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
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/96261
Ver los metadatos del registro completo
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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 Técnicas2025-09-29T09:49:52Zoai: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:34982025-09-29 09:49:52.307CONICET 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/ |
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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 |
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reponame:CONICET Digital (CONICET) instname:Consejo Nacional de Investigaciones Científicas y Técnicas |
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CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas |
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dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar |
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13.070432 |