US Patent 11688513 Systems and methods for prediction based care recommendations

A method for providing prediction based healthcare recommendations is performed by a healthcare prediction server. The method includes receiving an emergency room services request from a patient. The method also includes receiving a first portion of the plurality of historical claims data. The first portion includes associated historical outcome data. The method further includes applying a geospatial prevalence engine to the first portion of the plurality of historical claims data and the requestor location to identify at least one locally prevalent disease. The method additionally includes applying a claims processing engine to the first portion of the plurality of historical claims data and the requestor identifier to determine whether the patient is associated with at least one prior avoidable emergency room claim. The method includes predicting that the emergency room services request is associated with an avoidable visit. The method further includes transmitting an alternative services request.