Economic model for measuring the cost and value of a...

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Reexamination Certificate

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C705S002000, C705S004000

Reexamination Certificate

active

07958002

ABSTRACT:
The present invention provides a system and method for measuring the relative economic benefits from services offered by health care plans. The present invention quantifies value of health care quality by indicating an economic return on the investment in health care quality, enabling organizations and businesses to view health care quality in a familiar paradigm that extends health plan differentiation beyond premium and benefits. Businesses may employ the present invention to compare different health care plans or classes of plans, such as accredited versus non-accredited plans. Specifically, a particular plan or class of plans may provide improved monitoring, treatment and control of various medical conditions, and the present invention quantifies the economic benefits to employers from the improved health care for employees. In one embodiment, the present invention looks to a set of specific medical conditions and is based on three key steps. First, the present invention identifies the overall level of employees at the organization affected by these conditions. Second, the present invention uses the reduction in absenteeism and low productivity days made possible by improved monitoring and control of the medical conditions. Third, the present invention calculates a monetary valuation to the firm of the reduction in absenteeism and low productivity days based on the firm's average revenue per employee, average daily wage, and other parameters.

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Druss et al., Health and Disability Costs of Depressive Illness in a Major U.S. Corporation, Am J. Psychiatry, vol. 156, 2000, p. 1274-78.
Thompson et al., The NCQA's Quality Compass: Evaluating Managed Care in the United States, Health Tracking: Trends, Health Affairs, vol. 17, No. 1, p. 152-158.
Barringer et al., Predicting Employee Health Insurance Selections in a Flexible Benefits Environment, Cornell University, 1991, p. 1-34.
Burton et al., The Role of Health Risk Factors and Disease on Worker Productivity, J. Occup. Environ. Med., vol. 41, Issue 10, (Oct. 1999, p. 863-77.
Maxwell, et al., Managed Competition in Practice: ‘Value Purchasing’ by Fourteen Employers Are Large Employers the New Champions of Managed Competition? Health Affairs, vol. 17, No. 3, May/Jun. 1998.
Berger et al., Alternative Valuations of Work Loss and Productivity, J. Occup. Environ. Med., vol. 43, Issue 1 (Jan. 2001), p. 18-24.
Cockburn et al., Loss of Work Productivity due to Illness and Medical Treatment, J. Occup. Environ. Med., vol. 41, Issue 11 (Nov. 1999, p. 948-53.
Menon and Assiff, The Burden of Illness of Employees on United States Employers: A Critical Review of the Literature, Druck Information Journal, vol. 34, pp. 47-58, 2000.

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