公开(公告)号：US10147504B1

公开(公告)日：2018-12-04

申请号：US14060513

申请日：2013-10-22

Applicant: Express Scripts Strategic Development, Inc.

Inventor： Glen D. Stettin ,  Juliana Dierks

IPC: G16H50/30

Abstract: Methods and systems for risk assessment and adjustment are described. In one embodiment, a patient-level risk score associated with a patient is calculated. A plan-level average risk score associated with a benefit plan is calculated. The patient is a member of the benefit plan. A missing diagnosis code associated with the patient is identified based on medical claims history of the patient, historical prescription drug claims of the patient, and a drug marker. A revised patient-score associated with the patient is calculated based on identification of the missing diagnosis code. Additional methods and systems are disclosed.