A healthcare
risk index is generated using a patient or individual's
pharmacy claims. The index may be used to explain and predict variation in
pharmacy-related costs and variation in total healthcare costs or utilization. In particular, the index is generated by first examining the individual's
pharmacy claims to identify any chronic conditions possessed by the individual. Similarly, the individual's pharmacy claims are examined to identify any compliance medications prescribed to the individual. The
chronic condition information is used to generate a
chronic condition score by summing regression coefficients for each
chronic condition possessed by the individual. Likewise, the compliance
medication information is used to generate a compliance medication
score by summing products of regression coefficients for each compliance medication prescribed to the individual with associated medication supply weights. From there, a modified chronic condition
score is generated by multiplying the chronic condition score by an overall chronic condition regression coefficient. The modified chronic condition score may then be further modified by subtracting a no-claims weight from the chronic condition score in cases where the individual has no pharmacy claims. Finally, the
risk index may be determined by summing the modified chronic condition score and the compliance medication score.