Healthcare Risk Adjustment and Predictive Modeling
2011 By FIA, FCIA, MAAA Ian Duncan FSA (Author)


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 a test dataset.