SYSTEMS AND METHODS FOR MITIGATING RISK OF A HEALTH PLAN MEMBER
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United States of America Patent
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app pub date -
Sep 30, 2013
filing date -
Sep 30, 2013
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Abstract
A method for attempting to mitigate risk of a health plan member. The method includes: receiving medical data related to the health plan member; computing a first score for the health plan member corresponding to predicated future financial health care costs for the health plan member based on the medical data; computing a second score for the health plan member corresponding to a clinical risk for the health plan member based on the medical data; computing a third score for the health plan member corresponding to a probability of a future acute care event for the health plan member within a threshold amount of time based on the medical data; assigning the health plan member to a risk tier based on the first, second, and third scores; and engaging the health plan member based on the risk tier and one or more engagement factors.
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