Abstract: Methods and systems for monitoring and managing healthcare performance. The system comprises one or more network interfaces configured to provide access to a network and one or more data processing servers coupled to the one or more network interfaces to enable communication with one or more healthcare manager devices. The one or more data processing servers to execute instructions to receive healthcare data from a plurality of data source devices over the network, extract patient medical data from the received healthcare data, group the patient medical data according to episodes of care, analyze the patient medical data to determine variances, generate prescriptive opportunity scripts to reduce the determined variances, add the prescriptive opportunity scripts to a playbook, and generate output corresponding to the analysis and the playbook to the one or more healthcare manager devices.

Abstract: Systems and methods for determining options for reducing spend and/or trend for a prescription drug plan are provided. Based on an analysis of spend and/or trend for the prescription drug plan, a prescription drug spend and/or trend application may determine that an option is available to reduce spend and/or trend. For example, an option may be provided that addresses a primary component of spend and/or trend as determined by the spend and trend application. In another example, an option may be provided that addresses a deviation by the prescription drug plan from a selected performance metric. In yet another example, an option may be provided that addresses a status change for a drug in a marketplace. The spend and/or trend application may optionally project an impact of an option on the prescription drug plan (e.g., financial impact, member impact) using a related model.

Abstract: Systems and methods for simulating a change to a prescription drug plan may be provided. In response to receiving a request to simulate the change to the prescription drug plan, a prescription drug spend and/or trend application may retrieve data related to the prescription drug plan from a database. A model that includes a plurality of calculations to simulate the change may be applied to the retrieved data A user computing device may be provided with an indication of an impact on the prescription drug plan responsive to the at least one change based at least in part on the application of the model to the retrieved data. The modeling of the change may be related, for example, to an option to reduce spend and/or trend as determined by the spend and/or trend application.

Abstract: Systems and methods for simulating a change to a prescription drug plan may be provided. In response to receiving a request to simulate the change to the prescription drug plan, a prescription drug spend and/or trend application may retrieve data related to the prescription drug plan from a database. A model that includes a plurality of calculations to simulate the change may be applied to the retrieved data A user computing device may be provided with an indication of an impact on the prescription drug plan responsive to the at least one change based at least in part on the application of the model to the retrieved data. The modeling of the change may be related, for example, to an option to reduce spend and/or trend as determined by the spend and/or trend application.

Abstract: Systems and methods for determining options for reducing spend and/or trend for a prescription drug plan are provided. Based on an analysis of spend and/or trend for the prescription drug plan, a prescription drug spend and/or trend application may determine that an option is available to reduce spend and/or trend. For example, an option may be provided that addresses a primary component of spend and/or trend as determined by the spend and trend application. In another example, an option may be provided that addresses a deviation by the prescription drug plan from a selected performance metric. In yet another example, an option may be provided that addresses a status change for a drug in a marketplace. The spend and/or trend application may optionally project an impact of an option on the prescription drug plan (e.g., financial impact, member impact) using a related model.

Abstract: Systems and methods for determining an impact on spend and/or trend for a prescription drug plan are provided. In response to receiving the request to analyze spend and/or trend, a prescription drug spend and/or trend application may retrieve data related to the prescription drug plan from a database. The analysis of spend and/or trend includes a determination of components of spend and/or trend having a significant impact on spend and/or trend. In one example, the spend and/or trend application may determine whether an option is available to improve at least one of the components having the significant impact on spend and/or trend. If an option is available, the impact (e.g., financial impact, member impact) of the implementation of the option on the prescription drug plan may be modeled by the spend and/or trend application.