| abstract |
A system and method for developing and utilizing member condition groups (MCGs) determines whether an individual has been diagnosed with one or more diagnostic codes from a predetermined group of diagnostic codes. Each diagnosed individual is associated, based on the one or more diagnostic codes, with one or more member condition groups (MCGs), each MCG representing a group of individuals diagnosed with clinically related diagnostic codes. A healthcare-related cost, including a pharmacy cost, a disability benefit, a workers compensation benefit, a health benefit administration fee, or an absence cost, associated with each diagnosed individual from a predetermined MCG during a predetermined time period is determined. Additionally, a medical health benefits cost, which is distinct from the healthcare-related cost, can be determined for each diagnosed individual. The medical health benefits cost and the healthcare-related cost can be combined to determine a comprehensive healthcare cost associated with each diagnosed individual. |