AIMC Topic: Medicare

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Determining health care cost drivers in older Hodgkin lymphoma survivors using interpretable machine learning methods.

Journal of managed care & specialty pharmacy
BACKGROUND: The cost of health care for patients with Hodgkin lymphoma (HL) is projected to rise, making it essential to understand expenditure drivers across different demographics, including the older adult population. Although older HL patients co...

Artificial intelligence in Medicare: utilization, spending, and access to AI-enabled clinical software.

The American journal of managed care
OBJECTIVES: In 2018, CMS established reimbursement for the first Medicare-covered artificial intelligence (AI)-enabled clinical software: CT fractional flow reserve (FFRCT) to assist in the diagnosis of coronary artery disease. This study quantified ...

Patient Coded Severity and Payment Penalties Under the Hospital Readmissions Reduction Program: A Machine Learning Approach.

Medical care
OBJECTIVE: The objective of this study was to examine variation in hospital responses to the Centers for Medicare and Medicaid's expansion of allowable secondary diagnoses in January 2011 and its association with financial penalties under the Hospita...

Machine intelligence for early targeted precision management and response to outbreaks of respiratory infections.

The American journal of managed care
OBJECTIVES: To evaluate the utility of machine learning (ML) for the management of Medicare beneficiaries at risk of severe respiratory infections in community and postacute settings by (1) identifying individuals in a community setting at risk of in...

Does machine learning improve prediction of VA primary care reliance?

The American journal of managed care
OBJECTIVES: The Veterans Affairs (VA) Health Care System is among the largest integrated health systems in the United States. Many VA enrollees are dual users of Medicare, and little research has examined methods to most accurately predict which vete...

Novel Machine Learning Approach to Identify Preoperative Risk Factors Associated With Super-Utilization of Medicare Expenditure Following Surgery.

JAMA surgery
IMPORTANCE: Typically defined as the top 5% of health care users, super-utilizers are responsible for an estimated 40% to 55% of all health care costs. Little is known about which factors may be associated with increased risk of long-term postoperati...