System and method of prioritizing and administering healthcare to patients having multiple integral diagnoses

Abstract

A method of administering healthcare to patients with multiple integral diagnoses such that the clinical outcomes and health-related quality of life of said patients are improved while medical costs are minimized. A patient population is first identified. The population is then stratified into specific levels of intervention. Each individual patient is then assigned a Priority Care Nurse Manager who serves to establish communication between the patient, the patient's Primary Care Physician, and any healthcare providers. The most appropriate treatment plan is cooperatively developed and the patient receives treatment according to the plan. The most appropriate treatment may include home care and palliative measures. The patient may appoint a Health Care Agent to make medical decisions for the patient should the patient be unable to make decisions.

1 . A method of administering healthcare to patients with multiple integral diagnoses such that the clinical outcomes and health-related quality of life of said patients are improved while medical costs are minimized, the method comprising:
 a) identifying a patient population entitled to receive said healthcare;   b) stratifying the patient population identified in step a) into specific levels of intervention;   c) assigning a Priority Care Nurse Manager (PCNM) to each patient in said population;   d) establishing communication between the PCNM, the patient's Primary Care Physician (PCP), and the patient to cooperatively develop the most appropriate treatment plan that is available to the patient; and   e) rendering healthcare services according to the treatment plan developed in step d) to the patient.   
     
     
         2 . The method of  claim 1  wherein said patients identified in step a) are actively enrolled in a Health Maintenance Organization (HMO), Medicare, or Medicaid. 
     
     
         3 . The method of  claim 1  wherein said patients identified in step a) have ongoing needs to maintain optimal health status. 
     
     
         4 . The method of  claim 3  wherein said patients have a condition selected from the group consisting of a chronic medical condition; a recurring medical condition; multiple emergency room visits in the previous year; functional or emotional impairments; a mental or physical handicap or a developmental disability; a terminal illness; an organ transplant; a pain management recipient; dependency on medical, technological support; and multiple surgeries or hospitalization in the previous year. 
     
     
         5 . The method of  claim 1  wherein said patients identified in step a) have a specific condition requiring continuing treatment and monitoring. 
     
     
         6 . The method of  claim 5  wherein said patients have a condition selected from the group consisting of HIV/AIDS; cardiovascular conditions; multiple trauma or neurological conditions; sick neonates; obstetric conditions; and malignant cancer conditions. 
     
     
         7 . The method of  claim 1  wherein the stratification in step b) is based upon the severity of confirmed medical conditions of said patients. 
     
     
         8 . The method of  claim 7  wherein the patient population is divided into three specific groups. 
     
     
         9 . The method of  claim 1 , wherein step d) further includes communication with one or more of the people selected from the group consisting of a specialist physician, a provider of healthcare service, a patient's family member, and a patient's designee. 
     
     
         10 . The method of  claim 1  wherein, upon the patient's consent, the most appropriate treatment plan determined in step d) includes not hospitalizing the patient. 
     
     
         11 . The method of  claim 10  wherein the treatment plan comprises maintaining the patient at home, an assisted living facility, or a hospice facility; forgoing aggressive life-continuing treatment; and providing palliative care. 
     
     
         12 . The method of  claim 1  further comprising the step:
 f) the PCNM periodically monitoring said patient's overall status, adherence to the established treatment plan, and identifying any needed changes in the treatment plan. 
 
     
     
         13 . The method of  claim 12  further comprising the step:
 g) documenting all communications in step d), documenting all healthcare services rendered in step e), and documenting the results of all monitorings in step f). 
 
     
     
         14 . The method of  claim 1  further comprising the step:
 h) said patient completing a Health Care Proxy, in which a Health Care Agent is appointed to make medical decisions for said patient when said patient is unable to make said medical decisions.