AIMC Topic: Insurance, Health

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Incorporating machine learning and social determinants of health indicators into prospective risk adjustment for health plan payments.

BMC public health
BACKGROUND: Risk adjustment models are employed to prevent adverse selection, anticipate budgetary reserve needs, and offer care management services to high-risk individuals. We aimed to address two unknowns about risk adjustment: whether machine lea...

Ensuring trustworthy use of artificial intelligence and big data analytics in health insurance.

Bulletin of the World Health Organization
Technological advances in big data (large amounts of highly varied data from many different sources that may be processed rapidly), data sciences and artificial intelligence can improve health-system functions and promote personalized care and public...

Evaluating the performance of a predictive modeling approach to identifying members at high-risk of hospitalization.

Journal of medical economics
To evaluate the risk-of-hospitalization (ROH) models developed at Blue Cross Blue Shield of Louisiana (BCBSLA) and compare this approach to the DxCG risk-score algorithms utilized by many health plans. Time zero for this study was December 31, 2016....

What Legal Frameworks Should Govern Use of Genetic Test Results by Private Health Insurers in New Zealand?

Journal of law and medicine
The rising cost of private health insurance and constraints within public health systems are global concerns. Genetic testing presents a transformative opportunity for health care to enhance health outcomes and optimise resource allocation through pe...

Adverse drug event rates in pediatric pulmonary hypertension: a comparison of real-world data sources.

Journal of the American Medical Informatics Association : JAMIA
OBJECTIVE: Real-world data (RWD) are increasingly used for pharmacoepidemiology and regulatory innovation. Our objective was to compare adverse drug event (ADE) rates determined from two RWD sources, electronic health records and administrative claim...

Toward a normalized clinical drug knowledge base in China-applying the RxNorm model to Chinese clinical drugs.

Journal of the American Medical Informatics Association : JAMIA
OBJECTIVE: In recent years, electronic health record systems have been widely implemented in China, making clinical data available electronically. However, little effort has been devoted to making drug information exchangeable among these systems. Th...