System and method for predictive modeling in disease management
First Claim
1. A method of disease management embodied in a computer program product for execution on a computer system, comprising:
- 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;
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
outputting the classified future healthcare risk participants to the tangible storage medium.
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Accused Products
Abstract
A method and system for administering a disease management program to improve healthcare quality, reduce healthcare costs, and optimize delivery of healthcare services. A multi-condition risk assessment is conducted for all or a substantial portion of a population of program participants, and collected multi-condition risk assessment data are combined with claims data for predictive modeling of future healthcare risk and expense. Participants are risk-stratified into one or more classifications of future healthcare cost risk, and appropriate intervention or delivery of healthcare services is made based on the risk classification.
37 Citations
18 Claims
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1. A method of disease management embodied in a computer program product for execution on a computer system, comprising:
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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; 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 outputting the classified future healthcare risk participants to the tangible storage medium. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
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15. A method of disease management embodied in a computer program product for execution on a computer system comprising:
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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; conducting a multi-condition risk assessment of at least a substantial portion of program participants within a defined population; generating a patient record based on the multi-condition risk assessment; and providing differing degrees of healthcare intervention for program participants based on their patient record. - View Dependent Claims (16)
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17. A method of optimizing delivery of healthcare services to participants in a disease management program, said method comprising:
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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; conducting a multi-condition risk assessment of at least a substantial portion of a population; categorizing individual program participants selected from the population into at least a higher-risk category and a lower-risk category; and providing more intensive healthcare intervention to program participants categorized in the higher-risk category and less intensive healthcare intervention to program participants categorized in the lower-risk category. - View Dependent Claims (18)
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Specification