 422 of suggestions is available for the consumer
to review as the provider makes entries to it. The provider adds or
removes from the suggestions list throughout the engagement and
engagement wrap up interfaces. The types of provider suggestions
include patient education packages that are a collection of health
related articles, internet links, media files and so forth. The
content in these patient education packages may be from different
resources, such as content made available by health plans or
content made available through the system. Providers have the
option to add or remove items from the package, review the package
and send the package to the consumer. The packages are inserted as
a separate unscheduled engagement to the consumer's "My
Agenda."
[0183] Providers enter a module type engagement to the member's
unscheduled engagements in "My Agenda." These modules are trackers,
intake assessments or self care tools. When suggesting a follow-up
action, the provider selects from the list of available system
trackers. Providers define the frequency at which the member takes
the trackers and the duration, such as once a day, once a week,
once every two weeks, once a month, once every 3 months, once every
6 months, once a year, or once every 2 years.
[0184] Referring to FIG. 19a, a tracker 500 checks a consumer's
blood glucose levels. After the consumer has completed a hemoglobin
reading, the consumer enters hemoglobin levels 502, the date of the
reading 504 and the time of the reading 506. Referring to FIG. 19b,
the tracker 500 displays a graphical representation 508 of the
consumer's past hemoglobin readings.
[0185] In some examples, providers schedule a follow up with the
consumer during the consultation. If scheduled, the follow up
engagement is entered into the consumer's "unscheduled engagement"
in "My Agenda." In another example, the current provider in an
engagement suggests that the consumer follow-up with a different
service provider. If the consumer accepts this suggestion, then the
consumer's "My Agenda" is populated with this new unscheduled
engagement and the consumer is able to directly schedule the
engagement from within "My Agenda."
[0186] In one example of provider identification and suggestion of
follow-up actions, during a consultation, a consumer informs the
provider that the consumer experienced a heart attack three years
ago, is a pregnant, and has a family history of diabetes. Using the
rules engine described above, the system is capable of identifying
possible health risks and displaying them for the provider's
review. The provider has the option of either accepting or
rejecting the health risks, as previously discussed.
[0187] Still, referring to FIG. 17, based on the health risks the
provider has identified or accepted from the rules engine, the
provider makes four follow-up suggestions 442, 446, 448, 450. Some
of these suggestions 486 were generated by the rules engine 368,
accepted by the service provider, and merged with suggestions made
independently by the provider to create a compilation of provider
follow-up actions 482.
[0188] In this particular example, the provider suggests that the
consumer regularly measure the consumer's hemoglobin levels 442.
The provider prescribes insulin for gestational diabetes 446. In
some examples, the system notifies the consumer of this
prescription. Various communication channels can be used to notify
the consumer, including e-mail, an automated telephone call and
adding the prescription to the consumer's "My Agenda."
Additionally, the system is capable of notifying the consumer using
the communication mode most likely to quickly reach the consumer
according to the consumer's preferences.
[0189] In this example, the provider also recommends that the
consumer consult with a specialist about adult onset diabetes 448
and speak with a health coach 450. From within the "Follow-up
Suggestions" interface 442, the system provides the consumer with
the capability of scheduling appointments with physicians and
health coaches. Additionally, either the service providers
associated with the system or a different service provider
recommended to the consumer for follow-up are notified 408 of the
recommendations, enabling them to proactively follow-up with the
consumer.
[0190] The rules engine and service providers are capable of
identifying health conditions and suggesting follow-up actions.
Additionally, notification may occur after classification,
identification, or suggestion of follow-up actions or any
combination thereof.
[0191] Sample Use Cases in the Medical Field
[0192] Generally Well Consumer
[0193] In one example, a consumer logs on to the system to explore
a benefit that was promoted to him by his employer. The consumer is
advised that use of the platform to increase her understanding of
managing her health can be rewarded through an incentive program
offered by the employer-provided health plan. The consumer advisor
engages the consumer and undertakes a "no-reported-problem"
assessment. At the end of the assessment, the consumer is surprised
to find several areas where she can benefit from engagements. In
this example, these areas include missing key cancer screening
tests, improper gynecological follow-up, unattended family risk
factors and a collection of lifestyle issues that both impose
increasing risks and noticeably increase her stress and sleep
quality issue levels. The brokerage lists and sequentially connects
the consumer to an Ob/Gyn provider and a nurse coach, each already
knowledgeable about the respective gaps identified. A summary
report with a detailed appointment request is forwarded to the
consumer's registered primary care physician to schedule the tests
and referrals. The consumer receives educational material on the
specific tests and risk factors that were identified.
[0194] Parents of a Newborn
[0195] In another example two parents are concerned with a rash
developing on their child's left buttock. The parents are connected
to a pediatric nurse who walks them through the characterization of
the rash and determines it is a diaper-rash that can be managed by
simple moisturizing ointment. The parents are advised that such a
rash typically subsides in 2-3 days without treatment. In this
example, the parents opt for further reassurance via pediatrician
counseling. A connected pediatrician provides confirmation of the
nurse's diagnosis and advise after reviewing the online notes. The
parents follow-up with their regular pediatrician the following
week, after the documentation of the event has been faxed to the
pediatrician office.
[0196] A Chronic Diabetic Patient with Mobility Restrictions
[0197] In another example, a patient is a chronic overweight
diabetic that is home bound. The patient develops pain in his shin
above the ankle and engages the brokerage which directs him to an
internal medicine specialist. The patient chooses to engage over
the phone and connected with the specialist through the brokerage
switchboard. The specialist questions the patient to identify a
possible location of a developing leg ulcer and directs the patient
to exercise extreme hygiene and heated compresses in the affected
area. The specialist advises the patient not to wait for the pain
to possibly subside. The patient's provider and his health plan's
care manager are notified of the engagement and next-day admission
for investigation and debriedment is scheduled. The early stage
ulcer identified by the specialist during the telephone engagement
is managed, thus preventing a life-threatening deterioration of the
patient's condition.
[0198] A 46 Year Old Banking Executive Female
[0199] In another example, a consumer logs on and takes the health
risk assessment. The system recognizes that the consumer has
questions about certain cosmetic procedures. The system formulates
the questions that should be addressed and offers to connect the
consumer with a plastic surgery resident. The consumer receives a
list of the names and nature of the procedures she may want to
explore for her cosmetic concerns. Links to reference information
on each procedure are added to her record. Links that assist the
consumer in comparing costs and possible providers in her
geographical area who perform the procedures are also added.
[0200] Embodiments can be implemented in digital electronic
circuitry, or in computer hardware, firmware, software, or in
combinations thereof. Apparatus of the invention can be implemented
in a computer program product tangibly embodied or stored in a
machine-readable storage device for execution by a programmable
processor; and method actions can be performed by a programmable
processor executing a program of instructions to perform functions
of the invention by operating on input data and generating output.
The invention can be implemented advantageously in one or more
computer programs that are executable on a programmable system
including at least one programmable processor coupled to receive
data and instructions from, and to transmit data and instructions
to, a data storage system, at least one input device, and at least
one output device. Each computer program can be implemented in a
high-level procedural or object oriented programming language, or
in assembly or machine language if desired; and in any case, the
language can be a compiled or interpreted language.
[0201] Suitable processors include, by way of example, both general
and special purpose microprocessors. Generally, a processor will
receive instructions and data from a read-only memory and/or a
random access memory. Generally, a computer will include one or
more mass storage devices for storing data files; such devices
include magnetic disks, such as internal hard disks and removable
disks; magneto-optical disks; and optical disks. Storage devices
suitable for tangibly embodying computer program instructions and
data include all forms of non-volatile memory, including by way of
example semiconductor memory devices, such as EPROM, EEPROM, and
flash memory devices; magnetic disks such as internal hard disks
and removable disks; magneto-optical disks; and CD_ROM disks. Any
of the foregoing can be supplemented by, or incorporated in, ASICs
(application-specific integrated circuits).
[0202] Other embodiments are within the scope and spirit of the
description claims. For example, due to the nature of software,
functions described above can be implemented using software,
hardware, firmware, hardwiring, or combinations of any of these.
Features implementing functions may also be physically located at
various positions, including being distributed such that portions
of functions are implemented at different physical locations.
* * * * *