Patent ID: 8473311

Claim:
A method comprising: determining, on a processor, in accordance with medical information of an individual, a first medical condition indicator value reflecting that the individual has a first medical condition, and a second medical condition indicator value reflecting that the individual does not have a second medical condition; calculating, on the processor, a first medical condition score by using the first medical condition indicator value and a first regression coefficient; calculating, on the processor, a second medical condition score by using the second medical condition indicator value and a second regression coefficient; identifying, on the processor, a compliance medication taken by the individual based on analysis of a plurality of pharmacy claims associated with the individual; calculating, on the processor, a compliance medication score for the compliance medication taken by the individual based on a determination of compliance by the individual with a treatment regimen and a compliance medication weight associated with a medication class type of the compliance medication; calculating, on the processor, a risk index by summing the first medical condition score, the second medical condition score, and the compliance medication score, the risk index being indicative of medical costs of the individual, chronic medical conditions, variation in medical costs, or combinations thereof based on the first medical condition that is indicated as possessed by the individual and the second medical condition that is indicated as not being possessed by the individual; and analyzing, on the processor, the risk index to determine a clinical case identification, disease management, prediction of concurrent and prospective medical related utilization, prediction of concurrent and prospective pharmacy-related utilization, prediction of concurrent and prospective total healthcare utilization, comparison of groups which may have differing rates of chronic illness, or combinations thereof.