Data analytics framework for identifying a savings opportunity for self-funded healthcare payers

A method of identifying a savings opportunity in healthcare data for a self-funded payer, the method comprising:

• receiving, via a data intake utility, healthcare data from an external data source,
• wherein the healthcare data includes patient health data, and
• wherein the healthcare data is received over a network connection that connects the data intake utility to the external data source;
• storing the received healthcare data in a database;
• performing data analytics on the received healthcare data, wherein the data analytics includes:
• a benefits analysis to determine projected benefits;
• a spending analysis to determine projected spending;
• and
• a savings analysis to determine projected savings;
• determining a claim fact based on the data analytics performed on the received healthcare data;
• and
• generating a savings recipe for realizing a savings opportunity based on the determined claim fact.

A system for identifying a savings opportunity in healthcare data for a self-funded payer, the system comprising:

• an interface layer, wherein the interface layer includes a data intake utility configured to connect to an external data source;
• a database;
• and
• a data analytics server, the server comprising a processor configured for:
• receiving, via the data intake utility, healthcare data from the external data source,
• wherein the healthcare data includes patient health data, and
• wherein the healthcare data is received over a network connection that connects the data intake utility to the external data source;
• storing the received healthcare data in the database;
• performing data analytics on the received healthcare data, wherein the data analytics includes:
• a benefits analysis to determine projected benefits;
• a spending analysis to determine projected spending;
• and
• a savings analysis to determine projected savings;
• determining a claim fact based on the data analytics performed on the received healthcare data;
• and
• generating a savings recipe for realizing a savings opportunity based on the determined claim fact.