Healthcare management system and method of predicting high utilizers of healthcare services

Abstract

A healthcare management system and method identify individuals at risk of high near-term healthcare use. On step of the method includes collecting information from an individual for a predetermined set of predictive factors. Another step of the method includes assigning, based upon the information from the individual, a separate value to each predictive factor of the predetermined set of predictive factors. The method further includes the step of generating, based upon a predetermined predictive model and the separate values assigned to the predetermined set of predictive factors, a risk level of the individual utilizing healthcare services at a predetermined level within a prospective time span.

What is claimed is:  
     
         1 . A method of managing healthcare services, comprising the steps of: 
 collecting information describing an individual's perceived health relative to their subjective expectation of health; and    generating, based upon a predictive model, an output suggestive of future healthcare service use by the individual.    
     
     
         2 . The method of  claim 1 , wherein the output is a risk value indicative of the likelihood of the individual utilizing healthcare services at a predetermined level within a prospective time span.  
     
     
         3 . The method of  claim 1 , further including the step of assigning, based upon the information, a separate value to each of a plurality of predetermined factors in a set of predictive factors.  
     
     
         4 . The method of  claim 1 , wherein the information collected comprises at least one data point for each of a plurality of predetermined predictive factors.  
     
     
         5 . The method of  claim 4 , further including the step of comparing one collected data point to a set value for the respective predictive factor to determine if the collected data point is indicative of either a high risk or a low risk of future healthcare service use, and assigning, based upon the comparing step, a value to the predetermined predictive factor.  
     
     
         6 . The method of  claim 5 , wherein each of the predictive factors is inserted into the predictive model to generate the output.  
     
     
         7 . A method of managing healthcare services, comprising the steps of: 
 collecting information directly from an individual for a predetermined set of predictive factors;    assigning, based upon the information from the individual, a separate value to each predictive factor of the set of predictive factors; and    generating, based upon a predetermined predictive model and the separate values assigned to the predetermined set of predictive factors, a risk level of the individual utilizing healthcare service at a predetermined level.    
     
     
         8 . A method of managing healthcare services, comprising the steps of: 
 providing a survey including a plurality of questions;    receiving response information from an individual for each of said plurality of questions of the survey;    determining, from the information of each question, whether the response is indicative of one of a high or a low future use of healthcare services;    assigning values to a plurality of predictive factors based upon the determining step; and    generating, based upon the assigned values, an output suggestive of future use of healthcare services.    
     
     
         9 . The method of  claim 8 , wherein the survey is presented by a computer.  
     
     
         10 . The method of  claim 9 , further including the step of providing the individual with at least one intervention program in response to the generating step generating an output suggestive of a high risk of future use of healthcare services.  
     
     
         11 . The method of  claim 10 , wherein the intervention program is provided substantially contemporaneously with the receiving of responses from the individual.  
     
     
         12 . The method of  claim 8 , wherein the plurality of questions includes a question regarding the individual's perceived health.  
     
     
         13 . The method of  claim 8 , wherein the output is a risk value indicative of the likelihood of the individual utilizing healthcare services at a predetermined level.  
     
     
         14 . A method of managing healthcare service including the steps of: 
 collecting information about an individual including a plurality of data points corresponding to a plurality of factors in a set of predictive factors;    determining, for each data point, what the data point indicates about use of healthcare services by the individual; and    generating, based on a predictive model, an output suggestive of future use of healthcare services by the individual.    
     
     
         15 . The method of  claim 14 , further including the step of assigning a value to each factor in the set of predictive factors, each assignment being based upon the determining step for each of the corresponding data points, wherein the generating step is performed by inserting into the predictive model the assigned values for the set of predictive factors.  
     
     
         16 . The method of  claim 14 , wherein the determining step categorizes the data points as either indicative of a high use of healthcare services or a low use of healthcare services.  
     
     
         17 . The method of  claim 14 , wherein the determining step includes the step of assigning to each predictive factor one of two dichotomous values.  
     
     
         18 . The method of  claim 14 , wherein the output is a risk value indicative of the likelihood of the individual utilizing healthcare services at a predetermined level.  
     
     
         19 . A method of managing healthcare service including the steps of: 
 analyzing healthcare information utilizing a predictive model represented by the equations z=β 1 X 1 +β 2 X 2 +β 3 X 3 +β 4 X 4  . . . β n-1 X n-1 +β n X 1 X 2 +C, and P high     —     use =e z /(1+e z ), wherein β 1 , β 2 , β 3 , β 4 , . . . β n  represent regression coefficients, X 1 , X 2 , X 3 , X 4 , . . . X n-1  represent predictor variables, the predictor variables are dichotomous variables, and the values of the dichotomous predictor variables are determined based upon the healthcare information.    
     
     
         20 . The method of  claim 19 , wherein individuals with a P high     —     use  value greater than a threshold value are identified as individuals with a high-risk of high near-term healthcare use.  
     
     
         21 . The method of  claim 19 , wherein the analyzing step causes the generation of reports.  
     
     
         22 . The method of  claim 21 , wherein the reports are one or more reports selected from the group including: a general health report, advice as to how the individual may improve their overall health, information about appropriate intervention programs, and follow-up coaching reports from care providers.  
     
     
         23 . The method of  claim 21 , wherein the reports are one or more reports selected from the group including: a summary of the wellness of a managed care group, a list of individuals identified as high risk, and a report identifying intervention programs which address wellness needs of a managed care group.