SYSTEM AND METHOD FOR PROVIDING MODEL-BASED PREDICTIONS OF BENEFICIARIES RECEIVING OUT-OF-NETWORK CARE

SYSTEM AND METHOD FOR PROVIDING MODEL-BASED PREDICTIONS OF BENEFICIARIES RECEIVING OUT-OF-NETWORK CARE

The present disclosure pertains to a system for providing model-based predictions of beneficiaries receiving out-of-network care. In some embodiments, the system (i) obtains, from one or more databases, a collection of information related to care utilization and expenditures for a plurality of benef...

Ausführliche Beschreibung

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Bibliographische Detailangaben
Hauptverfasser: VAN DE CRAEN, Dieter Maria Alfons, WIRTH, Christoph Tobias, PAUWS, Steffen Clarence, DE MASSARI, Daniele
Format: Patent
Sprache:eng
Schlagworte:
CALCULATING
COMPUTER SYSTEMS BASED ON SPECIFIC COMPUTATIONAL MODELS
COMPUTING
COUNTING
DATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FORADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORYOR FORECASTING PURPOSES
HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA
INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS
PHYSICS
SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE,COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTINGPURPOSES, NOT OTHERWISE PROVIDED FOR
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Beschreibung
Zusammenfassung:The present disclosure pertains to a system for providing model-based predictions of beneficiaries receiving out-of-network care. In some embodiments, the system (i) obtains, from one or more databases, a collection of information related to care utilization and expenditures for a plurality of beneficiaries; (ii) extracts, from the collection of information, information related to healthcare services rendered to the beneficiaries within a predetermined time period; (iii) provides the extracted healthcare services information to a machine learning model to train the machine learning model; (iv) obtains characteristics information related to a current beneficiary and a corresponding healthcare provider; and (v) provides, subsequent to the training of the machine learning model, the current patient and corresponding healthcare provider characteristics information to the machine learning model to predict a likelihood of a future healthcare service provided to the current beneficiary to be rendered out-of-network.