Patent ID: 11955244
Assignee: OPTUM SERVICES (IRELAND) LIMITED
Field: Medical technology (Instruments)
Classification: CPC G | IPC G

Claim 7:
8. A computing system for generating a predicted risk measure for a first predictive entity, the computing system comprising one or more processors and memory including program code, the memory and the program code configured to, with the one or more processors, cause the computing system to at least:
generate, using a risk determination machine learning model and based at least in part on one or more hidden features of the first predictive entity, the predicted risk measure, wherein:
(i) the risk determination machine learning model is generated based at least in part on a ground-truth risk measure for each ground-truth predictive entity in a ground-truth subset of a plurality of candidate predictive entities,
(ii) the first predictive entity is among the plurality of candidate predictive entities but is outside of the ground-truth subset,
(iii) each ground-truth predictive entity is associated with a prediction time horizon and a per-horizon historical claim set within the prediction time horizon,
(iv) each per-horizon claim count of a per-horizon claim set for a ground-truth predictive entity satisfies a per-horizon claim count threshold,
(v) each prediction time horizon fora ground-truth predictive entity is determined based at least in part on a primary event associated with the ground-truth predictive entity,
(vi) each primary event for a ground-truth predictive entity is determined based at least in part on a diagnosis timestamp for a recipient entity associated with the ground-truth predictive entity, and
(vii) each ground-truth risk measure for a ground-truth predictive entity is determined based at least in part on the per-horizon claim set for the ground-truth predictive entity; and

initiate the performance of one or more prediction-based actions based at least in part on the predicted risk measure.