Methods and systems for healthcare assessment

摘要

Certain embodiments provide methods and systems by which a predictive modeling provider may provide a client with predictive healthcare analysis. The predictive healthcare analysis may be used to assess whether a beneficiary is likely to develop conditions requiring healthcare. If such conditions are identified, intervention plans are developed and implemented to address the conditions and reduce healthcare costs. Certain embodiments provide method and systems by which an integrated benefits management organization may manage a client's healthcare program. A claim audit may be performed on healthcare claims of the client's beneficiaries. A claim repricing process may be used to discount the healthcare claims of the client's beneficiaries. In at least certain embodiments, the predictive modeling provider or integrated benefits management organization are motivated to maximize the reduction in the client's healthcare costs.