Healthcare administration method for complex case and disease management

Abstract

The present invention discloses substantially more efficient and effective methods for delivering healthcare whereby patient care can be coordinated effectively and efficiently through changes in different physical settings and levels of care. Coordinated care helps ensure that patients seeking healthcare, and in particular chronically ill patients, with comorbidities get timely care to avoid unnecessary ER visits and admissions. Through risk and disease stratification, member profiling, inter disciplinary team follow-up and patient education, the methods of the present invention are operative to effectively allocate available resources, formulate and execute individualized care plans and successfully manage high risk members.

What is claimed is: 
     
         1 . A method of administering healthcare to a population of patients in need thereof wherein a portion of said patients within the population are afflicted with complex medical cases, said method comprising the steps:
 a) identifying a patient population entitled to receive said medical care, each respective patient being afflicted with a complex medical condition wherein said complex medical condition is characterized by at least two chronic medical conditions selected from the group consisting of asthma, depression, dementia, congestive heart failure, chronic obstructive pulmonary disease, diabetes, obesity, AIDS/HIV, anticoagulation, hypertension, peripheral artery disease, coronary artery disease, end-stage renal disease, and chronic kidney disease;   b) obtaining medical information for each patient within said patient population identified in step a) and storing such data in electronic records embodied on a computer readable media;   c) remotely receiving a request from a patient within said patient population identified in step a) to receive medical care;   d) establishing a telecommunications link with said patient identified in step c) and remotely obtaining data from said patient related to said request for medical care being sought by said individual in step c);   e) evaluating said information provided by said patient in step c) while simultaneously evaluating said data stored on said computer readable media in step b), said evaluation further comprising assessing said patient's medical case complexities;   f) determining an appropriate medical treatment based on said evaluation made in step e) and further determining if such care is capable of being rendered remotely from a medical treatment facility; and   g) rendering an appropriate treatment in response to said patient's request for medical care remotely from a medical facility.   
     
     
         2 . The method of  claim 1  wherein step g) comprises setting a disease management goal to treat said patient with said complex condition. 
     
     
         3 . The method of  claim 2  wherein step g) further comprises providing patient education materials to assist said patient in managing said complex condition. 
     
     
         4 . The method of  claim 3  wherein step g) further comprises assigning an interdisciplinary team of healthcare providers to assist in rendering treatment to said treatment. 
     
     
         5 . The method of  claim 1  wherein step e) further comprises evaluating said patient's condition and assigning a point score wherein said point score is indicative of self-management by the patient, complex case management or palliative/hospice care.