Amita S Rastogi

US Patent:

8630871, Jan 14, 2014

Filed:

Oct 18, 2011

Appl. No.:

13/275533

Inventors:

Amita Rastogi - Munster IN, US

Assignee:

Optumlnsight, Inc. - Eden Prairie MN

International Classification:

G06Q 10/00

US Classification:

705 2

Abstract:

A method for generating healthcare provider quality rating data includes grouping claim records into one or more claim groups, assigning each claim group to a responsible provider, assessing the claim records in each claim group using guidelines for the particular disease or condition, and generating a compliance score for the claim group, wherein the compliance score indicates the extent to which the claim records in the claim group match the guidelines, and generating normalized provider quality rating data. A method for generating healthcare provider cost rating data includes grouping claim records into one or more claim groups, assigning each claim group to a responsible provider, calculating the total cost of each claim group, aggregating the total cost for each claim group, and comparing the total aggregate cost of each claim group assigned to each provider to an expected cost value.

US Patent:

20090125348, May 14, 2009

Filed:

Nov 14, 2007

Appl. No.:

11/939900

Inventors:

Amita Rastogi - Munster IN, US

Assignee:

Ingenix, Inx. - Eden Prairie MN

International Classification:

G06Q 99/00

US Classification:

705 7

Abstract:

A computer-implemented method for generating healthcare provider quality rating data from healthcare claim records representing services provided by a plurality of healthcare providers (such as physicians or hospitals) to one or more patients includes grouping the claim records into one or more claim groups, each representing services provided to a patient by one or more providers; assigning each claim group to a responsible provider; assessing the claim records in each claim group using guidelines for the particular disease or condition and generating a compliance score for the claim group, wherein the compliance score indicates the extent to which the claim records in the claim group match the guidelines; and generating provider quality rating data for each provider using the normalized aggregate compliance score. The provider quality rating data may include one or more performance categories or graphic symbols that indicate the provider's quality of treatment in comparison to an average value. Provider volume data may also be generated.A computer-implemented method for generating healthcare provider cost rating data from healthcare claim records representing services provided by a plurality of healthcare providers to one or more patients includes grouping the claim records into one or more claim groups, each representing services provided to a patient by one or more providers; assigning each claim group to a responsible provider; calculating the total cost of each claim group, wherein the total cost is the sum of the costs associated with each claim record in the claim group; aggregating the total cost for each claim group; comparing the total aggregate cost of each claim group assigned to each provider to an expected cost value; and generating provider cost rating data. The provider cost rating data may include one or more performance categories or graphic symbols that indicate the provider's cost of treatment in comparison to an average value.

US Patent:

20170053075, Feb 23, 2017

Filed:

Aug 17, 2016

Appl. No.:

15/239604

Inventors:

- Newtown CT, US
Warren MCGUIRE - Shelton CT, US
Quinn COLDIRON - Gretna NE, US
Sarah BURSTEIN - Newton PA, US
Elizabeth BAILEY - Midland MI, US
Andrew WILSON - Somerville MA, US
Amita RASTOGI - Munster IN, US
Lawrence MOSLEY - Doyline LA, US
Francois DE BRANTES - Newtown CT, US
Jenna SLUSARZ - Amherst NH, US

International Classification:

G06F 19/00
G06Q 20/10

Abstract:

The invention provides a computer implemented method for constructing a patient-specific evidence-informed case rate (ECR) for an episode of medical care spanning a defined period of time for a particular payer-provider-patient triad to create a patient-specific, severity adjusted prospective budget for the patient. ECR Analytics is a tool that constructs episodes of care using administrative claims data, both medical and pharmacy. It calculates the cost of care of patient-specific episodes by assigning relevant services to each episode and further distinguishing those services as typical or routine versus those associated with a complication. The episodes calculated within ECR Analytics can be attributed to specific providers, risk adjusted for performance measurement, and can also be used to construct prospective budgets for payment purposes, such as episode of care payment or reference pricing.