Importance

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Abstract

In a system and method for identifying aberrations in treatment pattern for a medical condition, a group of healthcare claim data to be analyzed is identified, wherein the group of healthcare claim data to be analyzed includes claim data representing treatment of the medical condition. Actual treatment pattern data is generated that represents the claim data in the group of healthcare claim data to be analyzed. Defined treatment pattern data for the medical condition is retrieved and compared to the actual treatment pattern data to identify one or more discrepancies therebetween, and corresponding comparison data representing the results of the comparison is generated. The actual treatment pattern data may represent a patient's treatment for the medical condition, and the defined treatment pattern data may represent treatment of a group of other patients for the medical condition. Alternatively, the actual treatment pattern data may represent treatment of multiple patients for the medical condition by a healthcare provider, and the defined treatment pattern data may represent an established procedure for treatment of the medical condition. The system and method may also generate the defined treatment pattern data by identifying and compiling claim data relating to treatment of the medical condition from a database of historical claim data.

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First Claim