Abstract: A method of evaluating managed care organizations (MCOs) includes acquiring medical data associated with patients' healthcare encounters with the MCOs, calculating a health risk score of a subpopulation using patient characteristic data included in the medical data, providing encounter data included in the medical data and the health risk score as input to analytic processes that track services provided by the MCOs, and generating a risk-adjusted performance metric of the MCOs by the analytic processes. The risk-adjusted performance metrics relate to categories of concern. The method further includes generating a standardized score for each of the risk-adjusted performance metrics based on a comparison of the subpopulation with an entire population, assigning a weight to each of the standardized scores based on an importance level of each category of concern, and generating a final score corresponding to a performance category for each of the MCOs based on the standardized scores.

Abstract: A computer system configured to determine healthcare accessibility in a geographic region includes a memory storing a computer program, and a processor configured to execute the computer program. The computer program is configured to determine an expected level of care necessary for each member in the geographic region relating to a medical service type using member demographic data, aggregate the expected level of care necessary for each member to determine a total level of demand of the medical service type, and construct a ball tree representation indicating the healthcare accessibility for the medical service type on a display in real-time.

Abstract: A system and method for automating analytic processes to improve health outcomes and manage healthcare costs. Data associated with healthcare encounters with managed care organizations (MCOs) is acquired. Findings, predictions, and recommendations for tracking services provided by the MCOs are identified with analytic flows that are based on the data. Relations between the services provided by the MCOs and the healthcare encounters are identified. Utilization statistics are extracted from the data with the analytic processes. Information from the utilization statistics relevant to the healthcare encounters is output.