Patent ID: 8775200

Claim:
A computer-implemented method for generating health management data for one or more patients relating to a disease, health condition or pre-condition, comprising a computer system performing the following: storing, using a computer database, a plurality of health management groups, each relating to a disease, health condition or pre-condition and comprising one or more medical codes associated with the disease, health condition, or pre-condition, a health management group definition related to self-report survey data associated with the disease, health condition, or pre-condition, and an associated severity level; storing mapping data that enables mapping of self-report survey data obtained from a patient to one or more of the stored health management groups based on health management group definitions related to self-report survey data using the computer database; receiving, at a computer processor, medical claim data and self-report survey data associated with the patient, the received self-report survey data obtained from the patient and having no defined medical code; determining whether the medical claim data for the patient contains one or more of the stored medical codes associated with the disease, health condition or pre-condition using the computer processor; assigning the patient to a first health management group having a first associated severity level using at least the medical codes in the patient's medical claim data using the computer processor; assigning the patient to a second health management group having a second severity level using the received self-report survey data and the stored mapping data using the computer processor; reconciling the first and second health management groups using predefined reconciliation rules to generate a final health management group having an associated severity level for the patient for the disease, health condition or pre-condition using the computer processor; and storing the final health management group generated for the patient in the computer database.