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 system generates an automated survey and causes a user interface of an electronic device to present survey to a patient, so that the system can use the survey responses to identify and provide wellness or disease management content items that are tailored to the patient's behavioral needs. The system automatically generates an electronic survey document with data entry fields that each correspond to a question for a category of behavioral influence. The document includes fillable fields as presented on a user interface. When the system receives data via the fillable fields as presented on the user interface of the electronic device, it will assign a value to each response, construct a patient model, and it will use the patient model to extract intervention content items and provide the patient with those items.

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 computer system configured to improve health outcomes and reduce medical service costs includes a memory storing a computer program and a processor that executes the computer program. The computer program receives a medical inquiry, extracts a keyword using natural language processing (NLP), selects a category of concern indicated by the medical inquiry from a library using the keyword, determines leading factors contributing to the category of concern based on a statistical model analysis, selects analytic modules from a library that receive at least one of the leading factors as an input parameter or produce at least one of the leading factors as an output parameter, and generates a recommendation including a listing of the selected analytic modules and/or a constructed workflow including at least two of the selected analytic modules chained together via respective input parameters and output parameters of the at least two selected analytic modules.

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.