JP7556823B2 - Healthcare business support device and health care business support method - Google Patents

Description

The present invention relates to a health care project support device and a health care project support method.

As insurers of National Health Insurance, Medical Insurance for the Elderly, and Long-Term Care Insurance, local governments are promoting the health of their residents by providing various types of medical examinations, such as health checkups, health guidance, cancer screenings, and dental checkups, as well as setting up places for seniors to socialize and holding health events such as walking events. However, according to the Ministry of Health, Labor and Welfare, the participation rate in specific health checkups in fiscal 2017 was sluggish at 37.2% among insured persons under National Health Insurance, which is mainly run by local governments, and increasing the number of participants and examinees has become an issue. Insurers such as local governments are encouraging insured persons to participate through public relations and letters, but these methods alone are not leading to an increase in participation rates.

Background art in this technical field includes JP 2018-124836 A (Patent Document 1) and JP 2018-81397 A (Patent Document 2). Patent Document 1 states that "The health checkup institution identification unit 218 of the specific health checkup recommendation server 20 identifies a health checkup institution at which a health checkup is recommended for the user of the mobile terminal based on the user's medical history. The notification necessity determination unit 2192 determines whether the mobile terminal is within a predetermined range based on the identified health checkup institution. If the mobile terminal is within a predetermined range based on the identified health checkup institution, the message sending unit 2194 sends a message to the mobile terminal recommending that the user undergo a health checkup at the identified health checkup institution" (see abstract).

The publication of Patent Document 2 also states, "The method includes the steps of presenting a questionnaire regarding lifestyle-related diseases and sleep to the subject 40, and notifying the subject of information recommending a sleep test or information recommending a specific health check based on the questionnaire results obtained. When notifying the subject of the information recommending a sleep test, one or more storage locations are selected from a large number of storage locations that store sleep test equipment in advance, and the subject is also notified of information about locations where sleep test equipment can be loaned. When the subject undergoes a sleep test using the sleep test equipment loaned from the storage location for a certain period of time and obtains the sleep data, information recommending that the subject undergo a specific health check based on the results of the sleep data is notified" (see abstract).

JP 2018-124836 A JP 2018-81397 A

When the technologies described in Patent Documents 1 and 2 encourage an insured person to participate in a health program such as a medical checkup, the encouragement to participate is notified to the insured person via a mobile device or the like. In other words, with the technologies described in Patent Documents 1 and 2, the location and information are more detailed and individualized than in conventional notifications from insurers, but insured persons who participate in such a system using a mobile device or the like are likely to be people who are highly conscious of participating in health programs in the first place, and it may not be possible to significantly increase the willingness to participate of insured persons who have not previously participated in health programs, and ultimately it may not be possible to significantly increase the participation rate. Therefore, one aspect of the present invention aims to increase the willingness of insured persons to participate in health programs.

Therefore, one aspect of the present invention employs the following configuration. The health care project support device has a processor and a memory, and is connected to a display device, and the memory holds information indicating a health care project recipient, a health care facility, and medical information indicating a history of items of optimization of medical service provision carried out by the health care facility, and the processor refers to the medical information, calculates an evaluation value of the health care facility based on the optimization history, assigns the health care project recipient to the health care facility based on the evaluation value, and displays information indicating the health care facility to which the health care project recipient has been assigned on the display device.

One aspect of the present invention can increase the opportunities for face-to-face consultations with insured persons, thereby increasing the insured persons' willingness to participate in health programs.

Issues, configurations, and advantages other than those described above will become clear from the description of the embodiments below.

FIG. 2 is an explanatory diagram showing an application example of the health care project support system in the first embodiment. 1 is a block diagram showing a configuration example of a health care project support system according to a first embodiment. 4 is an example of personal health information in the first embodiment. 4 is an example of medical information according to the first embodiment. 4 is an example of insured person information according to the first embodiment. 4 is an example of health care project target criteria information in the first embodiment. 4 is an example of channel evaluation information according to the first embodiment. 4 is an example of consignment information according to the first embodiment. 4 is an example of result management information according to the first embodiment. 11 is a flowchart illustrating an example of a channel evaluation process in the first embodiment. 11 is a flowchart showing an example of a selection process of a entrusted health care business and an entrustee in the first embodiment. 13 is an example of a entrusted medical care facility display screen in the first embodiment. 13 is a flowchart showing an example of a health care business recommendation support process. 13 is an example of a health care service information display screen in the first embodiment. 11 is a flowchart illustrating an example of an incentive determination process in the first embodiment. 13 is an example of an incentive confirmation screen according to the first embodiment.

The following describes in detail an embodiment of the present invention with reference to the drawings. In this embodiment, the same components are generally given the same reference numerals, and repeated explanations are omitted. Note that this embodiment is merely one example for realizing the present invention, and does not limit the technical scope of the present invention.

Figure 1 is an explanatory diagram showing an example of the application of the health care project support system. Figure 1 shows an example of the relationships between stakeholders when the health care project system is used to implement health care projects for health care providers via medical facilities. The relationships shown here are between an insured person 1301, a health checkup institution 1302 and a health guidance institution 1303, which are examples of health care project institutions, a medical institution such as a clinic 1304, an insurer 1305 such as a local government, a service provider 1306, and a pharmacy 1307.

The health care business support system includes, for example, a management terminal 104 and a health database 101 owned by an insurer 1305, a server 103 which is an example of a health care business support device owned by a service provider 1306 or an insurer, a management terminal 104 and a service database 102 used by the service provider or the insurer, and a medical care facility terminal 105 owned by each of multiple pharmacies 1307.

The health database 101 and the service database 102 may be a single database, and the insurer 1305 and the service provider 1306 may own the database, or the database may be an external database to which computers owned by the insurer 1305 and the service provider 1306 can connect. Details of each device will be described later.

There may be multiple health checkup institutions 1302, health guidance institutions 1303, medical institutions 1304, and pharmacies 1307 for one insurer 1305, but for ease of explanation, only multiple pharmacies are listed here. This will be explained using an example where the insurer 1305 commissions a pharmacy to encourage the insured person 1301 to undergo and participate in health programs such as health checkups and health guidance that the insurer 1305 wants the insured person 1301 to undergo.

When the insured person 1301 visits a medical examination institution 1302, the medical examination data is reported to the insurer 1305 in addition to the insured person himself/herself, and is stored in the health database 101. Similarly, when the insured person 1301 participates in health guidance provided by a health guidance institution 1303, the health guidance data is reported to the insurer 1305 and stored in the health database 101.

In addition, when the insured person 1301 visits a medical institution 1304, the medical institution 1304 submits a medical receipt, which is a medical expense invoice, to the insurer 1305, and the medical institution 1304 receives medical expense income from the insurer, and the information on the receipt is stored in the health database 101.

When the insured person 1301 receives a prescription from the medical institution 1304, he or she visits the pharmacy 1307 with the prescription and receives the medicine. The pharmacy 1307 submits a medical receipt, which is a medical expense invoice for the prescribed medicine, to the insurer 1305, receives medical expense income, and the information on the receipt is stored in the health database 101.

The service provider 1306 obtains data based on the contract with the insurer 1305 from the health database 101 and evaluates each pharmacy 1307. The service provider 1306 also extracts insured persons 1301 who are eligible for health checkups or health guidance but have not yet received such checkups, and assigns which health programs the insured persons 1301 should be encouraged to participate in and which pharmacies should use them for each extracted insured person 1301. For example, the server 103 performs these processes based on instructions from the management terminal 104, and the execution results are stored in the service database 102.

Next, after visiting the medical institution 1304, the insured person 1301 visits one of the pharmacies 1307 to receive the prescribed medicine. The pharmacy 1307 uses the medical facility terminal 105 to inquire with the server 103, and is entrusted by the server 103 with encouraging the insured person to participate in the health program, depending on the result of the allocation described above.

The pharmacy 1307 recommends health care participation on behalf of the insurer 1305. For example, if the insured person 1301 has not yet undergone a health checkup and Pharmacy A, which the insured person 1301 visited, has been assigned to recommend the insured person 1301 to undergo a health checkup based on the evaluation of Pharmacy A, which the insured person 1301 visited, the medical care facility terminal 105 commissions Pharmacy A to recommend the insured person 1301 to undergo a health checkup, and Pharmacy A recommends the insured person 1301 to undergo a health checkup.

The results of the health care project are stored in the service database 102 from the medical care facility terminal 105 via the server 103. Also, when the insured person 1301 visits a medical examination institution 1302 or a health guidance institution 1303 in response to an invitation from the pharmacy, data including the results of the visit are reported to the insurer 1305 and stored in the health care database 101.

The server 103 acquires this data, and the service provider 1306 can ascertain whether or not the pharmacy actually participated in the health care project as a result of encouraging the pharmacy to participate in the health care project. The service provider 1306 determines the commission fee to the pharmacy from the insurer 1305 based on the entrustment of the health care project to the pharmacy, the implementation of the participation encouragement at the pharmacy 1307, and the result of whether or not the pharmacy participated in the health care project after the participation encouragement, and pays this commission fee to the pharmacy.

The server 103 evaluates the pharmacies 1307 based on, for example, the past activities of the pharmacies 1307, and determines which pharmacy 1307 to assign the insured person 1301 to. For example, the server 103 determines the number of pharmacies 1307 to assign to the insured person 1301, depending on the status of implementation of measures for the appropriate use of medical care and the optimization of medical expenses, such as the status of implementation of measures for leftover medicine and duplicate administration at the pharmacies 1307, and the status of implementation of the invitation to participate in this project.

Measures such as measures to deal with leftover medication and duplicate administration by the pharmacy 1307 cannot be implemented unless the pharmacy 1307 has sufficient communication with the insured person 1301 and the medical institution 1304. Therefore, by evaluating the implementation status and allocating the insured person 1301, the insured person 1301 can be allocated to a pharmacy 1307 that has good communication with the insured person 1301 and has a high possibility of being successful in encouraging participation.

In addition, by entrusting the encouragement of many insured persons 1301 to a pharmacy 1307 that is working to promote the appropriate use of medical care and the rationalization of medical expenses, the activities of the pharmacy 1307 can be further promoted. In addition, by determining the amount of payment to the pharmacy 1307 according to not only the amount of encouragement for participation in health care projects entrusted to the pharmacy 1307 but also, for example, the amount of participation encouragement implemented and the amount of participation in health care projects after the encouragement, the implementation of the encouragement for participation in health care projects by the pharmacy 1307 can be promoted.

Figure 2 is a block diagram showing an example of the configuration of a health care project support system. As described above, the health care project support system includes a health database 101, a service database 102, a server 103, a management terminal 104, and a medical care facility terminal 105, which are connected to each other via a network such as the Internet.

The health database 101 is a database that mainly stores data obtained from insurers. The health database 101 holds, for example, personal health information 111, medical information 112, and insured person information 113.

Personal health information 111 holds information showing the insured person's participation history in health programs and the results of the insured person's health checkups. Medical information 112 holds information on the insured person's use of medical facilities, such as prescription information. Insured person information 113 holds personal information such as the insured person's name, age, sex, and address.

The service database 102 is a database that manages information regarding the commissioning of encouraging pharmacies and other entities to participate in health care projects. The service database 102 holds, for example, health care project target criteria information 121, channel evaluation information 122, commission information 123, and performance management information 124.

Health care program target criteria information 121 holds information showing the criteria for insured persons to become targets of health care programs such as specific health checkups and cancer screenings. Channel evaluation information 122 holds indicators for evaluating medical care facilities, such as pharmacies, that serve as channels with insured persons. Entrustment information 123 holds the results of selection of which medical care facility is to be entrusted with encouraging which insured persons to participate in health care programs. Performance management information 124 holds the results of medical care facilities, such as pharmacies, implementing health care program participation encouragement.

For example, some or all of the information stored in the health database 101 may be stored in the service database 102, some or all of the information stored in the service database 102 may be stored in the health database 101, or some or all of the information stored in the health database 101 and the service database 102 may be stored in the auxiliary storage device 150 of the server 103.

In this embodiment, the information used by the health care project support system may be expressed in any data structure, regardless of the data structure. For example, the information may be stored in a data structure appropriately selected from a list, a table, a database, or a queue.

The server 103 is composed of a computer including, for example, a CPU (Control Processing Unit) 130, a memory 140, an auxiliary storage device 150, an input device 160, an output device 170, and a communication device 180. The CPU 130 includes a processor and executes programs stored in the memory 140. The memory 140 includes a ROM (Read Only Memory), which is a non-volatile storage element, and a RAM (Random Access Memory), which is a volatile storage element. The ROM stores immutable programs (for example, a BIOS (Basic Input/Output System)) and the like. The RAM is a high-speed, volatile storage element such as DRAM (Dynamic Random Access Memory), and temporarily stores programs executed by the CPU 130 and data used when executing the programs.

The auxiliary storage device 150 is, for example, a large-capacity, non-volatile storage device such as a magnetic storage device (HDD (Hard Disk Drive)) or a flash memory (SSD (Solid State Drive)), and stores the programs executed by the CPU 130 and data used when the programs are executed. In other words, the programs are read from the auxiliary storage device 150, loaded into the memory 140, and executed by the CPU 130.

The input device 160 is a device for receiving input from an operator, such as a keyboard, mouse, touch panel, camera, and card reader. The output device 170 is a device for outputting the results of program execution in a format that can be viewed by the operator, such as a display or printer.

The communication device 180 is a network interface device that controls communication with other devices according to a specific protocol. The communication device 180 may also include a serial interface such as a USB.

The programs executed by the CPU 130 are provided to the server 103 from removable media (CD-ROM, flash memory, etc.) or via the network 300, and are stored in the non-volatile auxiliary storage device 150, which is a non-transitory storage medium. For this reason, the server 103 should have an interface for reading data from removable media. The same applies to the management terminal 104 and the medical facility terminal 105.

The server 103 is a computer system configured on one physical computer or on multiple logically or physically configured computers, and may operate in separate threads on the same computer, or may operate on a virtual computer constructed on multiple physical computer resources. The same applies to the management terminal 104 and the medical care facility terminal 105. Also, for example, the server 103 may be integrated with the management terminal 104 and/or the medical care facility terminal 105.

The CPU 130 has, for example, the following functional units: an outsourcing processing unit 131, a channel evaluation unit 132, a notification unit 133, and an incentive determination unit 134. The outsourcing processing unit 131 selects which medical care facility is to be outsourced for encouraging which insured person to participate in which health care project.

The channel evaluation unit 132 evaluates an index for determining the priority of the medical facility to which the participation recommendation is entrusted, based on the efforts of the medical facility. The notification unit 133 notifies the medical facility terminal 105 of information on the participation recommendation to be implemented for the insured person. The incentive determination unit 134 determines an incentive according to the implementation status of the participation recommendation for the health project by the medical facility.

For example, CPU 130 functions as commission processing unit 131 by operating according to the commission processing program loaded into memory 140, and functions as channel evaluation unit 132 by operating according to the channel evaluation program loaded into memory 140. The relationship between the programs and the functional units is similar for the other functional units included in CPU 130. The relationship between the programs and the functional units is also similar for the functional units, described below, included in CPU 230 of management terminal 104, and the functional units, described below, included in CPU 330 of medical care facility terminal 105.

In addition, some or all of the functions of the functional units included in CPU 130, CPU 230, and CPU 330 may be realized by hardware such as an ASIC (Application Specific Integrated Circuit) or an FPGA (Field-Programmable Gate Array).

The management terminal 104 is configured by a computer including, for example, a CPU 230, memory 240, auxiliary storage device 250, input device 260, output device 270, and communication device 280. The hardware explanations of the CPU 230, memory 240, auxiliary storage device 250, input device 260, output device 270, and communication device 280 are similar to the hardware explanations of the CPU 130, memory 140, auxiliary storage device 150, input device 160, output device 170, and communication device 180, respectively, and therefore will not be repeated. The CPU 230 has, for example, a screen generation unit 231 that generates a screen to be displayed on the output device 270.

The medical facility terminal 105 is configured by a computer including, for example, a CPU 330, memory 340, auxiliary storage device 350, input device 360, output device 370, and communication device 380. The hardware explanations of the CPU 330, memory 340, auxiliary storage device 350, input device 360, output device 370, and communication device 380 are similar to the hardware explanations of the CPU 130, memory 140, auxiliary storage device 150, input device 160, output device 170, and communication device 180, respectively, and therefore will not be repeated. The CPU 330 has, for example, a screen generation unit 331 that generates a screen to be displayed on the output device 370.

Figure 3 is an example of personal health information 111. Personal health information 111 includes, for example, health program participation history information 601 indicating the insured person's participation history in health programs provided by the insurer, and health check information 602 indicating the insured person's health check results.

The health care project participation history information 601 includes, for example, an individual ID column 611, a year column 612, a health care project type column 613, a target column 614, a participation column 615, a participation date column 616, and a facility used column 617. The individual ID column 611 holds an ID that identifies the insured person. The year column 612 holds information indicating the end. The health care project type column 613 holds information indicating the type of health care project that is the target. The target column 614 holds a target flag (1 if the insured person is a target, 0 if the person is not a target) that indicates whether the insured person indicated in the individual ID column 611 is a target of the type of health care project indicated in the health care project type column 613 in the year indicated in the year column 612.

The participation column 615 holds a participation flag (1 if the insured person indicated in the personal ID column 611 participated in the health program when the target flag indicated in the target column 614 of the insured person indicated in the personal ID column 611 is 1) indicating whether the insured person participated in the health program (1 if the insured person participated, 0 if the insured person did not participate, and 0 or a null value if the insured person was not a target). The participation date column 616 holds information indicating the date on which the insured person indicated in the personal ID column 611 participated in the health program (for example, the date of a health check). The facility used column 617 holds information indicating the facility at which the insured person indicated in the personal ID column 611 received the health program.

The medical checkup information 602 includes, for example, a medical checkup ID column 621, a personal ID column 622, a receipt date column 623, an age at time of checkup column 624, a waist circumference column 625, a diastolic blood pressure column 626, a systolic blood pressure column 627, a blood glucose level column 628, and a triglyceride column 629. The medical checkup ID column 621 holds an ID that identifies the medical checkup. The personal ID column 622 holds an ID that identifies the insured person. The receipt date column 623 holds information indicating the date on which the insured person indicated in the personal ID column 622 underwent a medical checkup.

The age at time of examination column 624 holds information indicating the age at the time of the medical examination of the insured person indicated in the personal ID column 622. The waist circumference column 625, diastolic blood pressure column 626, systolic blood pressure column 627, blood glucose column 628, and triglyceride column 629 all hold numerical values indicating various results of the medical examination, but the medical examination information 602 may not hold some of these columns indicating various results of the medical examination, or may further hold columns indicating other types of results of the medical examination.

Figure 4 is an example of medical information 112. In the example of Figure 4, medical information 112 includes information contained in a prescription. A prescription is issued by a dispensing pharmacy to bill the insurer for the cost of dispensing medicine according to the prescription and providing the medicine to the insured person when the insured person visits a dispensing pharmacy bringing a prescription issued by a medical institution.

The medical information 112 includes, for example, a prescription ID column 501, a personal ID column 502, a medical treatment date column 503, a medical facility code column 504, a medical institution code column 505, a pharmaceutical management column 506, a medicine column 507, and a billing fee column 508.

The receipt ID column 501 holds an ID that identifies the prescription claim. The personal ID column 502 holds an ID that identifies the insured person. The medical treatment date column 503 holds information indicating the date and year of the medical treatment corresponding to the prescription claim. The medical facility code column 504 holds a code that identifies the medical facility. The medical institution code column 505 holds a code that indicates the medical institution that issued the prescription corresponding to the prescription.

The pharmaceutical management column 506 holds information indicating pharmaceutical management claims (claims related to the optimization of medical service provision) that are billed when the pharmacy adjusts remaining medication or takes measures such as preventing duplication or interactions. The pharmaceutical column 507 holds codes that identify pharmaceuticals dispensed by the pharmacy. The billing points column 508 holds information indicating billing points related to expense claims.

The pharmaceutical management column 506 is a surcharge that can be claimed when, for example, leftover medicine, duplication or interactions with medicines prescribed at other medical institutions are discovered, and the prescription contents are changed after an inquiry is made to the medical institution that issued the prescription. In other words, the value in the pharmaceutical management column 506 is an item that can be claimed when the insured person is able to communicate smoothly and cooperate with the medical institution that issued the prescription. Adjusting leftover medicine and taking measures against duplications not only leads to the reduction of unnecessary medical expenses, but is also expected to improve the insured person's medication status and prevent side effects caused by medicines.

Figure 5 is an example of insured person information 113. The insured person information 113 includes, for example, a personal ID column 1131, a name column 1132, an age column 1133, a gender column 1134, and an address column 1135. The personal ID column 1131 holds an ID that identifies the insured person. The age column 1133 holds information indicating the age of the insured person indicated by the personal ID column 1131. The gender column 1134 holds information indicating the gender of the insured person indicated by the personal ID column 1131. The address column 1135 holds information indicating the address of the insured person indicated by the personal ID column 1131.

Figure 6 is an example of health care project target criteria information 121. Health care project target criteria information 121 indicates the criteria for an insured person to become a target of a health care project that the insurer wishes to implement for the insured person and/or wishes to entrust the insurer with encouraging participation in a pharmacy or the like. Health care project target criteria information 121 includes, for example, a health care project column 701, a year column 702, and a condition column 703.

The health care project column 701 holds information indicating the type of health care project. The year column 702 holds information indicating the year in which the health care project is implemented. The conditions column 703 holds information indicating the conditions for insured persons who are the targets of the health care project in that year. The conditions may be those set by the national government or those set independently by a local government, which is an example of an insurer.

Figure 7 is an example of channel evaluation information 122. Channel evaluation information 122 is information indicating the evaluation of a medical facility (e.g., a pharmacy) that is entrusted with encouraging participation in health care projects (i.e., an example of a channel), and the value of an evaluation index is generated by a process described below. Channel evaluation information 122 holds, for example, a medical facility code column 801, a name column 802, and an evaluation index column 803.

The medical facility code column 801 holds a code that identifies the medical facility. The name column 802 holds information indicating the name of the medical facility. The evaluation index column 803 holds the value of an evaluation index that evaluates the medical facility. The evaluation index is, for example, an index of the performance of improvements in the insured person's medication due to pharmaceutical management implemented by a (dispensing) pharmacy. The method of calculating such an index will be described later.

A high evaluation index for a medical facility indicates that the medical facility is able to communicate with insured persons and has sufficient cooperation with medical institutions. Therefore, if the evaluation index for a medical facility is high, it can be expected that when the medical facility encourages insured persons to participate in a health program, the insured person is more likely to respond to the invitation. Note that, although this embodiment describes an example in which the medical facility is a pharmacy, the medical facility may also be a clinic, dental clinic, nursing care facility, or nursing care prevention institution.

Figure 8 is an example of the consignment information 123. The consignment information 123 is information showing the result of deciding the consignee for encouraging participation in the health project, and is generated by the process described below. The consignment information 123 includes, for example, a medical facility code column 901, a fiscal year column 902, an individual ID column 903, a recommended health project column 904, and a provision information column 905.

The medical facility code column 901 holds a code that identifies the medical facility. The year column 902 holds information indicating the year in which the commissioning of the participation recommendation is to be carried out. In this embodiment, an example is described in which an insured person who did not participate in the previous year's health program is encouraged to participate in the current year's health program, but an insured person who has not participated in the current year's health program may also be encouraged to participate in the current year's health program (i.e., the year stored in the year column 902 may be the same as the year in which the participation recommendation is to be carried out). The individual ID column 903 holds an ID that identifies the insured person who is to be encouraged to participate in the health program. The recommended health program column 904 holds information indicating the health program that the entrusted medical facility recommends to the insured person. The provided information column 905 holds information for encouraging participation in the health program.

Figure 9 is an example of the performance management information 124. The performance management information 124 is information that indicates the performance of a contracted medical facility in encouraging participation in a health project, and is generated by the process described below. The performance management information 124 includes, for example, a medical facility code column 1001, an implementation date column 1002, an individual ID column 1003, a recommended health project column 1004, and a result column 1005.

The medical facility code column 1001 holds a code that identifies the medical facility. The implementation date column 1002 holds information indicating the date on which the outsourced medical facility implemented the invitation to participate in the health program. The individual ID column 1003 holds an ID indicating the insured person who received the invitation to participate. The recommended health program column 1004 holds information indicating the health program for which participation was encouraged. The result column 1005 holds information indicating the result of the invitation from the outsourced medical facility to the insured person to participate in the health program (for example, a medical checkup appointment was made or was declined, etc.).

Figure 10 is a flowchart showing an example of a channel evaluation process. The channel evaluation unit 132 acquires medical information 112 from the health database 101 (S201). The channel evaluation unit 132 acquires the medical provider facility code from the medical provider facility code column 504 of the medical information 112 and the value of the pharmaceutical management from the pharmaceutical management column 506 (S202).

The channel evaluation unit 132 counts the number of pharmacy management claims for each healthcare facility according to the healthcare facility code and the pharmacy management value acquired in step S202 (for example, if there is one value in the pharmacy management column 506, the number of pharmacy management claims is counted as one), and determines the counted value as the evaluation index for the channel (healthcare facility) (S203). Note that the channel evaluation unit 132 may, for example, assign a predetermined weight to each type of pharmacy management claim (for example, if one remaining medication adjustment is performed, it is counted as three times, and if one duplication/dependency prevention is performed, it is counted as one time, etc.) to count the number of pharmacy management claims for each healthcare facility.

As another example of a weighting method, the channel evaluation unit 132 may assign a weight to each type of pharmacy management claim based on the inverse of the proportion of the number of claims of that type in the total number of claims in the pharmacy management column 506 of the medical information 112 (specifically, for example, if the claims in the entire medical information 112 consist of 200 for remaining medication adjustment and 300 for overlap/interaction prevention, a weight of (200+300)/200=2.5 is assigned to remaining medication adjustment, and a weight of (200+300)/300=1.66 is assigned to overlap/interaction prevention). Pharmacy management claims include multiple items, ranging from items that are claimed by many pharmacies, such as medication instructions, to items that are performed by few pharmacies, such as remaining medication adjustment. By assigning weights in this way, the channel evaluation unit 132 can evaluate the efforts of medical care facilities that perform claims with a small number of cases.

The channel evaluation unit 132 may also determine the total amount of drug costs reduced by the medical facility through, for example, leftover drug adjustments and prevention of duplications and interactions as the evaluation index (the evaluation index may be the evaluation index based on the billing items in the pharmacy management described above plus the total drug costs with a predetermined weighting). The drug costs reduced by pharmacy management may be stored in the records of the medical information 112, or the channel evaluation unit 132 may calculate the reduced drug costs from the value in the drug column 507 and the billing points. By determining the evaluation index in this way, the channel evaluation unit 132 can evaluate the medical facility based on the amount of reduced drug costs that would be wasted at home due to leftover drugs, etc.

The channel evaluation unit 132 stores the medical facility code and the determined evaluation index in the channel evaluation information 122 (S204), and ends the channel evaluation process. Note that the name of the medical facility may be stored in the medical information 112, and the channel evaluation information 122 may obtain the name from the medical information 112 and store it in the channel evaluation information 122.

The channel evaluation unit 132 determines the evaluation index of a medical facility based on the number of pharmaceutical management claims, such as surcharges for adjusting remaining medication and preventing duplications and interactions, and can highly evaluate medical facilities that communicate with insured persons and cooperate well with medical institutions. Medical facilities that are highly evaluated in this way can be expected to achieve high results when encouraging insured persons to participate in health programs.

Figure 11 is a flow chart showing an example of a selection process for outsourced health care projects and outsourcees. The outsourcing processing unit 131 acquires personal health information 111 and medical information 112 from the health database 101 (S301). The outsourcing processing unit 131 acquires health care project target criteria information 121 from the service database 102, and extracts insured persons (hereinafter simply referred to as health care project targets) who match the condition column 703, i.e., who are health care project targets, from the personal health information 111 acquired in S301 (S302).

For example, according to the first line of the health project target criteria information 121 in FIG. 6, the targets of the specific health checkup are people aged 40 or older, and according to the second line of the health project target criteria information 121 in FIG. 6, the targets of the specific health guidance are extracted according to the test value conditions such as sex, waist circumference, systolic blood pressure, diastolic blood pressure, fasting blood glucose level, HbA1c, and triglyceride from the health checkup results. Also, according to the first line of the health project target criteria information 121 in FIG. 6, for lung cancer screening, people who do not have lung cancer are extracted by referring to disease name information (not shown) in the health checkup information 602 along with age.

The entrustment processing unit 131 acquires the channel evaluation information 122 from the service database 102, and selects a medical care facility to be entrusted to for each insured person based on the channel evaluation information 122 and the usage status of the medical care facility in the medical information 112 for the health care project recipients extracted in step S302 (S303).

Specifically, for example, the entrustment processing unit 131 selects medical care facilities that the health care project recipient has used from the health care project participation history information 601 as target facilities for participation recommendation. If the health care project recipient has used multiple medical care facilities, the entrustment processing unit 131 may, for example, select the medical care facility that has been used the most (or a predetermined number in descending order), or may select the medical care facility with the highest value in the evaluation index column 803 of the channel evaluation information 122 (or a predetermined number in ascending order).

For example, for a health care project recipient who has never used a medical care facility, the entrustment processing unit 131 may select the medical care facility with the highest evaluation value in the evaluation index column 803 (or a predetermined number in descending order), or may refer to the address column 1135 of the insured person information 113 and select the medical care facility with the highest evaluation value (or a predetermined number in descending order) among the medical care facilities within a predetermined range (for example, within 1 km) from the address of the health care project recipient. Even if there is a medical care facility that the health care project recipient has used, the entrustment processing unit 131 may refer to the address column 1135 of the insured person information 113 and select the medical care facility with the highest number of uses (or a predetermined number in descending order) among the medical care facilities within a predetermined range (for example, within 1 km) from the address of the health care project recipient, or may select the medical care facility with the highest value in the evaluation index column 803 of the channel evaluation information 122 (or a predetermined number in descending order).

The entrustment processing unit 131 stores the health service recipients, the year (obtained from the year column 702), and the recommended health service for each medical facility in the entrustment information 123 (S304). The entrustment information 123 includes provided information indicating information on the facility where the health checkup is being conducted and reservation methods so that the medical facility can smoothly recommend medical checkups, and for example, this may be defined for each health service (or for each combination of health service and year) in the health service target criteria information 121, and the entrustment processing unit 131 may obtain the provided information from the health service target criteria information 121 and store it in the entrustment information 123.

The entrustment processing unit 131 may display an entrusted medical care facility display screen, described later in FIG. 12, on the output device 270 of the management terminal 104 (the entrustment processing unit 131 transmits screen information to the management terminal 104, and the screen generation unit 231 displays the screen on the output device 270 based on the screen information), and the user of the management terminal 104 may determine the medical care facility to which the participation recommendation is entrusted while checking the evaluation index for each medical care facility displayed on the entrusted medical care facility display screen, the allocation of insured persons to whom the participation recommendation is entrusted and the number of persons to be entrusted, and the entrustment budget calculated from the number of persons (not shown). Note that if there are multiple recommended health care projects, the entrustment processing unit 131 may assign health care project targets to medical care facilities for each health care project.

As described above, the entrustment processing unit 131 preferentially assigns health care project recipients to medical care facilities with high evaluation index values, and can entrust the encouragement of participation in health care projects to medical care facilities that are able to communicate with insured persons, cooperate with medical institutions, and have a high awareness of optimizing the use of medical services.

As described above, the entrustment processing unit 131 may assign one insured person to multiple medical care facilities, for example, by selecting a predetermined number of medical care facilities in descending order of the value of the evaluation index. In particular, since it is unclear which medical care facility an insured person who has no record of using a medical care facility such as a pharmacy in the medical information 112 will visit, the entrustment processing unit 131 assigns the insured person to multiple medical care facilities in descending order of the evaluation index, and makes it possible to invite the insured person to participate when the insured person visits any of the multiple medical care facilities, thereby increasing the probability of inviting the insured person to participate. As described below, when the server 103 receives a notification from the medical care facility terminal 105 indicating that the insured person has been invited to participate, the fact that the invitation to participate has been made is recorded in the record management information 124. Therefore, even if the entrustment processing unit 131 subsequently receives the personal ID of the insured person from another medical care facility terminal 105, if the insured person has already been invited to participate, by referring to the record management information 124, it may notify in step S403 that the insured person is not a target for the invitation to participate. This allows the commissioned processing unit 131 to prevent multiple medical care facilities from repeatedly encouraging a single insured person to participate in health care programs.

Figure 12 is an example of a entrusted medical care facility display screen displayed on the output device 170 of the management terminal 104. The entrusted medical care facility display screen includes, for example, a graph 1101, a medical care facility evaluation index display area 1102, and an entrustment information display area 1103. The X-axis of the graph 1101 arranges the medical care facilities in descending order of evaluation index, and the Y-axis displays the evaluation index 1111 for each medical care facility (obtained from the channel evaluation information 122) and the cumulative number of entrusted health care project recipients at the medical care facility 1112 (obtained from the entrustment information 123).

By sliding the entrustment range cursor 1113 left or right, it is possible to set which medical care facilities are to be included in the entrustment range (i.e., health care project recipients will not be assigned to medical care facilities located to the right of the entrustment range cursor 1113). This allows the user of the management terminal 104 to set the entrustment range while referring to the relationship between the evaluation index value of the medical care facility and the cumulative number of entrusted persons.

The healthcare facility evaluation index display area 1102 displays the contents of the channel evaluation information 122, and the consignment information display area 1103 displays the contents of the consignment information 123. There are differences in the implementation status of measures to adjust remaining medication and prevent duplication and interactions that healthcare facilities may implement, as these require time and effort, such as making the patient wait or contacting the medical institution to make inquiries about doubts and change the prescription during treatment. Such healthcare facilities that are proactive in pharmaceutical management are highly conscious of communicating with insured persons, collaborating with medical institutions, and optimizing the use of medical services, and by displaying healthcare facilities in descending order of evaluation index, the user of the management terminal 104 can assign more participation recommendations to healthcare facilities that are more likely to be successful in the recommendation.

Figure 13 is a flowchart showing an example of a health care business recommendation support process. The medical care facility terminal 105 accepts input of the personal ID of the insured person who visits the medical care facility via the input device 360, and transmits the personal ID and the medical care facility code of the medical care facility to the server 103 (S401).

The medical facility terminal 105 may directly accept input of the insured person's personal ID via the input device 360, or may obtain the personal ID from the insured person information 113 recorded in a two-dimensional code printed on a prescription brought by the insured person, or may read the personal ID from a card such as an insurance card, or may obtain the personal ID by linking with a system such as administrative information or a government web service such as PHR (Personal Health Record) based on online eligibility confirmation or the personal number.

The notification unit 133 of the server 103 refers to the entrusted information 123 to determine whether there is a record that matches the received combination of the insured person's personal ID and medical facility code, i.e., whether the insured person is eligible for an invitation to participate in the health program of the medical facility (S402).

If the notification unit 133 determines in step S402 that the insured person is a target for the recommendation to participate in the health care project, it acquires the recommended health care project and the provided information from the entrusted information 123 and transmits them to the medical care facility terminal 105 (S403). Note that if the notification unit 133 determines in step S402 that the insured person is not a target for the recommendation to participate in the health care project, it transmits a notification to the medical care facility terminal 105 indicating that the insured person is not a target for the recommendation to participate in the health care project.

The notification unit 133 displays the relevant health care project information on the output device 370 of the medical care facility terminal 105 (the notification unit 133 transmits screen information to the medical care facility terminal 105, and the screen generation unit 331 displays a screen on the output device 370 based on the screen information) (S404). This health care project information display screen will be described later with reference to FIG. 14. The person in charge at the medical care facility checks the health care project information display screen and encourages the insured person to participate, such as by encouraging them to take the specific health checkup.

The medical facility terminal 105 accepts input of the results of the participation invitation made by the medical facility staff via the input device 360 and transmits it to the server 103, and the notification unit 133 registers the received results in the performance management information 124 (S405). Specifically, the medical facility terminal 105 accepts input via the input device 360 of whether or not participation invitation was made (if participation invitation was not made, the reason), the results of the participation invitation (whether a reservation was made, and if a reservation was not made, the reason), etc., and transmits the accepted input, the insured person's personal ID, the medical facility code, and the date of the participation invitation to the server 103.

When an insured person visits a medical institution due to illness or injury, and is issued a prescription, they visit a pharmacy (healthcare facility) to pick up their medicine. Even insured persons who do not proactively intend to take advantage of health programs such as health checkups will visit a pharmacy (healthcare facility) when they become ill or injured.

The above process allows the insured person to receive medicine at the pharmacy (healthcare facility) at such a time, as well as an invitation to participate in the health care program to which the pharmacy (healthcare facility) has been entrusted. In this way, by encouraging participation in health care programs through pharmacists at the pharmacy (healthcare facility), who have more opportunities to communicate face-to-face with the insured person compared to the insurer, it is possible to increase the participation rate by raising awareness through pharmacists and other people, even for insured persons who did not respond to invitations to participate through letters or notifications received on mobile devices.

Figure 14 is an example of a health care project information display screen displayed on the output device 370 of the medical care facility terminal 105. The health care project information display screen displays information regarding the outsourcing of the implementation of the invitation to insured persons to participate, notified by the notification unit 133 of the server 103.

The health project information display screen includes, for example, an insured person information display area 1201, a participation recommendation information display area 1202, a health project implementation facility display area 1203, and a result registration area 1204. The insured person information display area 1201 displays information on the insured person who visited the health project facility, such as the personal ID and name of the insured person, obtained from the insured person information 113. The participation recommendation information display area 1202 displays information on the recommended health project corresponding to the health project facility and the insured person, obtained from the entrustment information 123.

The health project implementation facility display area 1203 displays information indicating facilities capable of implementing recommended health projects. For example, data defining the facilities capable of implementing each health project is stored in the health database 101, and the notification unit 133 identifies the facilities capable of implementing the recommended health project from the data, thereby realizing the display contents of the health project implementation facility display area 1203. Note that, in order to facilitate reservations for recommended health projects, it is desirable that the health project implementation facility display area 1203 includes a link to the reservation page of each facility (for example, information indicating the link of each facility is stored in the health database 101, and the notification unit 133 obtains the link from the information). This information may be stored in advance in the provided information 905, etc., and displayed using this information.

The result registration area 1204 includes a button for registering whether or not a participation invitation was implemented, a check box for registering the results of the participation invitation, and a text box for inputting the reason why the participation invitation was not implemented or why the participation invitation was implemented but declined by the insured person.

When an insured person visits a medical facility, for example, information identifying the insured person is input into a tablet terminal (corresponding to the input device 360 and output device 370 of the medical facility terminal 105), and the medical facility staff member can refer to the information on the health program information display screen notified by the server 103 to recognize that the insured person needs to be encouraged to participate, and can even make a reservation at the health program facility on the screen.

Figure 15 is a flowchart showing an example of the incentive determination process. The incentive determination process is a process in which the incentive determination unit 134 determines the incentive to be paid by the insurer to a medical care facility such as a pharmacy based on the performance of the health care project. The incentive determination process is executed, for example, every predetermined period, and the incentive for that period is calculated.

First, the incentive determination unit 134 obtains personal health information 111 from the health database 101, and commission information 123 and performance management information 124 from the service database 102 (S1501).

The incentive determination unit 134 identifies the number of times that invitations to participate were entrusted to each medical facility (number of entrustments) from the entrustment information 123, identifies the number of times that invitations to participate in health programs were made within the relevant period for each medical facility (number of invitations) from the performance management information 124, and identifies the number of times that insured persons who were invited to participate visited the health program for which they were invited to participate within the relevant period for each medical facility (number of visits) from the performance management information 124 and personal health information 111 (S1502).

The incentive determination unit 134 calculates an incentive for each medical facility based on the number of entrustments, the number of recommendations, and the number of visits (S1503). Specifically, for example, the incentive unit price for entrustment, the incentive unit price for implementation, and the incentive unit price for visits are determined in advance, and the incentive determination unit 134 determines the incentive to pay for each medical facility as follows: number of entrustments x incentive unit price for entrustment, number of recommendations x incentive unit price for recommendation, and number of visits x incentive unit price for visits.

The incentive determination unit 134 displays an incentive confirmation screen, described later with reference to FIG. 15, on the output device 270 of the management terminal 104 (the incentive determination unit 134 generates screen information and sends it to the management terminal 104, and the screen generation unit 231 displays the incentive confirmation screen on the output device 270 based on the screen information) (S1504), allowing the insurer or service provider to check the incentive payment amount to each medical care facility. The management terminal 104 uses a settlement service or the like to pay the incentive amount from the insurer or service provider to each medical care facility (S1505).

In this way, the incentive determination unit 134 calculates incentives for medical care facilities such as pharmacies according to three levels: the number of entrustments, the number of recommendations, and the number of visits. This encourages medical care facilities to promote the appropriate use of medical care and efforts to optimize medical expenses so that a large number of entrustments can be obtained; promote the implementation of health projects such as encouraging people to participate in health checkups; and encourage the development of communication methods to encourage people who have been recommended to participate to actually visit a doctor.

In addition, pharmacies (healthcare facilities) may experience a decrease in income by reducing the number of medicines, even though it is time-consuming, particularly when adjusting remaining medications and dealing with duplications and interactions. However, by using the above-mentioned process, pharmacies that are proactive in their pharmaceutical management efforts can be assigned the commission from insurers to encourage participation in health programs, and the amount of incentives received can be increased, which can prevent a decrease in income and ultimately increase income, providing an incentive to proactively work toward optimizing the use of medical services, such as pharmaceutical management.

Figure 16 is an example of an incentive confirmation screen displayed on the output device 270 of the management terminal 104. The incentive confirmation screen includes, for example, a graph 1401 and a medical care facility performance table 1402. The X-axis of the graph 1401 shows the medical care facilities in descending order of the evaluation index value, and the Y-axis shows the number of entrustments 1411, number of recommendations 1412, and number of visits 1413 for each medical care facility, as well as the cumulative number of entrustments 1414, cumulative number of recommendations 1415, and cumulative number of visits 1416.

The medical facility performance table 1402 also displays the number of entrustments, number of recommendations, and number of visits for each medical facility, as well as the incentive payment amount based on the number of entrustments, the incentive payment amount based on the number of recommendations, and the incentive payment amount based on the number of visits for each medical facility.

In this way, by allowing a user of the management terminal 104 (such as an insurer or a service provider) to check the number of entrustments, recommendations, and receptions for each medical facility on the incentive confirmation screen, the user can easily understand the status of the medical facility's efforts to encourage participation in health programs. Furthermore, the user can easily understand the amount of incentive payment according to the status of the efforts.

In the above embodiment, pharmacies have been mainly used as examples of medical care facilities, but other facilities may be included. Clinics, dental clinics, nursing care providers, and providers of preventive nursing care services are all examples of medical care facilities. By allocating participation encouragement for the health care service in this embodiment to these medical care facilities, it is possible to increase the contact points between the medical care facilities and insured persons, and to increase the opportunities for encouraging participation.

When the medical care facility is a clinic, dental clinic, nursing care business operator, or nursing care prevention business operator, the medical information 112 is generated based on data such as medical receipts, dental receipts, and nursing care receipts, rather than prescription receipts, and the server 103 determines a high evaluation index for medical care facilities that have many billing items related to the optimization of medical and nursing care service usage. Also, in medical care facilities other than pharmacies, medical or nursing care professionals who have the opportunity to communicate directly with insured persons, such as doctors, nurses, public health nurses, dentists, nursing care workers, registered dietitians, and health and exercise instructors, can encourage participation.

In the above embodiment, a medical facility such as a pharmacy encourages participation in the health program, but if the medical facility is able to provide health programs such as medical checkups and health guidance, it may provide the health program at the medical facility. Even if an insured person agrees to participate in the health program after being encouraged to do so, the participation rate may decrease if the insured person must visit the facility implementing the health program on another occasion. By making it possible for a medical facility such as a pharmacy to provide the equipment and personnel required for the health program, the actual participation rate can be increased.

The channel evaluation unit 132 may also increase the evaluation index of a medical facility that can provide health services (for example, by adding a predetermined number to the evaluation index of a medical facility that can provide health services, or by multiplying the evaluation index by a predetermined number (a number greater than 1)). This enables the server 103 to preferentially assign insured persons to medical facilities that can handle the entire process from encouraging participation to implementing the service, thereby increasing the participation rate of insured persons in health services.

The present invention is not limited to the above-described embodiments, but includes various modified examples. For example, the above-described embodiments have been described in detail to clearly explain the present invention, and are not necessarily limited to those having all of the configurations described. It is also possible to replace part of the configuration of one embodiment with the configuration of another embodiment, and it is also possible to add the configuration of another embodiment to the configuration of one embodiment. It is also possible to add, delete, or replace part of the configuration of each embodiment with other configurations.

The above configurations, functions, processing units, processing means, etc. may be realized in part or in whole in hardware, for example by designing them as integrated circuits. The above configurations, functions, etc. may be realized in software by a processor interpreting and executing a program that realizes each function. Information on the programs, tables, files, etc. that realize each function can be stored in a memory, a recording device such as a hard disk or SSD (Solid State Drive), or a recording medium such as an IC card, SD card, or DVD.

In addition, the control lines and information lines shown are those considered necessary for the explanation, and not all control lines and information lines on the product are necessarily shown. In reality, it can be assumed that almost all components are interconnected.

103 Server, 104 Management terminal, 105 Medical facility terminal, 111 Personal health information, 112 Medical information, 113 Insured person information, 121 Health business target criteria information, 122 Channel evaluation information, 123 Commission information, 124 Performance management information, 130 CPU, 131 Commission processing unit, 132 Channel evaluation unit, 133 Notification unit, 134 Incentive determination unit, 140 Memory, 150 Auxiliary storage device, 160 Input device, 170 Output device

Claims (8)

A health care business support device,
A processor and a memory,
connected to a display device,
The memory includes:
Information indicating the target population of the health program;
Maintaining medical information indicating a medical facility and a history of items of optimization of medical service provision implemented by the medical facility;
The processor,
calculating an evaluation value of the medical care facility based on the optimization history by referring to the medical information;
Allocating the health care service recipients to the health care facilities based on the evaluation values;
A health care service support device that displays, on the display device, information indicating the medical care facility to which the health care service recipient has been assigned. 2. The health care service support device according to claim 1,
The processor,
Calculate a weight for each of the optimization items in the medical information based on the inverse of the proportion of the optimization to the number of times the optimization is performed;
The health care project support device calculates the evaluation value based on the calculated weight and the number of times the optimization item is executed. 2. The health care service support device according to claim 1,
The memory holds information indicating costs reduced by the medical care facility through the optimization;
The processor,
A health care business support device that calculates an evaluation value of the medical care facility based on the optimization history and the costs. 2. The health care service support device according to claim 1,
The memory includes:
Personal health information indicating personal information of the insured person and the results of health care services received by the insured person;
and retaining health service eligibility criteria information indicating criteria for an insured person to be a health service eligibility target based on the results of the health service;
A health care business support device, wherein the information indicating the health care business recipients is obtained by the processor comparing the personal health information with the criteria indicated by the health care business recipient criteria information to identify the health care business recipients from the insured person. The health care project support device according to claim 4,
The processor,
Acquire personal information of the health service recipient to whom the medical care facility is assigned from the personal health information;
The health care project support device displays the acquired personal information on the display device. The health care project support device according to claim 4,
The memory holds performance management information indicating whether the health care service target person has been encouraged to participate in the health care service at the health care facility;
The processor is a health care business support device that determines an incentive to be paid to each of the health care facilities based on the number of health care business recipients assigned to the health care facility, the number of participation invitations indicated by the performance management information, and the number of health care business recipients who have been invited to participate and who have received the health care service indicated by the personal health information. 7. The health care project support device according to claim 6,
The processor displays on the display device an incentive for each medical facility based on the number of participation invitations, an incentive based on the number of health care program recipients who have been invited to participate and who have received the health care program, and an incentive based on the number of health care program recipients who have been invited to participate and who have received the health care program. A health care service support method using a health care service support device,
The health care business support device includes:
A processor and a memory,
connected to a display device,
The memory includes:
Information indicating the target population of the health program;
Maintaining medical information indicating a medical facility and a history of items of optimization of medical service provision implemented by the medical facility;
The health care business support method includes:
The processor refers to the medical information and calculates an evaluation value of the medical care facility based on the optimization history,
The processor assigns the health care service recipients to the health care facilities based on the evaluation values;
A health care project support method, in which the processor displays, on the display device, information indicating the medical care facility to which the health care project recipient has been assigned.

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