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Predictive modeling system and method for disease management

  • US 7,685,000 B1
  • Filed: 08/10/2005
  • Issued: 03/23/2010
  • Est. Priority Date: 08/10/2005
  • Status: Active Grant
First Claim
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1. A method of disease management embodied in a computer program product for execution on an instruction processing system, comprising a tangible storage medium readable by the instruction processing system and storing instructions for execution by the instruction processing system for performing the method comprising:

  • filtering claims data of program participants to define a population;

    conducting a multi-condition risk assessment of substantially all participants within the defined population;

    combining data gathered from said multi-condition risk assessment with claims data for participants within the defined population;

    classifying future healthcare risk of participants based on the combination of claims data and data gathered from said multi-condition risk assessment; and

    determining an appropriate level of disease management intervention and support for program participants based on the future healthcare risk classification that ranges from patient education for lower risk individuals, passive monitoring and reporting of progress and program compliance for middle risk individuals, to more active intervention and close one-on-one case management for higher risk individuals.

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