SYSTEM AND METHOD OF DETERMINING AND OPTIMIZING HEALTHCARE SAVINGS OPPORTUNITIES FOR INDIVIDUALS VIA ALTERNATIVE ENGAGEMENT CHANNELS

摘要

A system and method is provided for determining healthcare savings opportunities for individuals and the likelihood of achieving those savings via alternative engagement channels (or modalities) to optimize clinical (outreach) coaching opportunities. A potential cost savings associated with a targeted change (or coaching opportunity) of a customer may be determined. First and second probabilities of achieving a goal (that corresponds to the targeted change) when first and second modalities are used, respectively, to engage the customer to assist the customer in achieving the goal may be determined. A first score associated with the first modality and the goal may be determined based on the potential cost savings and the first probability. A second score associated with the second modality and the goal may be determined based on the potential cost savings and the second probability. Either the first modality or the second modality is selected as a selected modality based on a comparison of the first score and the second score for use in engaging the customer to assist the customer in achieving the goal.

主权项

1. A method of providing indications of modalities for targeted customer changes, the method being implemented on a computer system that includes one or more physical processors which, when executed, perform the method, the method comprising:
determining, by the computer system, a first potential cost savings associated with a first targeted change of a customer; determining, by the computer system, a first probability of achieving a first goal that corresponds to the first targeted change when a first modality is used to engage the customer to assist the customer in achieving the first goal; determining, by the computer system, a first score associated with the first modality and the first goal based on the first potential cost savings and the first probability; determining, by the computer system, a second probability of achieving the first goal that corresponds to the first targeted change when a second modality is used to engage the customer to assist the customer in achieving the first goal, wherein the second modality is different than the first modality; determining, by the computer system, a second score associated with the second modality and the first goal based on the first potential cost savings and the second probability; selecting, by the computer system, based on a comparison of the first score and the second score, either the first modality or the second modality as a selected modality for use in engaging the customer to assist the customer in achieving the first goal; and generating, by the computer system, a display that conveys the selected modality for facilitating the first targeted change.