Healthcare Risk Adjustment And Predictive Modeling

Author : Ian G. Duncan
Publisher : ACTEX Publications
ISBN 13 : 1566987695
Total Pages : 350 pages
Book Rating : 4.91/5 ( download)

DOWNLOAD NOW!

Download or read book Healthcare Risk Adjustment and Predictive Modeling written by Ian G. Duncan and published by ACTEX Publications. This book was released on 2011 with total page 350 pages. Available in PDF, EPUB and Kindle. Book excerpt: This text is listed on the Course of Reading for SOA Fellowship study in the Group & Health specialty track. Healthcare Risk Adjustment and Predictive Modeling provides a comprehensive guide to healthcare actuaries and other professionals interested in healthcare data analytics, risk adjustment and predictive modeling. The book first introduces the topic with discussions of health risk, available data, clinical identification algorithms for diagnostic grouping and the use of grouper models. The second part of the book presents the concept of data mining and some of the common approaches used by modelers. The third and final section covers a number of predictive modeling and risk adjustment case-studies, with examples from Medicaid, Medicare, disability, depression diagnosis and provider reimbursement, as well as the use of predictive modeling and risk adjustment outside the U.S. For readers who wish to experiment with their own models, the book also provides access to a test dataset.

Author : Ian Duncan, FSA, FIA, FCIA, MAAA
Publisher : ACTEX Publications
ISBN 13 : 1625421125
Total Pages : 446 pages
Book Rating : 4.28/5 ( download)

DOWNLOAD NOW!

Download or read book Managing and Evaluating Healthcare Intervention Programs written by Ian Duncan, FSA, FIA, FCIA, MAAA and published by ACTEX Publications. This book was released on 2014-01-20 with total page 446 pages. Available in PDF, EPUB and Kindle. Book excerpt: Since its publication in 2008, Managing and Evaluating Healthcare Intervention Programs has become the premier textbook for actuaries and other healthcare professionals interested in the financial performance of healthcare interventions. The second edition updates the prior text with discussion of new programs and outcomes such as ACOs, Bundled Payments and Medication Management, together with new chapters that include Opportunity Analysis, Clinical Foundations, Measurement of Clinical Quality, and use of Propensity Matching.

Author : Thomas G. McGuire
Publisher : Academic Press
ISBN 13 : 012811326X
Total Pages : 648 pages
Book Rating : 4.64/5 ( download)

DOWNLOAD NOW!

Download or read book Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets written by Thomas G. McGuire and published by Academic Press. This book was released on 2018-08-06 with total page 648 pages. Available in PDF, EPUB and Kindle. Book excerpt: Risk Adjustment, Risk Sharing and Premium Regulation in Health Insurance Markets: Theory and Practice describes the goals, design and evaluation of health plan payment systems. Part I contains 5 chapters discussing the role of health plan payment in regulated health insurance markets, key aspects of payment design (i.e. risk adjustment, risk sharing and premium regulation), and evaluation methods using administrative data on medical spending. Part II contains 14 chapters describing the health plan payment system in 14 countries and sectors around the world, including Australia, Belgium, Chile, China, Columbia, Germany, Ireland, Israel, the Netherlands, Russia, Switzerland and the United States. Authors discuss the evolution of these payment schemes, along with ongoing reforms and key lessons on the design of health plan payment. Provides a conceptual toolkit that describes the goals, design and evaluation of health plan payment systems in the context of policy paradigms, such as efficiency, affordability, fairness and avoidance of risk selection Brings together international experience from many different countries that apply regulated competition in different ways Delivers a practical toolkit for the evaluation of health plan payment modalities from the standpoint of efficiency and fairness

Author : Daniel L. Dunn
Publisher :
ISBN 13 :
Total Pages : 150 pages
Book Rating : 4.72/5 ( download)

DOWNLOAD NOW!

Download or read book A Comparative Analysis of Methods of Health Risk Assessment written by Daniel L. Dunn and published by . This book was released on 1996 with total page 150 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Author : National Academies of Sciences, Engineering, and Medicine
Publisher : National Academies Press
ISBN 13 : 0309493463
Total Pages : 195 pages
Book Rating : 4.68/5 ( download)

DOWNLOAD NOW!

Download or read book Integrating Social Care into the Delivery of Health Care written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2019-12-30 with total page 195 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond. The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend â€" at least in part â€" on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients' social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.

Author :
Publisher :
ISBN 13 : 9781567936063
Total Pages : 606 pages
Book Rating : 4.67/5 ( download)

DOWNLOAD NOW!

Download or read book Risk Adjustment for Measuring Health Care Outcomes written by and published by . This book was released on 2013 with total page 606 pages. Available in PDF, EPUB and Kindle. Book excerpt: Like its predecessors, the fourth edition of Risk Adjustment for Measuring Healthcare Outcomes presents the fundamental principles and concepts of risk adjustment for comparing outcomes of care and explains why risk adjustment is a critical tool for measuring quality and setting reimbursement rates. This book is a comprehensive guide to the issues raised by risk adjustment, including the pros and cons of different data sources, the validity and reliability of risk adjustment methods, the effects of various statistical modeling approaches, and concerns relating to special populations. The fourth edition features: A new chapter on the role of risk adjustment in managing healthcare organizations New information on risk factors, including genetics and social and environmental determinants of health Perspectives on electronic health records and new health information technologies Explanations of new statistical methods for comparing provider outcomes and their implications for risk adjustment

Author : Richard D. Riley
Publisher : Oxford University Press
ISBN 13 : 0192516655
Total Pages : 384 pages
Book Rating : 4.57/5 ( download)

DOWNLOAD NOW!

Download or read book Prognosis Research in Healthcare written by Richard D. Riley and published by Oxford University Press. This book was released on 2019-01-17 with total page 384 pages. Available in PDF, EPUB and Kindle. Book excerpt: "What is going to happen to me?" Most patients ask this question during a clinical encounter with a health professional. As well as learning what problem they have (diagnosis) and what needs to be done about it (treatment), patients want to know about their future health and wellbeing (prognosis). Prognosis research can provide answers to this question and satisfy the need for individuals to understand the possible outcomes of their condition, with and without treatment. Central to modern medical practise, the topic of prognosis is the basis of decision making in healthcare and policy development. It translates basic and clinical science into practical care for patients and populations. Prognosis Research in Healthcare: Concepts, Methods and Impact provides a comprehensive overview of the field of prognosis and prognosis research and gives a global perspective on how prognosis research and prognostic information can improve the outcomes of healthcare. It details how to design, carry out, analyse and report prognosis studies, and how prognostic information can be the basis for tailored, personalised healthcare. In particular, the book discusses how information about the characteristics of people, their health, and environment can be used to predict an individual's future health. Prognosis Research in Healthcare: Concepts, Methods and Impact, addresses all types of prognosis research and provides a practical step-by-step guide to undertaking and interpreting prognosis research studies, ideal for medical students, health researchers, healthcare professionals and methodologists, as well as for guideline and policy makers in healthcare wishing to learn more about the field of prognosis.

Author : Robert Larsen
Publisher : Linköping University Electronic Press
ISBN 13 : 9176851400
Total Pages : 77 pages
Book Rating : 4.01/5 ( download)

DOWNLOAD NOW!

Download or read book Risk-Adjustment for Swedish In-Hospital Trauma Mortality using International Classification of disease Injury Severity Score (ICISS) written by Robert Larsen and published by Linköping University Electronic Press. This book was released on 2019-02-11 with total page 77 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction Different methods have been used to describe the epidemiology of trauma with varying results. Crude mortality outcome data differ significantly from risk-adjusted information. A previous standard method for risk-adjustment in trauma was the Injury Severity Score (ISS), although it has several shortcomings. In this thesis I examine Swedish injury statistics from an epidemiological perspective using crude and risk-adjusted mortality, and to adjust for injury I used the International Classification of disease Injury Severity Score (ICISS). The groups of most lethal injuries (fall, traffic, and assault) were examined separately using an ICISS mortality prediction model that focused particularly on the effects on the prediction of mortality by adding coexisting conditions (comorbidity) to it. Differences in mortality between the sexes and changes over time were tested separately. Material and Methods Data from all patients with ICD-10 based diagnoses of injury (ICD-10: V01 to Y36) in the Swedish National Patient Registry and Cause of Death Registry were collected from 1999 to 2012 and used for assessment of mortality and comorbidity. A subgroup (patients in hospital) from 2001-2011 were selected as the study group. Their injuries were in the subgroups of falls, traffic, and assaults, and are the focus of this thesis. Mortality within 30 days of injury was used as the endpoint. The severity of injury was adjusted for using the ICISS, which was first described by Osler et al. The model was also adjusted for age, sex, and comorbidities. Results The study group comprised 815 846 patients (of whom 17 721 died). There was a decrease over time in injuries caused by falls and traffic (coefficient -4.71, p=0.047 and coefficient -5.37, p<0.001), whereas there was no change in assault-related injuries/100 000 inhabitants. The risk-adjusted 30-day mortality showed a decrease in injuries related to traffic and assault (OR 0.95, p<0.001 and OR 0.93, p=0.022) whereas for falls it remained unchanged. There was also a risk-adjusted survival benefit for women, which increased with increasing age. Adjusting for comorbidities made the prediction of 30-day mortality by the ICISS model better (accuracy, calibration, and discrimination). However, most of this effect was found to be the result of the other characteristics of the fall related injury group (they were older, and had more coexisting conditions). Conclusion During a 10-year period, there has been a significant overall decrease in crude as well as risk-adjusted mortality for these three injury groups combined. Within these groups there is a clear, risk-adjusted, female survival advantage. The ICISS model for the prediction of mortality improves when comorbidities are added, but this effect is minor and seen mainly among the injuries caused by falls, where comorbidity is significant. The ICISS method was a valuable adjunct in the investigation of data on Swedish mortality after injury that has been gathered from health care registry data. Introduktion Olika metoder har använts för att beskriva trauma, alla med varierande resultat. Riskjusterad respektive icke-justerad data skiljer sig markant åt. En metod som oftast används för riskjustering i traumasammanhang är Injury Severity Score (ISS) som tyvärr är belastad med ett antal praktiska tillkortakommande. I denna avhandling har jag undersökt de skadade i Sverige från ett epidemiologiskt perspektiv med både justerad och icke riskjusterad mortalitet. För att kunna justera för skadan använde jag International Classification of disease Injury Severity Score (ICISS). De dödligaste skademekanismerna i Sverige (fall, trafik och övergrepp) analyserades för sig med hjälp av en mortalitetsjusterad modell baserad på ICISS som fokuserade särskilt på mortalitetseffekterna av att lägga till tidigare sjukdomar (komorbiditet) i modellen. Skillnader i dödlighet mellan de olika könen samt förändringar över tid undersöktes. Material och Metod Information om alla patienter med en skadekod från ICD-10 systemet (ICD10: V01-Y36) i slutenvårdsregistret eller dödsorsaksregistrets under åren 1999–2012 samlades in för att användas för att kunna utvärdera mortalitet och komorbiditet. En undergrupp av sjukhusinlagda patienter från 2001–2011 valdes sedan som primär studiegrupp. De som i denna grupp hade drabbats av fall-, trafik- eller övergrepps-relaterade skador är det denna avhandling fokuserar på. Som mätpunkt (endpoint) användes avliden inom 30 dagar från skadan. Skadans allvarlighetsgrad bedömdes med ICISS som Osler var först att beskriva. Modellen justerades även för ålder, kön och komorbiditet. Resultat Studiegruppen innehöll 815 846 patienter (av vilka 17 721 avled). I gruppen med falloch trafik-relaterade skador var det en ren minskning över studietiden (koefficienten -4,71 med ett p=0,047 och med en koefficient på -5,37 med ett p <0,001), medans i övergreppsrelaterade skador kunde jag inte hitta någon minskning per 100 000 invånare. Den riskjusterade 30-dagars dödligheten hade en minskning i trafik- och övergreppsrelaterade skador (OR 0,95 med ett p <0,001 respektive OR 0,93 med ett p=0,022) men ingen minskning i fallrelaterade skador sågs. Riskjusterat gick det också att hitta en överlevnadsfördel för kvinnor, vilken ökade med ålder. När jag justerade för komorbiditeter blev prediktionsmodellen för ICISS med 30-dagars dödlighet bättre (detta gällde både precision, kalibrering och diskriminering). Det bör dock nämnas att det mesta av förbättringen vid eftergranskning var beroende på fall gruppens demografi (högre ålder och mer komorbiditeter). Konklusion Under denna tio-årsperiod har dödligheten minskat för dessa grupper, både riskjusterat och icke justerat. Inom dessa grupper finns en tydlig riskjusterad överlevnadsfördel för kvinnor. ICISS-modellen blir bättre på att förutspå 30-dagars dödlighet när man lägger till komorbiditet, men effekten är att betrakta som en mindre effekt och ses tydligast i fallrelaterade skador (där ålder och komorbiditet är högre). Metoden med ICISS är en värdefull metod för att undersöka stora datamaterial och dödlighet i stora grupper i Sverige. Detta kan göras med redan insamlade data i sjukvårdsregistren.

Author : Adam Bohr
Publisher : Academic Press
ISBN 13 : 0128184396
Total Pages : 385 pages
Book Rating : 4.94/5 ( download)

DOWNLOAD NOW!

Download or read book Artificial Intelligence in Healthcare written by Adam Bohr and published by Academic Press. This book was released on 2020-06-21 with total page 385 pages. Available in PDF, EPUB and Kindle. Book excerpt: Artificial Intelligence (AI) in Healthcare is more than a comprehensive introduction to artificial intelligence as a tool in the generation and analysis of healthcare data. The book is split into two sections where the first section describes the current healthcare challenges and the rise of AI in this arena. The ten following chapters are written by specialists in each area, covering the whole healthcare ecosystem. First, the AI applications in drug design and drug development are presented followed by its applications in the field of cancer diagnostics, treatment and medical imaging. Subsequently, the application of AI in medical devices and surgery are covered as well as remote patient monitoring. Finally, the book dives into the topics of security, privacy, information sharing, health insurances and legal aspects of AI in healthcare. Highlights different data techniques in healthcare data analysis, including machine learning and data mining Illustrates different applications and challenges across the design, implementation and management of intelligent systems and healthcare data networks Includes applications and case studies across all areas of AI in healthcare data

Author : Max Kuhn
Publisher : Springer Science & Business Media
ISBN 13 : 1461468493
Total Pages : 600 pages
Book Rating : 4.93/5 ( download)

DOWNLOAD NOW!

Download or read book Applied Predictive Modeling written by Max Kuhn and published by Springer Science & Business Media. This book was released on 2013-05-17 with total page 600 pages. Available in PDF, EPUB and Kindle. Book excerpt: Applied Predictive Modeling covers the overall predictive modeling process, beginning with the crucial steps of data preprocessing, data splitting and foundations of model tuning. The text then provides intuitive explanations of numerous common and modern regression and classification techniques, always with an emphasis on illustrating and solving real data problems. The text illustrates all parts of the modeling process through many hands-on, real-life examples, and every chapter contains extensive R code for each step of the process. This multi-purpose text can be used as an introduction to predictive models and the overall modeling process, a practitioner’s reference handbook, or as a text for advanced undergraduate or graduate level predictive modeling courses. To that end, each chapter contains problem sets to help solidify the covered concepts and uses data available in the book’s R package. This text is intended for a broad audience as both an introduction to predictive models as well as a guide to applying them. Non-mathematical readers will appreciate the intuitive explanations of the techniques while an emphasis on problem-solving with real data across a wide variety of applications will aid practitioners who wish to extend their expertise. Readers should have knowledge of basic statistical ideas, such as correlation and linear regression analysis. While the text is biased against complex equations, a mathematical background is needed for advanced topics.