Physician Recommender


Description:

In keeping with current green Health IT trends, we would propose a patient driven care request (online form and membership) originating through the patients health insurance company. The patient, instead of choosing unassisted, would fill out a health complaint directly through the proposed [insurance company patient/provider portal], or “ICPP”, and the portal software would suggest baseline tests or procedures, as well as a list of physicians and one “Recommended Physician.” Presumably, the recommended physician would be the historically least expensive for the Insurance company. If the patient chooses this recommended physician, he/she would receive a discount on co-pays. In order for the patient to continue receiving the discount, he/she must take an online after care report through the portal to report the visit and if he/she was denied any care, etc… The physician would receive incentives by keeping the patient healthy through a (number of visits / after care survey ratio.) The physician would receive the incentive only by filing the claim through the Insurance Company’s patient/provider portal. This incentive program will work from the bottom-up to do the majority of the ground work of converting our country’s patients’ medical records from paper to digital until such time it can be effectively mandated by insurance companies to minimize risk of physicians refusing new patients.

Ideas & Input:
• Patient receives copy of coded form/visit, reviews, and sends copy to insurance company.
• Doctor’s office sends visit overview form to insurance company.
• Both parties wait on response from insurance company
• Insurance company reviews visit and analyzes codes billed for and treatment received.
• Insurance company sends payment to Doctor’s office and subsequently, bills patient for co-pay.
• Any fraudulent coding is negated and doctor’s office loses money for any unnecessary coding



Team: Shannon Caldwell, Zac Larsen, Andrew Marks, Victor Marquez, Chris Fulgencio
Contact Info & Availability


Resources:





Project Portal:

Bellow is a link to our project. Items still to be done are setting up permissions for the users (doctor's and patients) as well as displaying a list of doctors for patients, and their ratings.

Integra Health Solutions


MD Recommender Flowchart:

HIT_WorkFlowchart_(2).png


Possible Resources (Edited by Ren, accessible via FSU libraries online journals):

Policies for patient access to clinical data via PHRs: current state and recommendations
Sarah A Collins, David K Vawdrey, Rita Kukafka, Gilad J Kuperman
JAMIA 2011;amiajnl-2011-000400Published Online First: 7 September 2011doi:10.1136/amiajnl-2011-000400

Research Paper: Using Computerized Provider Order Entry and Clinical Decision Support to Improve Referring Physicians' Implementation of Consultants' Medical Recommendations
Martin C Were, Greg Abernathy, Siu L Hui, Carol Kempf, Michael Weiner
JAMIA 2009;16:196-202 doi:10.1197/jamia.M2932


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