Abstract: Methods of health care administration operative to render high quality of health care are disclosed. A patient population is first identified and then information regarding each individual patient within the population is obtained, preferably in an electronic medical record format. Health care is thereafter provided to the patient within the patient population for both acute and chronic conditions according to a health care office scheduling procedure. Preventative health care and care for the treatment of chronic disorders are continuously rendered according to clinically appropriate standards. Extensive patient outreach services are provided to insure appropriate health care is rendered according to all applicable clinically appropriate standards.

Abstract: An insurance auction process comprises preliminary steps of establishing a network of participating insurers and establishing an insurance capacity for each participating insurer. Upon receipt of a request for insurance from a cedent, an underwriting analysis of the request for insurance is performed by the sponsor of the auction and underwriting report is produced. The request for insurance and the underwriting report are posted enabling participating insurers to submit bids to cover a portion of the insurance. Each bid includes a maximum percentage of insurance offered and a rate. After receiving the bids, the sponsor selects those bids which fulfill the request for insurance at an optimized rate and offers those bids, as an insurance proposal, to the cedent. The sponsor may guarantee payment of claims by the insurers, and if it does it assesses a credit risk charge to the rate charged to the cedent.

Abstract: A method for assessing and analyzing one or more drugs, adverse effects and associated risks, and patient characteristics resulting from the use of at least drug of interest is disclosed. The method comprises the steps of selecting one or more cases for analysis, said cases describing the behavior between at least one drug of interest and a patient genotype; profiling statistically derived values from multiple cases related to the safety of the at least one drug, wherein at least one filter is employed for deriving said values; at least one data mining engine; and an output device for displaying the analytic results from the data mining engine. A system for performing the method is likewise disclosed.

Abstract: This invention relates to an electronic means by which people can select the exact seat or seats they want for any type of event or reserve an appointment for any activity such as a doctor or dentist appointment or even an appointment to have their car lubed. More specifically, a customer or a ticket re-seller or a venue operator can go, for example, to the internet and select the event or activity for which they want a ticket or tickets or reserve a time and reserve and order the exact seat or seats or the time of their choosing directly online. The seat or seats or reserved time they select is then removed from the inventory for that activity or event and made not available for any other buyer and such is so indicated by a graphical representation or other such indicator on the online map or picture representing availability of seating or time for that event.

Abstract: A system and method for managing healthcare communication. In general, a system according to the present invention comprises a tool, which is integrated with a clinical information system, comprising an engine for dynamically generating and updating lists of patient-specific and provider-specific contact information using data that is accessed from one or more sources via search engine. The lists of contact information are readily accessible by healthcare providers while treating patients using any one of devices. The tool is preferably integrated with a call management system for tracking and flagging clinically necessary telephone calls, for example, that need to be repeated. Furthermore, the tool is preferably integrated with a workflow system to provide dynamic task assignment wherein the lists of contact information are dynamically generated and updated based on output events of a workflow engine of the workflow system.

Abstract: The invention relates to methods and systems for creating and utilizing a modular multi-coverage insurance product. The modular multi-coverage insurance product includes a set of modular state-pre-approved insurance coverages corresponding to a plurality of insurable liabilities.

Abstract: A system for scheduling a set of tasks to be performed by at least one individual to support healthcare delivery employs a method for providing a user interface for processing an event. The event represents a change in circumstances potentially affecting healthcare delivered to a patient. The method involves initiating generation of at least one display image in response to user command. The display image or images support the identification of an event and an associated parameter as well as the designation of a predetermined process associated with the identified event. The display image or images also support user indication of the parameter to be provided to the predetermined process in response to occurrence of the event. The predetermined process comprises a set of tasks to be performed by at least one individual to support healthcare delivery. The display image or images also support designating an executable procedure to be initiated in response to occurrence of the identified event.

Abstract: A system and method for modeling healthcare utilization based on usage data from physician claims, hospital claims, and pharmacy claims. The method includes extracting from a claims file the portion of the data from a base period that is relevant to modeling healthcare utilization in a target period by computing a utilization score based on the usage data. The models may be used concurrently by calibrating them with the base period equal to the target period and they may be also be used prospectively by calibrating the models with the target period representing a future time period.

Abstract: A system and method for generating and/or updating a personal/individual health record. Inputs of data to the system may come from diverse sources including, but not limited to, patient questionnaires, insurance company (or other payor) claims data, hospitals, clinics and other institutional providers, and individual physicians and physicians' offices.

Abstract: A method and system whereby one or more physicians work with a hospital to create savings and are compensated in a manner that is legal and acceptable to the United States Office of Inspector General of the Health and Human Services Department (OIG). In one example, a physician is paid to help implement cost-saving measures by the hospital or a consultant to the hospital under a personal service contract based upon an OIG safe harbor provision. In another example, the hospital can compensate physicians of its choosing for otherwise uncompensated services under the same safe harbor provision. Projected savings can be taken into consideration by the hospital when it determines how much it can afford to pay to physicians, although payments are made irrespective of whether projected savings are realized.

Abstract: A system and method for generating and/or updating a personal/individual health record. Inputs of data to the system may come from diverse sources including, but not limited to, patient questionnaires, insurance company (or other payor) claims data, hospitals, clinics and other institutional providers, and individual physicians and physicians' offices.

Abstract: A method of discouraging healthcare fraud in conjunction with providing a health care service to a patient in which the patient provides a biometric signature. An event record is created where the event record creates an association between the biometric signature, a patient identifier, and location information indicating a location at which the biometric signature is obtained. The event record is stored in a central data store and can be later retrieved to verify the patient was present at the location.

Abstract: A method of discouraging healthcare fraud in conjunction with providing a health care service to a patient in which the patient provides a biometric signature. An event record is created where the event record creates an association between the biometric signature, a patient identifier, and location information indicating a location at which the biometric signature is obtained. The event record is stored in a central data store and can be later retrieved to verify the patient was present at the location.

Abstract: An Internet-enabled method and system for processing insurance claims. The system may include an insurance claim processing server which is configured to estimate a value of an insurance claim as a function of insurance claim assessment data entered by a user during an insurance claim consultation session. The insurance claim assessment data may include one or more bodily injuries and one or more treatments of the bodily injuries. The insurance claim processing server may include a rules engine and a web server which may be executable to generate and send to a client computer system a plurality of web pages comprising insurance claim assessment questions. The client computer system may be coupled to the insurance claim processing server through a network such as the Internet. The client, including a web browser, may be operable to receive the insurance claim assessment data entered by the user and send the insurance claim assessment data across the network to the insurance claim processing server.

Abstract: A method for the construction and utilization of a medical records system capable of providing a continuous data stream of epidemiological data to the records system via kits provided to the symptomatic population to obtain and record an epidemiological profile in a searchable database by applying data mining or automated intelligence techniques whereby, when a valid epidemiological profile is established in the database, automated diagnosis and prescription of treatment may be had for patients presenting similar symptoms. Knowledge discovery techniques may further operate on the database to provide suggested courses of treatment for a virtual class of patients, epidemic threat awareness, and knowledge of drug resistance mutations by a pathogen without direct query of the database.

Abstract: A system and a method for scheduling an emergency procedure in response to detecting that a patient has a high probability of acute myocardial infarction. The system is able to identify patients that are suspected of having acute myocardial infarction (or acute ischemia). The system uses one or more expert software tools or algorithms to analyze received ECG records. Each software tool has logic (e.g., thresholds and/or settings) for automatic routing which is configurable by the customer via a graphical user interface. If any sufficient condition for automatic routing is satisfied, the system routes the data (including the underlying ECG record) and an alert to an electronic device which is accessible by the cardiologist “on call” via a bidirectional pager. If the cardiologist decides that the requested emergency treatment or procedure should be performed, the system accesses the schedules of all associated catheterization labs across multiple hospitals to identify a lab having optimum time-to-treatment.

Abstract: A method is provided for a virtual clinic to establish communications and working relationships among itself, patients, physicians, and insurance companies patient to facilitate the remote diagnosis and treatment of patients. In one embodiment, a patient may contact its insurance carrier via a web page on the Internet. The insurance company then matches the patient to one of its plans and then forwards information to the virtual clinic which then responds to the patient's web request. The patient is then put in operative communication with a physician who is known by the virtual clinic to be licensed to practice medicine in the patient's current location and to have expertise in the patient's condition.

Abstract: A system and method for enrolling patients in a medical study, includes: a database component operative to maintain a medical practice database component and their corresponding plurality of specialities and a clinical studies database component and their corresponding plurality of medical studies. The system further includes a communications component to alert the medical practices of the medical studies and observe changes to the database components. The system also includes a processor programmed to update the database components, periodically match compatible medical specialties with the medical studies, and generate reports of the matched medical practices in the medical practice database. The system also includes a fee database component which the processor uses to calculate a fee for conducting the study.

Abstract: An improved method and system to display messages, while processing insurance claims, using a messages table. The messages associated with the processing of insurance claims are primarily used to obtain inputs from the user of the claims processing computer system. Messages, which are typically displayed on a display screen, may include questions, answers, errors, warnings, and other text used with interactive claims processing. The messages are stored as message codes along with a corresponding message text in a messages table. The database, which includes the messages table is the repository and the lookup system for the message codes and the corresponding message texts. Each message code has a corresponding customizable message text, which may be specified at installation time. The application program requests display of specific messages by referring to its message code. The application program, thus, remains unaffected to changes in the corresponding customizable message texts.

Abstract: Methods and systems are provided for optimizing profits for healthcare practices and insurance networks. The methods and systems include modifying physician's cost management behavior to enhance profitability of healthcare practices and insurance networks by identifying physicians that are not profitable because of cost management behavior and providing intervention to change the management behavior of the physician.