Healthcare Risk Adjustment and Predictive Modeling

Healthcare Risk Adjustment and Predictive Modeling

• Listed on the Course of Reading for SOA fellowship study in the Group & Health specialty beginning 2010

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.