Express Scripts Strategic Development, Inc.

Evernorth Strategic Development, Inc.

Pritesh J Shah

Christopher R Markson

Christopher G Lehmuth

Amit K Bothra

Logan R Meltabarger

Bradley D Flynn

Adithya Chowdary Boppana

David Alfredo Tomala

Gang Wu

Varun Tandra

Akash Dwivedi

Keith L Widmer

Bose S Daggubati

Daniel C Casper

Zachary A Goodman

Snezana Mahon

Mark D Wong

Amy C Gross

Aanal Patel

Rahul Rajendran

Karnik D Patel

Jonelle Lofton

Gaspar Reyes

Kelcey A Blair

Jiawei Kuang

Jackie L Ahlstrom

Jeremy A Rower

Rochelle R Henderson

John J Felo, Ii

Callie S Carter

A computer system includes memory hardware configured to store a transcription database, a call database, and instructions. The transcription database includes multiple call transcription data entries. The call database includes multiple agent call log data entries. The computer system executes instructions including joining the call transcription data entries with the agent call log data entries according to associated timestamps. The instructions include, for at least one of the set of joined call data entries, generating an input vector for an unsupervised machine learning model. The instructions include supplying the input vector to the model to assign an output topic classification of the model to the joined call data entry associated with the input vector, and supplying the input vector to at least one sub-topic model associated with the output topic classification to assign one or more sub-topic output classifications to the joined call data entry associated with the input vector.

Machine learning models for automated processing of transcription database entries

A system includes memory hardware storing processor-executable instructions, a persona, and a data structure associated with the persona. Processor hardware executes the processor-executable instructions. The instructions include generating a graphical user interface and, in response to a first condition, inputting a first set of explanatory variables to a first trained machine learning model to generate a first metric and transforming the graphical user interface according to the persona and the first metric. The instructions include, in response to a second condition, inputting a second set of explanatory variables to a second trained machine learning model to generate a second metric and transforming the graphical user interface according to the persona and the second metric. The first trained machine learning model is different from the second trained machine learning model. The instructions include automatically approving a first prior authorization prescription in response to the first metric reaching a threshold value.

Machine learning model automation of user interface transformation

Systems and methods herein describe a mental health management system. The mental health management system accesses patient data associated with a patient from a database, determines that the patient is associated with a trigger event, identifies a category associated with the trigger event, generates a notification based on the trigger event and the identified category, validates the notification based on a notification history and transmits the notification to a computing device.

Mental health predictive model management system

A method includes receiving a prescription benefit request and identifying one or more covered alternative drugs. The method also includes identifying one or more additional alternative drugs based on at least one of the requested drug and determining whether the one or more additional alternative drugs includes at least one covered additional alternative drug. The method also includes determining, for each of the at least one covered additional alternative drug and the one or more covered alternative drugs, an alternative drug value. The method also includes identifying the at least one covered additional alternative drug and the one or more covered alternative drugs having a lowest alternative drug value and generating a request response indicating at least the alternative drug of the at least one covered additional alternative drug and the one or more covered alternative drugs having the lowest alternative drug value.

Drug alternative recommendation engine for real-time prescription benefit requests

A computer-implemented method includes defining model attributes including a training iteration value that defines a set of training iterations to be used in machine learning to associate portions of feedback data with a set of topic groups based on similarities in concepts conveyed in the feedback data. The method includes removing at least some of the confidential information from the feedback data. The method includes receiving a topic model number selection that indicates a subset of the set of topic groups. The method includes using machine learning to train a machine model based on the model attributes and the topic model number selection. The method includes generating a display showing at least one of a topic cluster graph or a word cloud based on the machine model.

Iterated training of machine models with deduplication

A method includes storing a parameter related to a user, storing descriptive data for multiple identifiers, and indexing multiple events. Each event corresponds to a physical object supplied to a user on behalf of an entity. The method includes identifying a first set of identifiers based on commonality among the descriptive data. The method includes training a machine learning model for the first set of identifiers based on event data from within a predetermined epoch. The method includes receiving an indication of a selected identifier and determining a first intake metric of the selected identifiers using the machine learning model. The method includes determining a second intake metric of the selected identifier and the parameter and transforming the user interface according to the first and second intake metrics. The first intake metric represents an amount of resources expected to be received during a second epoch subsequent to the predetermined epoch.

Systems and methods for user interface adaptation for per-user metrics

A content analysis system includes a processor executing instructions from memory. The instructions include, in response to receiving a request signal from a user device, obtaining feedback items, each having a source indicator; identifying unique source indicators; and, for each source indicator, aggregating corresponding ones of the feedback items. A set of filtered feedback items is generated according to either first or second access levels associated with a user of the user device. A subset of filtered feedback items is selected according to a date range specified by the request signal, a set of automated rules is applied, and natural language processing is performed based on frequency of presence of salient terms to identify themes. A control signal is transmitted to a user interface of the user device instructing display of a representation that indicates a change in the frequency of the identified themes over the specified date range.

Medical processing systems and methods

Systems and methods in this document describe a mental health management system. The mental health management system accesses patient data associated with a patient from a database, determines that the patient is associated with a trigger event, generates a prediction, using a predictive modeling system trained to analyze the patient data, the prediction corresponding to a probability that the patient's current medication data will be modified, stores the prediction in association with the patient data, and transmits the prediction to a computing device.

Predictive modeling for mental health management

A method includes receiving a first set of identifiers selected based on commonality among descriptive data corresponding to the identifiers of the first set. Each identifier corresponds to a user who has been supplied a physical object. The method includes identifying event data for the first set within a specified epoch. The method includes training a machine learning model for the first set using the identified event data. The machine learning model is trained using parallel processing of records from a storage structure storing the event data. The parallel processing includes assigning analysis of the event data of each of a subset of the first set to respective processor threads for parallel execution on processing hardware. The trained machine learning model is configured to receive a selected identifier and generate an output representing an amount of resources expected to be used by the selected identifier for a subsequent epoch.

A computer system includes processor hardware configured to execute instructions that include joining at least a portion of multiple call transcription data entries with at least a portion of multiple agent call log data entries according to timestamps associated with the entries to generate a set of joined call data entries, and validating the joined call data entry by determining whether a transcribed entity name matches with entity identifier information associated with the agent call log data entry. The instructions include preprocessing the joined call data entry according to word confidence score data entries associated with the call transcription data entry to generate preprocessed text, performing natural language processing vectorization on the preprocessed text to generate an input vector, and supplying the input vector to an unsupervised machine learning model to assign an output topic classification of the model to the joined call data entry associated with the input vector.

A method includes defining model attributes of a machine model that organizes feedback data into topic groups based on similarities in concepts in the feedback data. The model attributes include a topic model number that defines how many topic groups are to be created, a hyperparameter optimization alpha value, and/or a hyperparameter optimization beta value. The method also includes generating the machine model using the model attributes that are defined and the feedback data, and applying the machine model to the feedback data to divide different portions of the feedback data into the different topic groups based on contents of the feedback data, the topic model number, the hyperparameter optimization alpha value, and/or the hyperparameter optimization beta value.

Machine model generation systems and methods

A method includes generating an intervention model by determining principal components for features of a training set, associating each feature of the training set with one of the principal components, selecting features of the training set most closely correlated with the principal components, performing a regression analysis on the selected features to determine a subset of the selected features that are most closely correlated with a model target, training a machine learning model with the subset, verifying the trained machine learning model with a verification set, and saving the verified trained machine learning model as the intervention model. The method includes determining an intervention expectation indicating a likelihood that the user will take action in response to an intervention being execute, determining a likelihood of a gap in care for the user, selecting and scheduling an intervention for execution based on the care gap likelihood and the intervention expectation.

Automated intervention system based on channel-agnostic intervention model

A method includes generating an intervention model by determining principal components for features of a training set, associating each feature of the training set with a principal component, selecting features of the training set most highly correlated with principal components, training a machine learning model with at least some of the selected features, and saving the verified trained machine learning model as the intervention model. The method includes determining multiple channel-specific intervention expectations. Each channel-specific intervention expectation indicates a likelihood that the user will take action in response to an intervention being executed using the engagement channel corresponding to the channel-specific intervention expectation. The method includes selecting an intervention and scheduling the selected intervention for execution.

Channel-specific engagement machine learning architecture

A computerized method for transforming an interactive graphical user interface according to machine learning includes selecting a persona, loading a data structure associated with the selected persona, and generating the interactive graphical user interface. The method includes, in response to a user selecting a first selectable element, inputting a first set of explanatory variables to a first trained machine learning model to generate a first metric, and transforming the user interface according to the selected persona and the first metric. The method includes, in response to the user selecting a second selectable element, inputting a second set of explanatory variables to a second trained machine learning model to generate a second metric, and transforming the user interface according to the selected persona and the second metric. In various implementations, first metric is a first probability of the persona being approved for a first prior authorization prescription.

Systems and methods for transforming an interactive graphical user interface according to machine learning models

A computer system for transforming a user interface according to data store mining includes a data store configured to store a parameter related to a user and index event data of a set of events. A data processing circuit is configured to identify a first set of identifiers and train a machine learning model based on event data by the data store. An interface circuit is configured to receive an indication of a selected identifier of the plurality of identifiers, determine a first intake metric of the selected identifier using the machine learning model, and a second intake metric of the selected identifier and the parameter using the machine learning model. The interface circuit is configured to transform the user interface according to the first intake metric and the second intake metric.

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Paramus, NJ, United States of America

Pritesh J Shah