Analyzing administrative healthcare claims data and other data sources

• US 9,129,059 B2
• Filed: 02/20/2014
• Issued: 09/08/2015
• Est. Priority Date: 12/06/2005
• Status: Active Grant

• Current Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Original Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Inventors: Rawlings, Jean W., Anderson, David R., Kraus, Carl, Paris, Andrew
• Primary Examiner(s): Beausoliel, Jr., Robert
• Assistant Examiner(s): Rayyan, Susan F
• Application Number:
  US14/185,476
• Publication Number:
  US 20140236618A1
• Time in Patent Office: 565 Days
• Field of Search: None
• US Class Current: 1/1
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation
• CPC Class Codes: Y10S 707/941 Human sciences

Abstract

Techniques suitable for identifying potential subjects for a clinical trial and other applications are disclosed. One or more exclusion or inclusion criteria are defined for the clinical trial. One or more specialized searching tables are pre-generated using administrative healthcare claims data and the one or more exclusion or inclusion criteria. The specialized searching tables are searched. Through the searching step, subjects are identified within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria. Through the searching step, a geographical area is identified corresponding to the subjects who match the one or more exclusion or inclusion criteria. A customized report is generated using the identified subjects and geographical area.

Claims

1. A computer program product, comprising:

a non-transitory computer readable medium comprising;

code to search data;

code to compare one subset of the data against a plurality of other subsets of the data; and

code to calculate a hypergeometric statistical result based, at least in part, on the comparing step using one or more pre-generated factorial tables, the pre-generated factorial tables comprising logarithmic entries.

2. The computer program product of claim 1, further comprising code to detect fraud based, at least in part, on the calculated hypergeometric statistical result.

3. The computer program product of claim 1, further comprising code to perform quality control on the data.

4. The computer program product of claim 1, further comprising code to perform pattern recognition on the data.

5. The computer program product of claim 1, further comprising code to perform cluster validity analysis on the data.

6. The computer program product of claim 1, further comprising code to perform tree classifier design on the data.

7. The computer program product of claim 1, further comprising code to perform image template matching on the data.

8. The computer program product of claim 1, further comprising code to cluster the data into appropriate groupings before calculating the hypergeometric statistical result.

9. The computer program product of claim 1, further comprising code to present certain portions of the data to a user based, at least in part, on the calculated hypergeometric statistical result.

10. The computer program product of claim 1, wherein the code to calculate the hypergeometric statistical result comprises:

code to calculate a starting probability distribution function (pdf) value; and

code to recursively generate additional pdf values using the logarithmic entries.

11. The computer program product of claim 1, wherein the logarithmic entries comprise natural logarithmic entries.

12. The computer program product of claim 1, wherein the data comprises specialized search tables (SSTs), and the medium further comprises code to generate the specialized search tables (SSTs) by selecting particular data for inclusion in the specialized search tables (SSTs).

13. A method for statistical calculations based on administrative health claims data comprising:

searching, with a computing device, data;

comparing, with the computing device, one subset of the data against a plurality of other subsets of the data; and

calculating, with the computing device, a hypergeometric statistical result based, at least in part, on the comparing step using one or more pre-generated factorial tables, the pre-generated factorial tables comprising logarithmic entries.

14. The method of claim 13, further comprising using the hypergeometric statistical result to detect medical-related fraud.

15. The method of claim 13, further comprising performing quality control on the data.

16. The method of claim 13, further comprising performing pattern recognition on the data.

17. The method of claim 13, further comprising performing cluster validity analysis on the data.

18. The method of claim 13, further comprising performing tree classifier design on the data.

19. The method of claim 13, further comprising performing image template matching on the data.

20. The method of claim 13, further comprising clustering the data into appropriate groupings before calculating the hypergeometric statistical result.

21. The method of claim 13, further comprising:

calculating a starting probability distribution function (pdf) value; and

recursively generating additional pdf values using the logarithmic entries.

22. The method of claim 13, wherein the logarithmic entries comprise natural logarithmic entries.

23. The method of claim 13, wherein the data comprises specialized search tables (SSTs), and the medium further comprises code to generate the specialized search tables (SSTs) by selecting particular data for inclusion in the specialized search tables (SSTs).