Healthcare Risk Adjustment and Predictive ModelingThis 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. |
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Great read.very helpfull
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This 'appetizer' portion of Mr. Duncan's book is quite good and in fact prompted me to buy a hard copy
for use. I anticipate using it weekly if not daily and look forward to the book's arrival.
Common terms and phrases
actual Actuaries additional admission algorithm allowed amount analysis applied assigned associated average beneficiaries benefits calculated capitation Chapter claims clinical codes combination compared contains cost coverage covered data set demographic dependent depression determine developed Diabetes diagnosis discussed disease distribution DRGs drug eligible enrollment episode equal estimate evaluation event example expected experience factors Figure function funds groups health plan healthcare higher hospital identify illustrate important increase independent indicator individual intervention linear MCOs measure Medicaid Medicare method months node Note observations outcomes patient payment performance period physician population Positive practice predictive modeling probability procedure profitability provider records regression relative response risk adjustment risk factors risk score sample selection severity shows specific standard statistical Table techniques treatment tree values variables visits weights
Bibliographic information
| Title | Healthcare Risk Adjustment and Predictive Modeling ACTEX professional series |
| Author | Ian G. Duncan |
| Publisher | ACTEX Publications, 2011 |
| ISBN | 1566987695, 9781566987691 |
| Length | 338 pages |
| Export Citation | BiBTeX EndNote RefMan |