SYSTEMS AND METHODS FOR HEALTH RISK DETERMINATION

摘要

Embodiments of the present disclosure help provide an accurate and easily-interpreted measure of health risk based on medical claims, pharmaceutical claims, and lost time claims. Embodiments of the present disclosure also allow for the efficient and accurate comparison of the health risks between different groups of individuals.

主权项

1. A computer-implemented method comprising:
retrieving, by a computer system, claims data for a plurality of individuals from a database, the claims data including medical claims, pharmacy claims, and lost time claims; determining, by the computer system, an average cost per individual for the medical claims, an average cost per individual for the pharmacy claims, and an average cost per individual for the lost time claims; determining, by the computer system, a percentage contribution to total claim costs from the medical claims, a percentage contribution to total claim costs from the pharmacy claims, and a percentage contribution to total claim costs from the lost time claims; determining, by the computer system for a future time period, a predicted increase in costs associated with the medical claims, a predicted increase in costs associated with the pharmacy claims, and a predicted increase in costs associated with the lost time claims; determining, by the computer system, a respective weight for each of a plurality of categories within the medical claims based on the average cost per individual for the medical claims, the percentage contribution to total claim costs from the medical claims, and the predicted increase in costs associated with the medical claims; determining, by the computer system, a respective weight for each of a plurality of categories within the pharmacy claims based on the average cost per individual for the pharmacy claims, the percentage contribution to total claim costs from the pharmacy claims, and the predicted increase in costs associated with the pharmacy claims; and determining, by the computer system, a respective weight for each of a plurality of categories within the lost time claims based on the average cost per individual for the lost time claims, the percentage contribution to total claim costs from the lost time claims, and the predicted increase in costs associated with the lost time claims.