Patent ID: 7987102

Claim:
A computer implemented method of utilization analysis and performance evaluation of providers in a health care organization, comprising the steps of: collecting health care data over a network, wherein said health care data comprises health plan information of consumers, said providers, claims, and hospitals; analyzing said collected health care data for said utilization analysis and said performance evaluation of the providers using a data analytics engine stored on said computer, comprising the steps of: determining a plurality of costs of said health care organization using at least one or more of the health plan information of the consumers, the providers, the claims, and said hospitals; calculating an average cost of the health plan adjusted for a specific age, sex and disease condition of the consumers; determining an expected cost for each consumer in the health plan based on said average cost and a number of consumers of the specific age, sex and disease condition; storing said expected cost for the consumer in a database; determining a total expected cost for the disease condition by summing expected costs for all the consumers of the specific age, sex and disease condition in the health plan; calculating a total actual cost for all the consumers associated with each of the providers using said health plan information; and assessing performance of the providers for said health plan, comprising calculating a utilization performance ratio of a provider to rank said provider, wherein said data analytics engine calculates said utilization performance ratio as a ratio of a sum of the total actual cost of the consumers associated with the provider to a sum of total expected cost for the consumers, adjusted for the age, the sex and the disease condition; whereby the utilization and performance of the providers in providing health care to the consumers are evaluated by analyzing the health care data.