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Eden Prairie, MN, United States

Systems, methods, and apparatuses for maintaining and processing proprietary or sensitive data using an application implemented in a split/hybrid-cloud system are described. The split/hybrid system utilizes cloud and local platforms, while complying with customer security concerns and HIPAA security standards. Configuration of the application occurs in a cloud platform whereas processing of proprietary or sensitive data occurs within a customers local computing environment. The customer may create their own unique application configuration that is stored in the cloud platform and that is delivered back to the customer as a package that includes both the unique application configuration as well as general application configuration requirements. The customer may implement the package within one or more local computing environments while managing the application from a single site that is separated from proprietary or sensitive data.


A system and method that provides for integrated data entry and workflow capabilities through one or more computing devices provided to personnel who work at various stations throughout a facility. Automated identification, record updates, workflow management, and alerts are facilitated through the computing devices, which include a headset that includes one or more input devices such as a microphone, a speaker, a camera, and/or a visual display device.


Actively engaging members in managing their own healthcare, improving their health, and reducing healthcare costs to the payer involves providing a unified interface for member engagement. The interface may be communicatively coupled with a healthcare system, may be personalized to the member, and may offer multiple possible rewards to the member to encourage member behavior to effectively reduce healthcare costs and improve the quality of healthcare plans. The interface may provide the member with a pathway guiding the member to engage in activities to achieve short-term, intermediate and long-term goals for which actions are presented. Goals or actions may be predefined and may additionally be selected by the member. When member-engagement in the actions is verified, rewards may be granted to the members account. In connection with such member engagement, the healthcare system collects member information, applies rules to that information, and generates alerts from those rules.


Patent
Optum Inc | Date: 2014-08-01

Computer implemented systems and methods of health care claim data analysis are provided by storing a claim data set in a computer database, including patient information and a DRG assignment based on at least primary and secondary diagnosis codes. A nominal DRG weight is determined for the claim data set, using a processor in communication with the computer database. An alternate DRG weight is determined for the claim data set by swapping the primary and secondary diagnosis codes. A claim rating is generated for the claim data set, based at least in part on a difference between the nominal and alternate DRG weights. The claim rating is output to a user interface in communication with the processor.


Patent
Optum Inc | Date: 2014-08-01

Computer implemented systems and methods of health care claim analysis are provided by storing a claim data set in a computer database, including patient information and a DRG assignment based on at least a primary diagnosis code and one or more associated procedure codes. A nominal DRG weight is determined for the claim data set, using a processor in communication with the computer database. The processor looks up an alternate procedure code in the database, and determines an alternate DRG weight for the claim data set by swapping the associated procedure code with the alternate procedure code. A claim score is output to a user interface in communication with the processor, based at least in part on a difference between the nominal and alternate DRG weights.

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