Abstract: An apparatus, system, and method for rapid cohort analysis. In one embodiment, the apparatus includes an interface and a processor. The interface may receive an identifier of a first index attribute. The processor may search the database for a first group of records associated with the first index attribute, search the database for a second group of records, each record in the second group of records sharing a common second index attribute with a record in the first group of records, but not associated with the first index attribute, and calculate a statistic in response to information associated with the first group of records and the second group of records.

Abstract: An apparatus, system, and method for member matching. In one embodiment, the apparatus includes an input adapter, a processor, and an output adapter. The input adapter may receive a first data record from a plurality of data records stored in one or more databases. The processor may generate a first data key from one or more field values in the first data record, compare a second data key associated with a second data record with the first data key associated with the first data record, and identify a match between the first data key and the second data key. In one embodiment, the output adapter may produce an output configured to identify the first data record and the second data record in response to identification of the match.

Abstract: An apparatus, system, and method for member matching. In one embodiment, the apparatus includes an input adapter, a processor, and an output adapter. The input adapter may receive a first data record from a plurality of data records stored in one or more databases. The processor may generate a first data key from one or more field values in the first data record, compare a second data key associated with a second data record with the first data key associated with the first data record, and identify a match between the first data key and the second data key. In one embodiment, the output adapter may produce an output configured to identify the first data record and the second data record in response to identification of the match.

Abstract: A computer-implemented system and method for administering a drug registry database generates a display of a plurality of new drug/comparator drug pairings, wherein each new drug is added to the database when a threshold number of healthcare claims for the new drug have been received. Upon receiving a selection of a new drug/comparator drug pairing, and filter parameters input by a user, an analysis engine searches the healthcare claims stored in the database to identify a first and second group of patients satisfying the filter parameters input by the user; wherein the first group includes patients with claim data indicating use of the new drug and the second group includes patients with claim data indicating use of the comparator drug.

Abstract: A system and method for transforming data from a first format to a second format. A pre-existing set of software instructions may be used to transform the data from the first format to the second format. A user may document a set of format parameters for the first format of data, which can be used to determine which portion of the pre-existing software instructions are used to transform the data from the first format to the second format.

Abstract: Methods, systems, and apparatuses for comparing healthcare data are disclosed. Some embodiments of the method for comparing healthcare data may include receiving healthcare data for geographic regions. The healthcare data may include healthcare variables and clinical data. Some embodiments of the method may further include analyzing, with a processing device, one or more healthcare variables for geographic regions. In some embodiments of the method, analyzing the one or more healthcare variables may include assigning each geographic region to one of several clusters based on the one or more healthcare variables. Some embodiments of the method may further include analyzing, with a processing device, the clinical data for geographic regions. In some embodiments of the method, analyzing the clinical data may include determining a primary magnitude for each geographic region of a primary measure, determining a secondary magnitude for each geographic region of a secondary measure, and comparing them.

Abstract: A computer-implemented method for profiling medical claims to assist health care managers in determining the cost-efficiency and service quality of health care providers. The method allows an objective means for measuring and quantifying health care services. An episode treatment group (ETG) is a patient classification unit, which defines groups that are clinically homogenous (similar cause of illness and treatment) and statistically stable. The ETG grouper methodology uses service or segment-level claim data as input data and assigns each service to the appropriate episode. The program identifies concurrent and recurrent episodes, flags records, creates new groupings, shifts groupings for changed conditions, selects the most recent claims, resets windows, makes a determination if the provider is an independent lab and continues to collect information until an absence of treatment is detected.

Abstract: A method for managing insurance claim data across insurance policies involves identifying a first insurance claim data and a second insurance claim data using pattern recognition on multiple insurance claim data associated with an insured party, where the first insurance claim data and the second insurance claim data are associated with a single insurance claim of the insured party, where the first insurance claim data is further associated with a first insurance policy, and where the second insurance claim data is further associated with a second insurance policy. The method further involves determining a financial responsibility of the insured party for the single insurance claim based on the first insurance claim data and the second insurance claim data, and presenting the financial responsibility in a graphical user interface (GUI).

Abstract: A method for managing insurance claim data involves identifying a first insurance claim data and a second insurance claim data using pattern recognition on multiple insurance claim data associated with an insured party, where the first insurance claim data and the second insurance claim data are associated with a single insurance claim associated with the insured party, where the second insurance claim data is later in time than the first insurance claim data, and where the second insurance claim data includes a modification of the single insurance claim relative to the first insurance claim data. The method further involves determining a financial responsibility of the insured party for the single insurance claim based on the second insurance claim data, and presenting the first insurance claim data, the second insurance claim data, and the financial responsibility in a graphical user interface (GUI).

Abstract: A method for generating healthcare provider quality rating data includes grouping claim records into one or more claim groups, assigning each claim group to a responsible provider, assessing the claim records in each claim group using guidelines for the particular disease or condition, and generating a compliance score for the claim group, wherein the compliance score indicates the extent to which the claim records in the claim group match the guidelines, and generating normalized provider quality rating data. A method for generating healthcare provider cost rating data includes grouping claim records into one or more claim groups, assigning each claim group to a responsible provider, calculating the total cost of each claim group, aggregating the total cost for each claim group, and comparing the total aggregate cost of each claim group assigned to each provider to an expected cost value.

Abstract: A computer-implemented system and method for administering a drug registry database generates a display of a plurality of new drug/comparator drug pairings, wherein each new drug is added to the database when a threshold number of healthcare claims for the new drug have been received. Upon receiving a selection of a new drug/comparator drug pairing, and filter parameters input by a user, an analysis engine searches the healthcare claims stored in the database to identify a first and second group of patients satisfying the filter parameters input by the user; wherein the first group includes patients with claim data indicating use of the new drug and the second group includes patients with claim data indicating use of the comparator drug.

Abstract: Techniques suitable for identifying potential subjects for a clinical trial and other applications are disclosed. One or more exclusion or inclusion criteria are defined for the clinical trial. One or more specialized searching tables are pre-generated using administrative healthcare claims data and the one or more exclusion or inclusion criteria. The specialized searching tables are searched. Through the searching step, subjects are identified within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria. Through the searching step, a geographical area is identified corresponding to the subjects who match the one or more exclusion or inclusion criteria. A customized report is generated using the identified subjects and geographical area.

Abstract: Various embodiments for estimating a cost of a medical procedure. In one example, a method may include the operations of averaging data from various geographies of the amount billed to form a national average amount billed for the medical procedure; associating the average amount billed with one or more claim data items from a health plan; grouping the claim data items from the health plan using episode classes; calculating an average amount billed for each episode class; and adjusting the average amount billed for each episode class by a geographic adjustment factor to form an estimated cost of the medical procedure.

Abstract: A computer-implemented method for profiling medical claims to assist health care managers in determining the cost-efficiency and service quality of health care providers. The method allows an objective means for measuring and quantifying health care services. An episode treatment group (ETG) is a patient classification unit, which defines groups that are clinically homogenous (similar cause of illness and treatment) and statistically stable. The ETG grouper methodology uses service or segment-level claim data as input data and assigns each service to the appropriate episode. The program identifies concurrent and recurrent episodes, flags records, creates new groupings, shifts groupings for changed conditions, selects the most recent claims, resets windows, makes a determination if the provider is an independent lab and continues to collect information until an absence of treatment is detected.

Abstract: A computer-implemented system and method for administering a drug registry database generates a display of a plurality of new drug/comparator drug pairings, wherein each new drug is added to the database when a threshold number of healthcare claims for the new drug have been received. Upon receiving a selection of a new drug/comparator drug pairing, and filter parameters input by a user, an analysis engine searches the healthcare claims stored in the database to identify a first and second group of patients satisfying the filter parameters input by the user; wherein the first group includes patients with claim data indicating use of the new drug and the second group includes patients with claim data indicating use of the comparator drug.

Abstract: System and methods for processing price data for health services are provided. In one embodiment, the system includes a data storage device configured to store a database comprising one or more records. The system may also include a server in data communication with the data storage device. The server may be suitably programmed to search the database to obtain a group of records of prices for a health service received by a group of subjects, wherein the health service is comprised in a service category; extract a representative price for the health service; determine a weight for the health service relative to the service category; and generate, using a processor, a weighted price for the health service based on the weight and the representative price.

Abstract: A system, method, and tangible computer program product for analysis of condition, cost, and duration are presented. In one embodiment, the system includes an interface and a processor. The interface may receive or obtain one or more attributes associated with a subject having a condition. The processor may search a database for a group of records associated with the attributes, wherein the records comprise cost and duration information associated with the condition, estimate cost and duration in response to the cost and duration information, and generate an output in response to the cost estimate and duration estimate.

Abstract: Method and system for identifying safety concerns regarding a new drug. In one example, a database of healthcare claims is utilized and the method may include identifying from the database a first group of patients that have received the drug; extracting one or more medical events that the first group of patients have experienced; identifying a second group of patients that have received a comparator drug; extracting one or more medical events that the second group of patients have experienced; and comparing the one or more medical events of the first group to the one or more medical events of the second group to determine one or more common occurrences therebetween. The method may also include computing a probability value for each of the one or more common occurrences. In this way, embodiments of the present invention may be used to identify and quantify the probability that certain medical events will occur to patients taking the new drug.

Abstract: Techniques suitable for identifying potential subjects for a clinical trial and other applications are disclosed. One or more exclusion or inclusion criteria are defined for the clinical trial. One or more specialized searching tables are pre-generated using administrative healthcare claims data and the one or more exclusion or inclusion criteria. The specialized searching tables are searched. Through the searching step, subjects are identified within the administrative healthcare claims data who match the one or more exclusion or inclusion criteria. Through the searching step, a geographical area is identified corresponding to the subjects who match the one or more exclusion or inclusion criteria. A customized report is generated using the identified subjects and geographical area.

Abstract: System and methods for rapid generation of attribute driven temporal clustering are provided. In one embodiment, the system includes a data storage device and a server. The data storage device may be configured to store a database comprising a plurality of records. The system may also include a server in data communication with the data storage device. The server may be suitably programmed to receive a first attribute and a second attribute, search a database stored on a data storage device to obtain a first group of records associated with the first attribute, search the first group of records to obtain a second group of records associated with the second attribute, determine a temporal relationship between a first index date of a first attribute and a second index date of the second attribute, and generate an output comprising a graphical representation of the temporal relationship.