PATIENT LOAD MANAGEMENT FOR HEALTHCARE NETWORKS
Systems and methods may include obtaining data identifying a plurality of cancelled health-related appointments for a plurality of patient records stored in a database, the cancelled health-related appointments associated with a shared health event. Each of the plurality of patient records may be associated with a risk category from a plurality of risk categories. A risk category may be determined based on at least a health-related need associated with a cancelled health-related appointment. One or more healthcare facilities in a healthcare network may be identified to treat a patient associated with a cancelled health-related appointment based at least on a health-related need of the patient, a risk category associated with the patient and an operating margin of the healthcare network.
1 . A system for performing patient load management, the system comprising:
a database system implemented using a server computing system, the server computing system configurable to cause:
obtaining, by the server computing system from a database associated with the database system, data identifying a plurality of cancelled health-related appointments for a plurality of patient records stored in the database, the cancelled health-related appointments associated with a shared health event;
associating, by the server computing system, each of the plurality of patient records with a risk category from a plurality of risk categories ranging from a lowest risk to a highest risk, wherein a risk category is determined based on at least a health-related need associated with a cancelled health-related appointment;
identifying, by the server computing system, one or more healthcare facilities in a healthcare network to treat a patient associated with a cancelled health-related appointment based at least on a health-related need of the patient, a risk category associated with the patient and an operating margin of the healthcare network;
communicating, by the server computing system, to a client device associated with the patient choices of the one or more healthcare facilities to enable the patient to select one of the one or more healthcare facilities, the communicating including receiving a selected healthcare facility; and
scheduling, by the server computing system, the patient for a return appointment at the selected healthcare facility.
2 . The system of claim 1 , further comprising:
determining, by the server computing system, a treatment code associated with the health-related need of the patient; and
determining, by the server computing system, a reimbursement amount associated with the treatment code by an insurance company associated with the patient.
3 . The system of claim 2 , further comprising:
determining, by the server computing system, an operating expense associated with the treatment code for each of the healthcare facilities in the healthcare network; and
determining, by the server computing system, an operating margin associated with the treatment code for each of the healthcare facilities in the healthcare network for the patient based on the operating expense associated with the treatment code for each of the healthcare facilities and the reimbursement amount associated with the treatment code by the insurance company associated with the patient.
4 . The system of claim 3 , wherein the one or more healthcare facilities in the healthcare network communicated to the client device associated with the patient are determined at least based on comparing, by the server computing system, the operating margin associated with the treatment code for each of the healthcare facilities with the operating margin of the healthcare network.
5 . The system of claim 4 , wherein the one or more healthcare facilities in the healthcare network communicated to the client device associated with the patient includes at least one healthcare facility with a highest operating margin as related to the treatment code.
6 . The system of claim 5 , wherein the risk category associated with the patient is further determined based on evaluating data identifying a medical history of the patient stored in the database.
7 . The system of claim 6 , wherein the identifying the one or more healthcare facilities in the healthcare network to treat the patient associated with the cancelled health-related appointment based on the health-related need of the patient comprises:
determining, by the server computing system, resources necessary to treat the patient based on the treatment code associated with the patient; and
identifying, by the server computing system, the one or more healthcare facilities in the healthcare network having the resources necessary to treat the patient based on the treatment code.
8 . A computer program product for performing patient load management as related to a shared health event comprising computer-readable program code to be executed by one or more processors when retrieved from a non-transitory computer-readable medium, the program code including instructions to:
obtain from a database associated with the database system data identifying a plurality of cancelled health-related appointments for a plurality of patient records stored in the database, the cancelled health-related appointments associated with a shared health event;
associate each of the plurality of patient records with a risk category from a plurality of risk categories ranging from a lowest risk to a highest risk, wherein a risk category is determined based on at least a health-related need associated with a cancelled health-related appointment;
identify one or more healthcare facilities in a healthcare network to treat a patient associated with a cancelled health-related appointment based at least on a health-related need of the patient, a risk category associated with the patient and an operating margin of the healthcare network;
communicate to a client device associated with the patient choices of the one or more healthcare facilities to enable the patient to select one of the one or more healthcare facilities, the communicating including receiving a selected healthcare facility; and
schedule the patient for a return appointment at the selected healthcare facility.
9 . The computer program product of claim 8 , further comprising instructions to:
determine a treatment code associated with the health-related need of the patient; and
determine a reimbursement amount associated with the treatment code by an insurance company associated with the patient.
10 . The computer program product of claim 9 , further comprising instructions to:
determine an operating expense associated with the treatment code for each of the healthcare facilities in the healthcare network; and
determine an operating margin associated with the treatment code for each of the healthcare facilities in the healthcare network for the patient based on the operating expense associated with the treatment code for each of the healthcare facilities and the reimbursement amount associated with the treatment code by the insurance company associated with the patient.
11 . The computer program product of claim 9 , wherein the one or more healthcare facilities in the healthcare network communicated to the client device associated with the patient are determined at least based on comparing the operating margin associated with the treatment code for each of the healthcare facilities with the operating margin of the healthcare network.
12 . The computer program product of claim 11 , wherein the one or more healthcare facilities in the healthcare network communicated to the client device associated with the patient includes at least one healthcare facility with a highest operating margin as related to the treatment code.
13 . The computer program product of claim 12 , wherein the risk category associated with the patient is further determined based on evaluating data identifying a medical history of the patient stored in the database.
14 . The computer program product of claim 13 , wherein the instructions to identify the one or more healthcare facilities in the healthcare network to treat the patient associated with the cancelled health-related appointment based on the health-related need of the patient comprises instructions to:
determine resources necessary to treat the patient based on the treatment code associated with the patient; and
identify the one or more healthcare facilities in the healthcare network having the resources necessary to treat the patient based on the treatment code.
15 . A computer-implemented method for performing patient load management as related to a shared health event, the method comprising:
obtaining, by a server computing system, from a database associated with a database system, data identifying a plurality of cancelled health-related appointments for a plurality of patient records stored in the database, the cancelled health-related appointments associated with a shared health event;
associating, by the server computing system, each of the plurality of patient records with a risk category from a plurality of risk categories ranging from a lowest risk to a highest risk, wherein a risk category is determined based on at least a health-related need associated with a cancelled health-related appointment;
identifying, by the server computing system, one or more healthcare facilities in a healthcare network to treat a patient associated with a cancelled health-related appointment based at least on a health-related need of the patient, a risk category associated with the patient and an operating margin of the healthcare network;
communicating, by the server computing system, to a client device associated with the patient choices of the one or more healthcare facilities to enable the patient to select one of the one or more healthcare facilities, the communicating including receiving a selected healthcare facility; and
scheduling, by the server computing system, the patient for a return appointment at the selected healthcare facility.
16 . The method of claim 15 , further comprising:
determining, by the server computing system, a treatment code associated with the health-related need of the patient; and
determining, by the server computing system, a reimbursement amount associated with the treatment code by an insurance company associated with the patient.
17 . The method of claim 16 , further comprising:
determining, by the server computing system, an operating expense associated with the treatment code for each of the healthcare facilities in the healthcare network; and
determining, by the server computing system, an operating margin associated with the treatment code for each of the healthcare facilities in the healthcare network for the patient based on the operating expense associated with the treatment code for each of the healthcare facilities and the reimbursement amount associated with the treatment code by the insurance company associated with the patient.
18 . The method of claim 17 , wherein the one or more healthcare facilities in the healthcare network communicated to the client device associated with the patient are determined at least based on comparing, by the server computing system, the operating margin associated with the treatment code for each of the healthcare facilities with the operating margin of the healthcare network.
19 . The method of claim 18 , wherein the one or more healthcare facilities in the healthcare network communicated to the client device associated with the patient includes at least one healthcare facility with a highest operating margin as related to the treatment code.
20 . The method of claim 19 , wherein the risk category associated with the patient is further determined based on evaluating data identifying a medical history of the patient stored in the database.