Patent ID: 7444291

Claim:
A method in a computer system for predicting a level of consumption of healthcare resources by modeling utilization of healthcare resources in a target period, the method comprising: a computer system performing the following: compiling a plurality of provider claims for each of a plurality of members of a health plan, wherein the provider claims for the plurality of members occur within a base period and include a plurality of health conditions or diseases; storing a plurality of disease categories representing a plurality of health conditions or diseases; storing category weight data, wherein the category weight data comprises a weight value associated with each stored disease category, wherein each weight value associated with a stored disease category represents an average incremental cost for a plan member associated with the presence of the associated stored disease category during the base period; for each of the plurality of health plan members, identifying each stored disease category present in the plurality of provider claims for the member; calculating a burden of illness score for each member, wherein the burden of illness score is a number calculated by summing the stored weight values associated with each disease category identified in the member's provider claims; storing at least one explanatory variable, wherein the explanatory variable is derived from demographic data or prior healthcare utilization data associated with the member; computing a utilization score for each health plan member as a function of the burden of illness score and the at least one explanatory variable, wherein the utilization score is computed by assigning a weight factor to the burden of illness score and to the explanatory variable and summing (a) the product of the burden of illness score and its assigned weight factor and (b) the product of the explanatory variable and its assigned weight factor; and using the utilization score to predict healthcare resource consumption in the target period by at least one plan member.