Patent ID: 7904311

Claim:
A method for calculating a potential return on investment associated with a disease management program comprising computer implemented steps of: querying, by a medical management modeling computer, a user to input data relating to a study population that is linked to a potential investment in a disease management program; validating, via the medical management modeling computer, data associated with the study population; obtaining, via the medical management modeling computer, cost and participation data associated with the disease management program; determining, via the medical management modeling computer, a control member cohort by: electronically selecting a random sample population from a medical insurance member database; constructing a plurality of unique cohort keys, each cohort key comprising one or more member characteristics selected from the group consisting of age category, gender, member geographic region, insurance product associated with the member, a dichotomous indicator of one or more predetermined diseases or conditions associated with the member, and a retrospective risk score associated with the member; and applying the cohort keys to the random sample population to identify the control member cohort; the medical management modeling computer further performing the following steps: (a) calculating expected costs for individual members of the study population through use of at least one control equation that uses the validated study population data and data associated with the control member cohort as inputs; (B) calculating aggregate expected savings associated with the disease management program; (c) calculating expected fees associated with the disease management program; (d) calculating the potential return on investment by dividing the expected savings by the expected fees; (e) calculating statistical confidence limits associated with the potential return on investment and (f) presenting the user with a result of the calculations.