Abstract: Evaluation of health care provider quality is described. Data is obtained, the data including claims data and member data of a member panel of a health care provider, the member panel including patients to which the provider provides health care services. Based on the obtained data, quality scores are determined for the provider across the member panel and across health care quality domains. A composite health provider quality score of the health provider is then determined, where the composite health provider quality score is a composite of the determined quality scores across the member panel and across the multiple health care quality domains. In some embodiments, risk-adjustment is performed for the quality scores, such as risk-adjustment against a peer reference base based on disease categories, patient age, and patient gender.

Abstract: Facilities are provider herein for predicting potentially preventable patient readmissions after discharge from a health care provider. A patient readmission prediction model is built based on received patient data for one or more health care providers. Patient attributes discernible from that patient data are extracted and analyzed, and certain attributes are selected as being meaningful in predicting likelihood of post-discharge, potentially preventable patient readmission by patients newly admitted to a health care provider. Patient data for a newly admitted patient is obtained, and the readmission prediction model is applied against that patient data for the newly admitted patient to obtain a predictive risk score that is indicative of the likelihood that the newly admitted patient will experience a potentially preventable readmission post-discharge from the health care provider.