Abstract: Intelligence and analytics may be improved by combining sets of disparate data records and matching records between entities. The matched records may then be analyzed by identifying relevant entities and providing information to a user containing the combined sets of secure data records and the analysis. The information may be customized for the user after identifying the user accessing the interface. Additionally, rules may be applied to the analyzed data to enhance the data when viewed by the user.

Abstract: Intelligence and analytics may be improved by combining sets of disparate data records and matching records between entities. The matched records may then be analyzed by identifying relevant entities and providing information to a user containing the combined sets of secure data records and the analysis. The information may be customized for the user after identifying the user accessing the interface. Additionally, rules may be applied to the analyzed data to enhance the data when viewed by the user.

Abstract: A relationship management apparatus, method and computer program product providing a user interface containing treatment protocol for an individual comprising: (a) a user interface electrically connected with a data storage device; (b) a server electrically connected with the user interface and the data storage device; and (c) a treatment processor electrically connected with the server, wherein the treatment processor is configured to generate an optimized treatment protocol for the individual.

Abstract: A relationship management device and method providing a user interface containing treatment protocol for an individual comprising: (a) a user interface electrically connected with a data storage device; (b) a server electrically connected with the user interface and the data storage device; and (c) a treatment processor electrically connected with the server, wherein the treatment processor is configured to generate an optimized treatment protocol for the individual.

Abstract: A system and method for receiving demographic data on a patient and data on at least one pharmacy service prescribed for the patient; assigning a unique drug class to each pharmacy service; using the unique drug classes for ordering the pharmacy services according to a predetermined hierarchy of classes; and providing a risk score for the patient using the ordered pharmacy services.

Abstract: Intelligence and analytics may be improved by combining sets of disparate data records and matching records between entities. The matched records may then be analyzed by identifying relevant entities and providing information to a user containing the combined sets of secure data records and the analysis. The information may be customized for the user after identifying the user accessing the interface. Additionally, rules may be applied to the analyzed data to enhance the data when viewed by the user.

Abstract: A relationship management device and method providing a user interface containing treatment protocol for an individual comprising: (a) a user interface electrically connected with a data storage device; (b) a server electrically connected with the user interface and the data storage device; and (c) a treatment processor electrically connected with the server, wherein the treatment processor is configured to generate an optimized treatment protocol for the individual.

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.

Abstract: Methods, apparatus, and software packages for data processing are disclosed. In some embodiments, the method may include receiving a dataset. In some embodiments, the method may include determining a control number of a processing system. In some embodiments, the control number may include a number of evaluation units within the processing system. The method may include processing the dataset using a plurality of evaluation units. In some embodiments, processing the dataset may include allocating a free evaluation unit to form a busy evaluation unit. Processing the dataset may also include creating a data subdivision for the busy evaluation unit, the data subdivision including a part of the dataset. Processing the dataset may also include evaluating the data subdivision. Processing the dataset may also include releasing the busy evaluation unit. The allocating, creating, evaluating, and releasing may performed concurrently by the plurality of evaluation units.

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: 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 system and method for receiving demographic data on a patient and data on at least one pharmacy service prescribed for the patient; assigning a unique drug class to each pharmacy service; using the unique drug classes for ordering the pharmacy services according to a predetermined hierarchy of classes; and providing a risk score for the patient using the ordered pharmacy services.

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: 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: A computer-implemented system and method utilizes patient claim data, including medical, pharmaceutical, laboratory claims, and self-report survey data to classify patients into one or more health management groups (HMGs) relating to one or more particular diseases, health conditions or health pre-conditions, each having an associated severity level that indicates the severity of the patient's condition. The HMGs assigned to each patient (e.g., health plan member) enable users of the system and method to identify patients having particular diseases, health conditions and pre-conditions based not only upon the patients' claim data but also based upon the patients' self-report survey data obtained from various sources. The HMGs assigned for each patient also enable the user to identify the severity of the patient's disease, condition or pre-condition to facilitate intervention and/or preventative care of the patient.

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: 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, shills 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: 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 system and method for matching drugs and diseases involves matching drugs identified in a specific patient's prescription claim records with diseases identified in the patient's medical claims. A weighted relationship is generated between the matched drugs and diseases by calculating a link weight in accordance with a preprogrammed formula for each of the diagnosis codes identified in the patient's medical claims that is identified as associated with the disease identified and the drug. The link weight provides a statistical match association value to each of the matched diseases identified by way of a diagnosis code in the patient's medical claim and the drug identified in the prescription claim.

Abstract: A system and computer-implemented method for grouping medical records implements a multi-level analysis of the records. The level of analysis is based upon the time proximity of each record to the defining medical procedure or service (anchor procedure) to be analyzed. Claim records are processed to determine whether any of the records should be grouped with the anchor procedure into a procedure episode group (PEG) using the date of service for each claim record and a level of relationship between the claim records and the anchor procedure. The requisite level of relationship between the claim records and the anchor procedure depends upon the position of the records within the time window. Claim records having the requisite relationship level associated with the portion of the time window in which they fall are included in the PEG.