DETECTING UNEXPECTED HEALTHCARE UTILIZATION BY CONSTRUCTING CLINICAL MODELS OF DOMINANT UTILIZATION GROUPS

摘要

A system and method for identifying unexpected utilization profiles at a patient level includes determining one or more clusters that have a profile based on patient profiles and building a representative model for each cluster including demographic and clinical information. Using the model, demographic and clinical characteristics are determined which form expected utilization cluster. An expected utilization cluster for each patient, which is derived from the demographic features and the clinical characteristics, is compared against an actual utilization profile for that patient to determine whether the actual utilization profile is unexpected.