Method and Apparatus for Providing Incentives to Physicians

Abstract

The present invention provides a method of providing a monetary incentive to a health care provider, typically a physician, responsible for treatment decisions of a patient with a condition during an episode of care. Once the patient identity and condition are obtained, a baseline value related to treatment of the condition can be associated. Thereafter, all the claims processed during the episode of care of the patient for the condition can be summed to obtain a total treatment cost. And, if the total treatment is less than the baseline value, then a monetary incentive can be provided to the provider based upon that episode of care.

1 - 55 . (canceled) 
   
   
       56 . A computer-implemented method of providing an apportioned monetary incentive for treatment of a medical patient, comprising:
 identifying a responsible provider who performs a defining procedure, from among a plurality of healthcare providers involved in the treatment;   creating a baseline value related to the treatment;   receiving from a payer, a diagnosis of the patient performed by a healthcare provider and provided to the payer, along with an associated cost quantified by the baseline value;   creating an episode of care based upon the diagnosis of the healthcare provider and the treatment;   summing all claims processed during the episode of care to obtain a total treatment cost;   determining if the total treatment cost is less than the baseline value, thus resulting in a cost savings for the decided course of treatment;   representing the cost savings as an incentive payment that is to be apportioned among the responsible provider, the payer and the incentive administrator;   causing a first portion of the cost savings to be sent to the responsible provider in the form of a monetary incentive that is individually calculated based on the episode of care, and correlated to the total treatment cost;   causing a second portion of the cost savings to be sent to the payer, the second portion constituting a savings in the amount paid out for the course of treatment; and   causing a third portion of the cost savings to be retained by the incentive administrator, wherein at least two of the responsible provider, the payer, and the incentive administrator are independent parties.