Abstract: A method and system for analyzing historical medical provider billings to statistically establish a normative utilization profile. Comparison of a medical provider's utilization profile with a normative profile is enabled. Based on historical treatment patterns and a fee schedule, an accurate model of the cost of a specific medical episode can be created. Various treatment patterns for a particular diagnosis can be compared by treatment cost and patient outcome to determine the most cost-effective treatment approach. It is also possible to identify those medical providers who provide treatment that does not fall within the statistically established treatment patterns or profiles.

Abstract: A method of de-identifying data, wherein the data to be de-identified is stored in a transaction table containing transactions and a personal information table containing identifiable information. The method includes the steps of generating a de-identification pointer associated with an individual in the personal information table, wherein the individual is associated with at least one transaction in the transaction table; creating a non-protected transaction table, wherein the non-protected transaction table includes a non-protected transaction reference and non-protected information associated with a transaction from the transactional table; and creating an index table including the identification and the non protected transaction reference. According to a preferred embodiment, the identification is advantageously unique and may also lack context to the individual. According to a further feature, the identification may be random or pseudo-random.

Abstract: A managed care expert system provides a graphical, interactive computer system which accepts user input relating to contract variables for a plurality of alternative contract scenarios, consults a database of national and locality-specific utilization data, performs a utilization and revenue analysis for both commercial and Medicare-age beneficiaries, and provides a synthetic fee schedule for comparing the likely revenue under capitation for a plurality of services to revenue for those services under a current reimbursement scenario. The system of the invention in its preferred embodiment enables a physician or other health care professional to use a broad array of assumptions to forecast utilization of medical procedures and estimated revenue per procedure under multiple capitation scenarios.

Abstract: A managed care expert system provides a graphical, interactive computer system which accepts user input relating to contract variables for a plurality of alternative contract scenarios, consults a database of national and locality-specific utilization data, performs a utilization and revenue analysis for both commercial and Medicare-age beneficiaries, and provides a synthetic fee schedule for comparing the likely revenue under capitation for a plurality of services to revenue for those services under a current reimbursement scenario. The system of the invention in its preferred embodiment enables a physician or other health care professional to use a broad array of assumptions to forecast utilization of medical procedures and estimated revenue per procedure under multiple capitation scenarios.

Abstract: A method and system for analyzing historical medical provider billings to statistically establish a normative utilization profile. Comparison of a medical provider's utilization profile with a normative profile is enabled. Based on historical treatment patterns and a fee schedule, an accurate model of the cost of a specific medical episode can be created. Various treatment patterns for a particular diagnosis can be compared by treatment cost and patient outcome to determine the most cost-effective treatment approach. It is also possible to identify those medical providers who provide treatment that does not fall within the statistically established treatment patterns or profiles.

Abstract: A managed care expert system provides a graphical, interactive computer system which accepts user input relating to contract variables for a plurality of alternative contract scenarios, consults a database of national and locality-specific utilization data, performs a utilization and revenue analysis for both commercial and Medicare-age beneficiaries, and provides a synthetic fee schedule for comparing the likely revenue under capitation for a plurality of services to revenue for those services under a current reimbursement scenario. The system of the invention in its preferred embodiment enables a physician or other health care professional to use a broad array of assumptions to forecast utilization of medical procedures and estimated revenue per procedure under multiple capitation scenarios.