Method and apparatus for determining high service utilization patients

A method of identifying patients who are likely to have future high utilization of medical services, comprising the steps of:

• collecting patient claims data in electronic form on a population of patients as records for each patient, each patient record including at least an identification of the patient and claims data associated with a predetermined group of high relevance claims variables;
• applying a probability equation to the claims data for at least one of the patient records based on the sum of each of the predetermined high relevance claims variables multiplied by a predetermined weighing coefficient;
• assigning a score to the patient record based the result of the probability equation, said score being a prediction of the relative likelihood that the patient will incur high use of medical services;
• and
• intervening with the patient having a score indicating an above average probability that the patient will incur high use of medical services.

Apparatus for identifying patients who are likely to have high use of medical services, comprising:

• at least one data processing terminal through which patient claims data is collected on patients in electronic form, said terminal collecting the data in the form of records for each patient, each patient record including variable elements of data providing at least an identification of the patient and the utilization by the patient of medical services;
• a database in the form of an organized memory in which the patient records are stored;
• a predictive computing system including a processor, a processor memory and a device for accessing patient records in said database;
• said program memory storing a model as a probability equation predicting which patients will incur high utilization of medical services, said processor further assigning a score to each patient record based on the model, the score being a prediction of the relative likelihood that the patient will incur high use of medical services;
• and
• an output device for indicating the score.