Reducing Cost and Improving Quality of Health Care Through Analysis of Medical Condition Claim Data

摘要

Techniques are disclosed for identifying opportunities for saving costs and increasing quality of health care. Claim information is organized according to an associated medical condition. A team focused on one major practice category uses historical claim data to identify particularly costly conditions within the major practice category. Additional research is performed with respect to that condition by constructing detailed data requests and reviewing recent literature, publications and news from real and virtual libraries. Using the research and additional data, opportunities are formulated and given to functional work teams to implement in one or more of a variety of ways.