Inventors:
- Hartford CT, US
Bonnie K. Smith - Royersford PA, US
Pamela Broadway - Doylestown PA, US
Daniel Greden - West Hartford CT, US
Steve Emanuel - Colchester CT, US
Kyra Jessene Bobinet - Walnut Creek CA, US
Assignee:
Aetna, Inc. - Hartford CT
International Classification:
G06F 19/00
Abstract:
A method for attempting to mitigate risk of a health plan member. The method includes: receiving medical data related to the health plan member; computing a first score for the health plan member corresponding to predicated future financial health care costs for the health plan member based on the medical data; computing a second score for the health plan member corresponding to a clinical risk for the health plan member based on the medical data; computing a third score for the health plan member corresponding to a probability of a future acute care event for the health plan member within a threshold amount of time based on the medical data; assigning the health plan member to a risk tier based on the first, second, and third scores; and engaging the health plan member based on the risk tier and one or more engagement factors.