US Patent 7987102 Healthcare provider performance and utilization analytics

Disclosed herein is a computer implemented method and system that addresses the need for utilization analysis and performance evaluation of providers in a health care organization. The health care data comprising health plan information of consumers, providers, claims, and hospitals is collected, translated, and organized in a structured relational format and stored in standard tables. The organized health care data is analyzed by calculating consumer statistics for a health plan using the health plan information of the consumers. The claims of the consumers are processed to classify the claims based on age, gender, disease, and comorbid conditions of the consumers. A plurality of costs of the health care organization is determined using one or more of the health plan information. The performance of the providers is assessed using the determined plurality of costs. The providers comprising primary care physicians are analyzed based on entire population of the associated consumers.