Chronic Population Based Cost Model to Compare Effectiveness of Preventive Care Programs

Abstract

Our invention is a cost model for healthcare, based not on “age”, as it is done currently, but on “chronic illness” as a risk factor. Using the model it is possible to derive two burden numbers, “Primary” and “Secondary” that is an inverse measure of the success of primary and secondary preventive care programs. Using this new metric, a better explanation for cost increases is possible. It can help estimate increases more accurately and make explicit suggestions on where the focus of attention should be to lowering costs. Trendlines of the metric can measure performance of care programs month by month and not have to wait a decade to yield perceptible results. A particular embodiment of this model is the software program described in this application, called Health Keys, which serves as a decision support system for CFOs of companies and healthplans to help institute relevant preventive care programs and measure the success of them. Health Keys is one example of a “useful, concrete and tangible result” that is based on our invention of a new cost model.

What is claimed is: 
     
         1 . A non-transitory computer-readable medium storing computer-readable instructions that are executed by a processor to perform operations comprising:
 classifying a population into a plurality of health states, the plurality of health states being based on one or more combinations of chronic diseases, wherein each individual in the population is uniquely assigned to a single health state;   generating a transition matrix to represent a plurality of transitions of individuals in the population from one health state into another, the transition matrix being generated using the plurality of health states as a basis; and   using the transition matrix to determine a time evolution of the one or more combinations of chronic diseases suffered by the population.   
     
     
         2 . The computer-readable medium of  claim 1 , wherein the plurality of health states are further based on the one or more combinations of chronic diseases and a cancerous state. 
     
     
         3 . The computer-readable medium of  claim 1 , wherein the transition matrix enables a determination of a time evolution of the one or more combinations of chronic diseases and the cancerous state. 
     
     
         4 . The computer-readable medium of  claim 1 , wherein the operations further comprise associating the transition matrix with a preventative care program related to one or more of the plurality of health states. 
     
     
         5 . The computer-readable medium of  claim 4 , wherein the operations further comprise comparing the transition matrix with a second transition matrix associated with a second preventative care program to determine a comparative efficacy of the preventative care programs. 
     
     
         6 . The computer-readable medium of  claim 5 , wherein the population is isolated to a geographic region. 
     
     
         7 . The computer-readable medium of  claim 6 , wherein the comparative efficacy of the preventative care programs is isolated to the geographic region. 
     
     
         8 . The computer-readable medium of  claim 7 , wherein the operations further comprise generating a map depicting the plurality of transitions in the geographic region. 
     
     
         9 . The computer-readable medium of  claim 8 , wherein the map further depicts a cost associated with each of the plurality of transitions in the geographic region. 
     
     
         10 . The computer-readable medium of  claim 9 , wherein the operations further comprise associating each of the plurality of transitions with a difference in a cost of treatment between the health state and a subsequent health state associated with said each transition. 
     
     
         11 . A method, comprising:
 identifying, by a processor executing computer-readable instructions, one or more transitions within a population from a first health state to a second health state over a definite period of time, wherein the first and second health states are differentiated by one or more chronic diseases or cancerous states in any combination, and wherein each individual in the population is uniquely assigned to only one of the health states; and   depicting, by the processor, the one or more transitions in a transition matrix having dimensions determined by the plurality of distinct health states that act as a basis.   
     
     
         12 . The method of  claim 11 , wherein the plurality of health states is ordered based on a number of chronic diseases in any combination. 
     
     
         13 . The method of  claim 11 , wherein the plurality of health states comprises a first chronic disease, and any combination of the first chronic disease with one or more additional chronic diseases. 
     
     
         14 . The method of  claim 11 , wherein the chronic diseases are determined from diagnosis codes associated with said each individual. 
     
     
         15 . The method of  claim 14 , wherein the diagnosis codes are extracted from a patient's claims data. 
     
     
         16 . A non-transitory computer-readable medium storing computer-readable instructions that are executed by a processor to perform operations comprising:
 assigning a plurality of individuals an initial health state based on a combination of chronic diseases suffered by each of the plurality of individuals, wherein the combination of chronic diseases for each individual is determined by retrieving one or more diagnosis codes for said each individual; and   generating a transition matrix representing transitions of any of the plurality of individuals over a definite period of time from said initial health state into one of a plurality of subsequent health states, the transition matrix having elements that are based on a predefined total number of health states;   wherein each individual is assigned to only one health state.   
     
     
         17 . The computer-readable medium of  claim 16 , wherein the operations further comprise associating the transition matrix with a preventative care program related to one or more of the initial and subsequent health states. 
     
     
         18 . The computer-readable medium of  claim 17 , wherein the operations further comprise associating each transition from the initial health state into any of said plurality of subsequent health states with a cost. 
     
     
         19 . The computer-readable medium of  claim 18 , wherein the operations further comprise setting a target for each transition to implement an improved preventative care program. 
     
     
         20 . The computer-readable medium of  claim 16 , wherein the transitions are tracked on a monthly basis.