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AssigneeAetna Inc.
InventorsMark Friedlander, Hyong Un
Estimating the term…
A system and method for administering reductions in future behavioral health care costs through interventions in an insurance plan participant's behavioral health regimen, is disclosed. Information is processed and provided to case managers and/or health care providers in a manner than significantly improves the ability of such individuals to selectively identify plan participants that are most likely to benefit from the intervention. A database is built from a larger set of insurance data, and this data is then further processed to generate, based at least in part on clinical data derived from medical and pharmacy claims, a predictive model that is used to predict the likelihood of future utilization of behavioral health services by a plan participant. The prediction results indicate the relative desirability of intervention in the participant's behavioral health regimen and are used to guide the case, disease, and behavioral health services utilization management for all plan participants.
A method for administering reductions in future behavioral health care costs for those participants in a health insurance plan for whom the future behavioral health care costs may be reduced through intervention (“intervention candidates”), the method comprising:
A system for administering reductions in future behavioral health care costs for those participants in a health insurance plan for whom the future behavioral health care costs may be reduced through intervention (“intervention candidates”), the system comprising:
Dependencies are inferred from the claim text.