DETAILED ACTION
Status of Claims
This action is in reply to the application filed on 23 October, 2024.
Claims 1 - 20 are currently pending and have been examined.
The present application is a continuation of U.S. Application Number 17/665,847 now U.S. Patent Number 12,131,397; which is a continuation of U.S. Application Number 17/039,309 now U.S. Patent Number 11,244,416; which is a continuation in part of U.S. Application Number 15/162,217 now U.S. Patent Number 10,867,361.
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Claim Rejections - 35 USC § 101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1 - 20 are rejected under 35 U.S.C. 101 because the claimed invention is directed to a judicial exception (i.e. a law of nature, a natural phenomenon, or an abstract idea), and does not include additional elements that either: 1) integrate the abstract idea into a practical application, or 2) that provide an inventive concept – i.e. an element or combination of elements that amount to significantly more than the abstract idea. The Claims are directed to an abstract idea because, when considered as a whole, the plain focus of the claims is on an abstract idea.
Claim 1 is representative. Claim 1 recites:
A computer-implemented method for determining a significance of departure of a medical care provider from a plurality of process-of-care standards, the significance communicated at a granularity of specific procedures and services performed for specific medical conditions, the method implemented in at least one processor in communication with a memory device, a user input device, and a graphical user interface (GUI) on a display device, the method comprising steps executed by the at least processor of:
retrieving a file of claim line item records numbering at least 100,000, each of the claim line item records corresponding to an episode of care associated with a claim submitted to a health plan;
reorganizing the file of claim line item records based on episodes of care, wherein each of the episodes of care includes the claim line item records corresponding to the claim submitted to the health plan, and wherein an episode identifier for the associated episode of care is added to each of the claim line item records;
storing the reorganized file of claim line item records;
retrieving an episode file that assigns episode identifiers for a non-outlier subset of the episodes of care to corresponding medical care providers;
retrieving, from a database, definitions for marker code groups, wherein each of the marker code groups comprises one or more related codes from the health plan, and is associated with a corresponding one of the plurality of medical conditions, and wherein each marker code group and the associated medical condition defines a marker-condition pair;
receiving user input at a service detail display displayed on the GUI in a first pane for selecting a medical care provider from among the plurality of medical care providers, the medical care provider associated with a medical specialty from among a plurality of medical specialties, each of the medical specialties associated in the database with a set of medical conditions from among the plurality of medical conditions and with marker-condition pairs associated with the set of medical conditions;
receiving user input at a target control displayed in a second pane for selecting a target point definition, the second pane being displayed along with the first pane;
receiving user input at a pass/fail threshold control displayed in a second pane for selecting a threshold definition;
receiving user input at a qualifying standard control displayed on the GUI in the first pane, wherein a qualifying standard requires a minimum number of episodes of the medical condition of the marker-condition pair attributed to the medical care provider;
parsing the episode file to identify the episode identifiers assigned to the selected medical care provider for the non-outlier subset of the episodes of care for the set of medical conditions in the selected medical specialty associated with the selected medical care provider;
parsing the claim line item records in the stored reorganized file of claim line item records having the identified episode identifiers to determine an actual rate of utilization by the selected medical care provider of the marker code groups for each marker-condition pair in the selected medical specialty associated with the selected medical care provider;
retrieving, from the database, a protocol range for each marker-condition pair in the selected medical specialty associated with the selected medical care provider;
retrieving, from the database for each marker code group of the marker-condition pairs associated with the selected medical specialty, a bundle cost associated with a single utilization of the marker code group; and
generating an output for display in the second pane by switching content displayed in the second pane while displaying the first pane, the generated output including:
a listing of the one or more marker-condition pairs associated with the selected medical specialty;
for each of the listed marker-condition pairs, a target point for a rate of utilization of the marker code group for the associated medical condition, wherein the target point is determined by applying, by the processor for each of the listed pairs, the target point definition to the retrieved protocol range associated with the pair;
for each of the listed marker-condition pairs, an indication of a status, wherein the status is selected from among a group comprising (i) a fail status, assigned in response to the actual rate of utilization by the selected medical care provider for the marker-condition pair exceeding the target rate of utilization, and (ii) a pass status, assigned in response to the actual rate of utilization by the selected medical care provider for the marker-condition pair not exceeding the target rate of utilization; and
for each failed marker-condition pair, a calculated cost of overuse based on the bundle cost of the marker code group associated with the respective marker-condition pair and a difference between the actual rate of utilization for the marker-condition pair and the target rate of utilization for the marker-condition pair, wherein the cost of overuse communicates the significance of departures from the process-of-care standard for the associated marker-condition pair.
Claim 19 recites medium with instructions executed by a processor, and Claim 10 recites a system that executes the steps of the method recited in Claim 1.
Claim Interpretation
Claim 1 is directed to a method, implemented in a generic computer processor, that determines, for a selected medical care provider, a cost of overuse of marker-condition pairs (i.e. specific procedures and services performed for specific medical conditions). Overuse is defined as an actual rate of utilization that exceeds a target rate of utilization, such as may be defined by a best practice guideline or the utilization of a peer group, and indicates inefficient practitioners. The specification discloses that health plans expend a significant amount of resources trying to identifying inefficient practitioners (@ 0005). The method comprises multiple abstract ideas as detailed below, that may overlap, as well as extra-solution activities that involve data gathering, storage and display.
Initially, the method retrieves a file of claim line item records (data gathering) and reorganizes the file of claim line item records based on episodes of care (filtering). (“Filtering” is an abstract method of organizing human activity.) The method further retrieves an episode file (data gathering) and parses the episode file to identify the episode identifiers assigned to the selected medical provider (filtering). The retrieving and filtering are also, fundamentally, data gathering steps for the cost of overuse determination steps that follow.
The method further recites additional data gathering steps including: retrieving definitions for marker-code groups; receiving user input selecting a medical care provider; receiving user input for selecting a target point definition; receiving user input for selecting a threshold definition; receiving user input for a minimum number of episodes; retrieving a protocol range; retrieving a bundle cost. The data is gathered from a conventional database, or based on user input on a GUI.
The method requires several mathematical operations that are applied to the gathered data including: determining an actual rate of utilization by the selected medical care provider; determining the target point by applying the target point definition to the retrieved protocol range; a calculated cost of overuse based on the bundle cost and a difference between the actual rate of utilization and the target rate of utilization. After the large volume of claim line item records have been filtered into episodes of care, and further filtered based on the selected medical care provider, it may or may not be reasonable to determine an actual rate of utilization mentally. Nonetheless, once the rates of utilization are determined, one of ordinary skill can calculate the target point, the difference between the actual utilization and the target utilization, and the cost of overuse, mentally or with the aid of pen and paper.
The method assigns a pass/fail status to each marker-condition pair based on a comparison of the actual rate to the target rate. A pair is assigned a fail status when the actual rate exceeds the target rate. This comparison can be readily performed mentally.
STEP 1
The claims are directed to a system, a method and non-transitory computer readable medium which are included in the statutory categories of invention.
STEP 2A PRONG ONE
The claims, as illustrated by Claim 1, also recite limitations that encompass an abstract idea within the “certain methods of organizing human activity” grouping –
fundamental economic principles or practices including hedging, insurance, mitigating risk;
commercial or legal interactions including agreements in the form of contracts; legal obligations; advertising, marketing or sales activities or behaviors; business relations;
managing personal behavior or relationships or interactions between people including social activities, teaching, and following rules or instructions.
The claims recite limitations directed to “filtering content” including:
retrieving a file of claim line item records numbering at least 100,000, each of the claim line item records corresponding to an episode of care associated with a claim submitted to a health plan;
reorganizing the file of claim line item records based on episodes of care, wherein each of the episodes of care includes the claim line item records corresponding to the claim submitted to the health plan, and wherein an episode identifier for the associated episode of care is added to each of the claim line item records;
retrieving an episode file that assigns episode identifiers for a non-outlier subset of the episodes of care to corresponding medical care providers;
parsing the episode file to identify the episode identifiers assigned to the selected medical care provider for the non-outlier subset of the episodes of care for the set of medical conditions in the selected medical specialty associated with the selected medical care provider.
The claims retrieve claim line item records and reorganize/sort/filter the records based on episode of care. The claims retrieve an episode file and parse/sort/filter the episode file to identify episodes assigned to a selected provider. Filtering data is a method of organizing human activity (see MPEP 2106.04(a)(2) II C). These steps serve as data gathering steps for later processing that includes:
receiving user input at a service detail display displayed on the GUI in a first pane for selecting a medical care provider from among the plurality of medical care providers, the medical care provider associated with a medical specialty from among a plurality of medical specialties, each of the medical specialties associated in the database with a set of medical conditions from among the plurality of medical conditions and with marker-condition pairs associated with the set of medical conditions;
parsing the claim line item records in the stored reorganized file of claim line item records having the identified episode identifiers to determine an actual rate of utilization by the selected medical care provider of the marker code groups for each marker-condition pair in the selected medical specialty;
retrieving, from the database for each marker code group of the marker-condition pairs associated with the selected medical specialty, a bundle cost associated with a single utilization of the marker code group; and
generating an output, the generated output including:
a listing of the one or more marker-condition pairs associated with the selected medical specialty;
for each of the listed marker-condition pairs, a target point for a rate of utilization of the marker code group for the associated medical condition, wherein the target point is determined by applying, by the processor for each of the listed pairs, the target point definition to the retrieved protocol range associated with the pair;
for each of the listed marker-condition pairs, an indication of a status, wherein the status is selected from among a group comprising (i) a fail status, assigned in response to the actual rate of utilization by the selected medical care provider for the marker-condition pair exceeding the target rate of utilization, and (ii) a pass status, assigned in response to the actual rate of utilization by the selected medical care provider for the marker-condition pair not exceeding the target rate of utilization; and
for each failed marker-condition pair, a calculated cost of overuse based on the bundle cost of the marker code group associated with the respective marker-condition pair and a difference between the actual rate of utilization for the marker-condition pair and the target rate of utilization for the marker-condition pair, wherein the cost of overuse communicates the significance of departures from the process-of-care standard for the associated marker-condition pair.
The claims recite selecting a provider and determining an actual rate of utilization for each marker-code group for each marker-condition pair in the selected provider’s specialty. The actual rate of utilization is compared to a target rate of utilization and a status is determined. The status may be a fail status when the actual rate of utilization exceeds the target rate. For each marker-code group for each marker-condition pair in the selected provider’s specialty that has a fail status, the method calculates the cost of overuse using the difference between the actual utilization and the target utilization and the bundle cost. This allows a comparison of the provider’s utilization to a target rate, such as a best practice guideline (i.e. determine whether the provider is following instructions presented in the guideline, which represents a contract with the health plan). Identifying providers who are overutilizing medical procedures and services, according to guidelines from a health plan, is a fundamental economic activity.
This combination of limitations lists the pass/fail status of a selected medical provider in the utilization of various medical procedures and services in the treatment of various medical conditions. The status indicates whether the provider is utilizing the various medical procedures and services in the treatment of various medical conditions in accordance with a user established target. The method calculates a cost of overuse for marker code groups that have an actual rate of utilization over a target rate. Ensuring a practitioner is acting in accordance with a performance target is a method of managing personal behavior and following rules or instructions. Calculating a cost of overutilization is a fundamental economic activity that serves to manage the personal behavior. This type of activity, i.e. identifying inefficient practitioners, includes conduct that would normally occur when managing a health plan. For example, it is routine in medicine for health plan to evaluate the utilization of services by providers to identify outliers. As such, the claims recite an abstract idea within the certain methods of organizing human activity grouping.
The claims, as illustrated by Claim 1, recite limitations that encompass an abstract idea within the mathematical formula or relationship grouping including:
determine an actual rate of utilization by the selected medical care provider of the marker code groups for each marker-condition pair in the selected medical specialty associated with the selected medical care provider;
the target point is determined by applying, by the processor for each of the listed pairs, the target point definition to the retrieved protocol range associated with the pair;
for each failed marker-condition pair, a calculated cost of overuse based on the bundle cost of the marker code group associated with the respective marker-condition pair and a difference between the actual rate of utilization for the marker-condition pair and the target rate of utilization for the marker-condition pair.
The claims derive an actual rate of utilization (counts or ratios) of a marker code group for episodes of care for an associated medical condition for a selected provider having a specialty, assign a status based on a comparison with a target rate of utilization, by applying a target point definition to a protocol range, and calculates a cost of overuse. The specification discloses the actual rate of utilization as a percentage of the total episodes for the medical condition attributable to the provider in which any of the one or more related codes of the marker code group was utilized (0144). Counting episodes in which a code appears, compared to the total number of episodes, to obtain a percentage of the total is a mathematical relationship. Similarly, assigning a status based on a comparison of the actual rate to a target rate is a simply binary classification relationship (0146). Calculating a cost of overuse is disclosed as a calculation that includes multiplying the bundle cost (a cost associated with a single utilization of the marker code group) to the product of the number of episodes of the medical condition and a difference between the actual rate of utilization and the target rate of utilization (0158). (Cost of Overuse = Bundle Cost * (# Episodes * (Actual Rate – Target Rate). As such, the claims recite a mathematical formula or relationship.
The claims, as illustrated by Claim 1, recite limitations that encompass an abstract idea within the mental process grouping – concepts performed in the human mind including observation, evaluation, judgment and opinion including:
the target point is determined by applying, by the processor for each of the listed pairs, the target point definition to the retrieved protocol range associated with the pair;
for each of the listed marker-condition pairs, an indication of a status, wherein the status is selected from among a group comprising (i) a fail status, assigned in response to the actual rate of utilization by the selected medical care provider for the marker-condition pair exceeding the target rate of utilization, and (ii) a pass status, assigned in response to the actual rate of utilization by the selected medical care provider for the marker-condition pair not exceeding the target rate of utilization;
for each failed marker-condition pair, a calculated cost of overuse based on the bundle cost of the marker code group associated with the respective marker-condition pair and a difference between the actual rate of utilization for the marker-condition pair and the target rate of utilization for the marker-condition pair.
Applying the target point definition to the protocol ranges is a simple mathematical operation that can be performed mentally, or with the aid of pen and paper. Similarly, assigning a status by comparing the actual rate to the target rate is a process that, except for the generic computer implementation, can be performed mentally. Calculating the cost of overuse is also a simple mathematical relationship that can be performed mentally, or with the aid of pen and paper.
STEP 2A PRONG TWO
The claims recite additional limitations beyond those that encompass the abstract idea, including the following extra-solution data gathering steps:
retrieving a file of claim line item records numbering at least 100,000, each of the claim line item records corresponding to an episode of care associated with a claim submitted to a health plan;
retrieving an episode file that assigns episode identifiers for a non-outlier subset of the episodes of care to corresponding medical care providers;
retrieving, from a database, definitions for marker code groups, wherein each of the marker code groups comprises one or more related codes from the health plan, and is associated with a corresponding one of the plurality of medical conditions, and wherein each marker code group and the associated medical condition defines a marker-condition pair;
receiving user input at a service detail display displayed on the GUI in a first pane for selecting a medical care provider from among the plurality of medical care providers, the medical care provider associated with a medical specialty from among a plurality of medical specialties, each of the medical specialties associated in the database with a set of medical conditions from among the plurality of medical conditions and with marker-condition pairs associated with the set of medical conditions;
receiving user input at a target control displayed in a second pane for selecting a target point definition, the second pane being displayed along with the first pane;
receiving user input at a pass/fail threshold control displayed in a second pane for selecting a threshold definition;
receiving user input at a qualifying standard control displayed on the GUI in the first pane, wherein a qualifying standard requires a minimum number of episodes of the medical condition of the marker-condition pair attributed to the medical care provider;
retrieving, from the database, a protocol range for each marker-condition pair in the selected medical specialty associated with the selected medical care provider;
retrieving, from the database for each marker code group of the marker-condition pairs associated with the selected medical specialty, a bundle cost associated with a single utilization of the marker code group.
The claims recite additional elements beyond those that encompass the abstract ideas above including:
at least one processor, in communication with a memory device, a user input device, and a display device;
generating an output for display in the second pane by switching content displayed in the second pane while displaying the first pane.
However, these additional elements do not integrate the abstract idea into a practical application of that idea in accordance with MPEP 2106.05.
Retrieving files from a database, and receiving using input using conventional input devices is an insignificant extra-solution activity – i.e. a data gathering step.
The processor, memory, input and display devices are recited at a high level of generality such that it amounts to no more than instructions to apply the abstract idea using a generic computer component. These elements merely add instructions to implement the abstract idea on a computer, and generally link the abstract idea to a particular technological environment. The recited first pane and second pane are disclosed as generic user interfaces for selecting inputs and displaying outputs, and using conventional tab controls to switch between panes. The recited user interface is construed as a conventional computer element. “A graphic user interface so a user can select data merely recites a generic computer component and does not contribute an inventive concept to the claim. Graphical user interfaces that allow a user to select and enter information describe purely conventional features on the disclosed devices.” (Affinity Labs v. DIRECTV).
Displaying the results of the abstract idea is an extra-solution activity. A general purpose computer that applies a judicial exception by use of conventional computer functions, as is the case here, does not qualify as a particular machine, nor does the recitation of a generic computer impose meaningful limits in the claimed process. (see Ultramercial, Inc. v. Hulu, LLC, 772 F.3d 709, 716-17 (Fed. Cir. 2014)). As such, the additional elements recited in the claim do not integrate the abstract provider scoring process into a practical application of that process.
STEP 2B
The additional elements identified above do not amount to significantly more than the abstract provider scoring process. Displaying the results of the abstract process merely appends a conventional post solution activity to the abstract process, and is an ancillary part of the abstract idea as in Electric Power Group. As such, the additional element do not provide an inventive concept that transforms the claims into a patent eligible invention.
The additional structural elements or combination of elements in the claims, other than the abstract idea per se, amount to no more than a recitation of generic computer structure (i.e. a computing system/processor and memory). Each of the above components are disclosed in the specification as being purely conventional and/or known in the industry. Because the specification describes these additional elements in general terms, without describing particulars, Examiner concludes that the claim limitations may be broadly, but reasonably construed, as reciting well-understood, routine and conventional computer components and techniques. The specification describes the elements in a manner that indicates that they are sufficiently well-known that the specification does not need to describe the particulars in order to satisfy U.S.C. 112. Considered as an ordered combination the limitations recited in the claims add nothing that is not already present when the steps are considered individually.
The dependent claims add additional features including:
those that merely serve to further narrow the abstract idea above such as:
actual rate of utilization definitions (4 – 9, 13 - 18);
those that recite additional abstract ideas such as:
aggregating statuses by calculating a pass/fail ratio and comparing to a threshold (Claim 2, 11, 20);
aggregating statuses, assigning weights based on bundle cost, calculating a weighted pass/fail ratio, and comparing to a threshold; (Claim 3, 12);
those that recite insignificant extra-solution activities such as:
including the score in the output; (Claim 2, 3, 11, 12 and 20);
those that recite well-understood, routine and conventional activity or computer functions; or those that are an ancillary part of the abstract idea.
The limitations recited in the dependent claims, in combination with those recited in the independent claims add nothing that integrates the abstract idea into a practical application, or that amounts to significantly more. As such, the additional element do not integrate the abstract idea into a practical application, or provide an inventive concept that transforms the claims into a patent eligible invention.
The apparatus claims are no different from the method claims in substance. “The equivalence of the method, system and media claims is readily apparent.” “The only difference between the claims is the form in which they were drafted.” (Bancorp). The method claims recite the abstract idea implemented on a generic computer, while the apparatus claims recite generic computer components configured to implement the same idea. Specifically, Claims 10 - 20 merely add the generic hardware noted above that nearly every computer will include. The apparatus claim’s requirement that the same method be performed with a programmed computer does not alter the method’s patentability under U.S.C. 101 (In re Grams). Therefore, the claims are rejected under 35 U.S.C. 101 as being directed to non-statutory subject matter.
Double Patenting
The nonstatutory double patenting rejection is based on a judicially created doctrine grounded in public policy (a policy reflected in the statute) so as to prevent the unjustified or improper timewise extension of the “right to exclude” granted by a patent and to prevent possible harassment by multiple assignees. A nonstatutory double patenting rejection is appropriate where the conflicting claims are not identical, but at least one examined application claim is not patentably distinct from the reference claim(s) because the examined application claim is either anticipated by, or would have been obvious over, the reference claim(s). See, e.g., In re Berg, 140 F.3d 1428, 46 USPQ2d 1226 (Fed. Cir. 1998); In re Goodman, 11 F.3d 1046, 29 USPQ2d 2010 (Fed. Cir. 1993); In re Longi, 759 F.2d 887, 225 USPQ 645 (Fed. Cir. 1985); In re Van Ornum, 686 F.2d 937, 214 USPQ 761 (CCPA 1982); In re Vogel, 422 F.2d 438, 164 USPQ 619 (CCPA 1970); In re Thorington, 418 F.2d 528, 163 USPQ 644 (CCPA 1969).
A timely filed terminal disclaimer in compliance with 37 CFR 1.321(c) or 1.321(d) may be used to overcome an actual or provisional rejection based on nonstatutory double patenting provided the reference application or patent either is shown to be commonly owned with the examined application, or claims an invention made as a result of activities undertaken within the scope of a joint research agreement. See MPEP § 717.02 for applications subject to examination under the first inventor to file provisions of the AIA as explained in MPEP § 2159. See MPEP §§ 706.02(l)(1) - 706.02(l)(3) for applications not subject to examination under the first inventor to file provisions of the AIA . A terminal disclaimer must be signed in compliance with 37 CFR 1.321(b).
The USPTO Internet website contains terminal disclaimer forms which may be used. Please visit www.uspto.gov/patent/patents-forms. The filing date of the application in which the form is filed determines what form (e.g., PTO/SB/25, PTO/SB/26, PTO/AIA /25, or PTO/AIA /26) should be used. A web-based eTerminal Disclaimer may be filled out completely online using web-screens. An eTerminal Disclaimer that meets all requirements is auto-processed and approved immediately upon submission. For more information about eTerminal Disclaimers, refer to www.uspto.gov/patents/process/file/efs/guidance/eTD-info-I.jsp.
Claims 1 - 20 are rejected on the ground of nonstatutory double patenting as being unpatentable over corresponding claims 1 - 20 of U.S. Patent No. 12,131,397 B2. Although the claims at issue are not identical, they are not patentably distinct from each other because the pending claims recite all of the limitations of the issued claims. The pending claims are mapped to the issued claims as follows:
Pending Claim Issued Claim
Claims 1, 10 and 19 Claims 1, 10 and 19
Claims 2 and 11 Claims 2 and 11
Claims 3 and 12 Claims 3 and 12
Claims 4 and 13 Claims 4 and 13
Claims 5 and 14 Claims 5 and 14
Claims 6 and 15 Claims 6 and 15
Claims 7 and 16 Claims 7 and 16
Claims 8 and 17 Claims 8 and 17
Claims 9 and 18 Claims 9 and 18
Claim 20 Claim 20
Pending Claims 1, 10 and 19 differ from the issued claims as follows:
removing details regarding data in the claim line item records;
adds receiving input of a minimum number of episodes.
However, specifying a minimum number of episodes for analysis would have been obvious to one of ordinary skill in the art. For example, it is well-known that a data sample must have a minimum number of data point in order to provide a statistically significant output; a fact for which Examiner takes Official Notice.
THE PRIOR ART
The prior art does not teach or suggest the claimed invention. The closest prior art is Seare et al.: (US PGPUB 2006/0293922 A1) and related applications. Seare teaches a method and system for generating medical provider utilization profiles by analyzing historical medical claims organized by episode of care, and comparing the profiles to a normative profile. Seare enables the identification of medical providers who do not fall within the normal pattern of utilization. Seare associates a group of CPT codes with medical conditions (i.e. marker code groups and marker-condition pairs) and identifies and displays the number of instances of using the CPT code for the medical condition for each provider during a selected period of time. (Seare 0028, 0029, 0103, 0104, 0252 – 0255, 0258, 0314, 0318, 0341). Nonetheless, Seare does not disclose the additional elements of the independent claims including: assigning a pass/fail status for each marker-condition pair based on a comparison of the actual utilization rate to the target rate of utilization; aggregating the statuses (i.e. calculating a ratio of # pass/ # total).
CONCLUSION
The prior art made of record and not relied upon is considered pertinent to applicant's disclosure.
US 5,324,077 to Kassler et al. discloses utilizing medical data to analyze over-utilization of medical care to control costs and provide feedback to providers.
US PGPUB 2004/0236605 A1 to Somani discloses a healthcare management system that includes monitoring health services utilization for over-utilization and educating the provider (or revoking participation in the health plan if not improved).
US PGPUB 2007/0078680 A1 to Wennberg discloses a system for analyzing healthcare provider performance including over-utilization of services.
Any inquiry of a general nature or relating to the status of this application or concerning this communication or earlier communications from the Examiner should be directed to John A. Pauls whose telephone number is (571) 270-5557. The Examiner can normally be reached on Mon. - Fri. 8:00 - 5:00 Eastern. If attempts to reach the examiner by telephone are unsuccessful, the Examiner’s supervisor, Robert Morgan can be reached at (571) 272-6773.
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/JOHN A PAULS/Primary Examiner, Art Unit 3683
Date: 30 December, 2025