Revealing Physicians Referrals from Health Insurance Claims Data

Autores
Santana, Vagner Figueredo de; Appel, Ana Paula; Moyano, Luis Gregorio; Ito, Marcia; Pinhanez, Claudio Santos
Año de publicación
2018
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Health insurance companies in Brazil have their data about claims organized having the view only for service providers. In this way, they lose the view of physicians’ activity and how physicians share patients. Partnership between physicians can be seen as fruitful, when they team up to help a patient, but could represent an issue as well, when a recommendation to visit another physician occurs only because they work in same clinic. This work took place during a short-term project involving a partnership between our lab and a large health insurance company in Brazil. The goal of the project was to provide insights (with business impact) about physicians’ activity from the analysis of the claims database. This work presents one of the outcomes of the project, i.e., a way of modeling the underlying referrals in the social network of physicians resulting from health insurance claims data. The approach considers the flow of patients through the physician–physician network, highlighting connections where referrals between physicians potentially occurred. We present the results from the analysis of a claims database (detailing 18 months of activity) from the health insurance company we partnered with. The main contribution presented in this paper is the model to reveal mutual referrals between physicians. Results show the proposed model reveals underlying characteristics of physicians’ activity from real health insurance claims data with multiple business applications.
Fil: Santana, Vagner Figueredo de. Ibm Research; Estados Unidos
Fil: Appel, Ana Paula. Ibm Research; Estados Unidos
Fil: Moyano, Luis Gregorio. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Ito, Marcia. Ibm Research; Estados Unidos
Fil: Pinhanez, Claudio Santos. Ibm Research; Estados Unidos
Materia
healthcare
complex networks
medical claims
big data
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/96261
Acceder
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oai_identifier_str oai:ri.conicet.gov.ar:11336/96261
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Revealing Physicians Referrals from Health Insurance Claims DataSantana, Vagner Figueredo deAppel, Ana PaulaMoyano, Luis GregorioIto, MarciaPinhanez, Claudio Santoshealthcarecomplex networksmedical claimsbig datahttps://purl.org/becyt/ford/1.2https://purl.org/becyt/ford/1Health insurance companies in Brazil have their data about claims organized having the view only for service providers. In this way, they lose the view of physicians’ activity and how physicians share patients. Partnership between physicians can be seen as fruitful, when they team up to help a patient, but could represent an issue as well, when a recommendation to visit another physician occurs only because they work in same clinic. This work took place during a short-term project involving a partnership between our lab and a large health insurance company in Brazil. The goal of the project was to provide insights (with business impact) about physicians’ activity from the analysis of the claims database. This work presents one of the outcomes of the project, i.e., a way of modeling the underlying referrals in the social network of physicians resulting from health insurance claims data. The approach considers the flow of patients through the physician–physician network, highlighting connections where referrals between physicians potentially occurred. We present the results from the analysis of a claims database (detailing 18 months of activity) from the health insurance company we partnered with. The main contribution presented in this paper is the model to reveal mutual referrals between physicians. Results show the proposed model reveals underlying characteristics of physicians’ activity from real health insurance claims data with multiple business applications.Fil: Santana, Vagner Figueredo de. Ibm Research; Estados UnidosFil: Appel, Ana Paula. Ibm Research; Estados UnidosFil: Moyano, Luis Gregorio. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ito, Marcia. Ibm Research; Estados UnidosFil: Pinhanez, Claudio Santos. Ibm Research; Estados UnidosElsevier2018-09info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/96261Santana, Vagner Figueredo de; Appel, Ana Paula; Moyano, Luis Gregorio; Ito, Marcia; Pinhanez, Claudio Santos; Revealing Physicians Referrals from Health Insurance Claims Data; Elsevier; Big Data Research; 13; 9-2018; 3-102214-5796CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S2214579617302952info:eu-repo/semantics/altIdentifier/doi/10.1016/j.bdr.2018.03.002info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-nd/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-10-22T11:19:12Zoai:ri.conicet.gov.ar:11336/96261instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-10-22 11:19:12.882CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Revealing Physicians Referrals from Health Insurance Claims Data
title Revealing Physicians Referrals from Health Insurance Claims Data
spellingShingle Revealing Physicians Referrals from Health Insurance Claims Data
Santana, Vagner Figueredo de
healthcare
complex networks
medical claims
big data
title_short Revealing Physicians Referrals from Health Insurance Claims Data
title_full Revealing Physicians Referrals from Health Insurance Claims Data
title_fullStr Revealing Physicians Referrals from Health Insurance Claims Data
title_full_unstemmed Revealing Physicians Referrals from Health Insurance Claims Data
title_sort Revealing Physicians Referrals from Health Insurance Claims Data
dc.creator.none.fl_str_mv Santana, Vagner Figueredo de
Appel, Ana Paula
Moyano, Luis Gregorio
Ito, Marcia
Pinhanez, Claudio Santos
author Santana, Vagner Figueredo de
author_facet Santana, Vagner Figueredo de
Appel, Ana Paula
Moyano, Luis Gregorio
Ito, Marcia
Pinhanez, Claudio Santos
author_role author
author2 Appel, Ana Paula
Moyano, Luis Gregorio
Ito, Marcia
Pinhanez, Claudio Santos
author2_role author
author
author
author
dc.subject.none.fl_str_mv healthcare
complex networks
medical claims
big data
topic healthcare
complex networks
medical claims
big data
purl_subject.fl_str_mv https://purl.org/becyt/ford/1.2
https://purl.org/becyt/ford/1
dc.description.none.fl_txt_mv Health insurance companies in Brazil have their data about claims organized having the view only for service providers. In this way, they lose the view of physicians’ activity and how physicians share patients. Partnership between physicians can be seen as fruitful, when they team up to help a patient, but could represent an issue as well, when a recommendation to visit another physician occurs only because they work in same clinic. This work took place during a short-term project involving a partnership between our lab and a large health insurance company in Brazil. The goal of the project was to provide insights (with business impact) about physicians’ activity from the analysis of the claims database. This work presents one of the outcomes of the project, i.e., a way of modeling the underlying referrals in the social network of physicians resulting from health insurance claims data. The approach considers the flow of patients through the physician–physician network, highlighting connections where referrals between physicians potentially occurred. We present the results from the analysis of a claims database (detailing 18 months of activity) from the health insurance company we partnered with. The main contribution presented in this paper is the model to reveal mutual referrals between physicians. Results show the proposed model reveals underlying characteristics of physicians’ activity from real health insurance claims data with multiple business applications.
Fil: Santana, Vagner Figueredo de. Ibm Research; Estados Unidos
Fil: Appel, Ana Paula. Ibm Research; Estados Unidos
Fil: Moyano, Luis Gregorio. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Ito, Marcia. Ibm Research; Estados Unidos
Fil: Pinhanez, Claudio Santos. Ibm Research; Estados Unidos
description Health insurance companies in Brazil have their data about claims organized having the view only for service providers. In this way, they lose the view of physicians’ activity and how physicians share patients. Partnership between physicians can be seen as fruitful, when they team up to help a patient, but could represent an issue as well, when a recommendation to visit another physician occurs only because they work in same clinic. This work took place during a short-term project involving a partnership between our lab and a large health insurance company in Brazil. The goal of the project was to provide insights (with business impact) about physicians’ activity from the analysis of the claims database. This work presents one of the outcomes of the project, i.e., a way of modeling the underlying referrals in the social network of physicians resulting from health insurance claims data. The approach considers the flow of patients through the physician–physician network, highlighting connections where referrals between physicians potentially occurred. We present the results from the analysis of a claims database (detailing 18 months of activity) from the health insurance company we partnered with. The main contribution presented in this paper is the model to reveal mutual referrals between physicians. Results show the proposed model reveals underlying characteristics of physicians’ activity from real health insurance claims data with multiple business applications.
publishDate 2018
dc.date.none.fl_str_mv 2018-09
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/96261
Santana, Vagner Figueredo de; Appel, Ana Paula; Moyano, Luis Gregorio; Ito, Marcia; Pinhanez, Claudio Santos; Revealing Physicians Referrals from Health Insurance Claims Data; Elsevier; Big Data Research; 13; 9-2018; 3-10
2214-5796
CONICET Digital
CONICET
url http://hdl.handle.net/11336/96261
identifier_str_mv Santana, Vagner Figueredo de; Appel, Ana Paula; Moyano, Luis Gregorio; Ito, Marcia; Pinhanez, Claudio Santos; Revealing Physicians Referrals from Health Insurance Claims Data; Elsevier; Big Data Research; 13; 9-2018; 3-10
2214-5796
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S2214579617302952
info:eu-repo/semantics/altIdentifier/doi/10.1016/j.bdr.2018.03.002
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 12.982451

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