Unbiased Analysis of Today's Healthcare Issues

Archive for June, 2012

Weekend Links

HWR: Supreme Court Edition. Health Reform and Workers Comp. Health Reform…in China. Will health reform cause job loss? PEDs don’t work?

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HEALTH REFORM UPHELD

Today the Supreme Court upheld the large majority of Affordable Care Act (a.k.a., Health Reform, ObamaCare, ACA) including the individual mandate. Why was the individual mandate allowed to remain in the law?  According to Justice Ginsburg and others, it is a form of a tax. “Justice Ginsburg makes clear that the vote is 5-4 on […]

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Risk Adjustment: K-fold Cross Validation

Oftentimes, researchers will use an existing risk adjustment model and apply it to new data.  The question is, which risk adjustment model should be used?  The most popular method is to calibrate the model (i.e., estimate model parameters or coefficients) using one sample and validate the model using a separate data file.  This standard approach, […]

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Cavalcade of Risk #160 is up

The latest edition of the Cavalcade of Risk is up at Colorado Health Insurance Insider.

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Risk Adjustment: Overfitting the Model

When creating risk adjustment models to predict health care spending, many researchers aim to maximize the goodness-of-fit of the model.  Maximize the goodness of fit, however, can produce the problem of overfitting. Overfitting occurs when a model describes random error or noise instead of the underlying relationship. Overfitting generally occurs when a model is excessively […]

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Risk Adjustment: Measuring Model Fit

You are the CEO of a health plan with millions of beneficiaries.  If you have a demographic and health status information on these beneficiaries, can you predict how much each beneficiary will cost you?  If so, how accurate will your prediction be? Most likely, you will use a risk adjustment model to predict how much […]

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Greece and Germany Battle over Supremacy in Europe

Greece isn’t asking for a bailout.  Today, they expect no help from Germany.  The Germans themselves, even if they would like to, can no longer assume the role of the paymaster.  They may dictate much of the pace, but they will have to earn an of their Euro goals through hard work, not by mandates. […]

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UnitedHealth Group to Reveal Healthcare Prices?

According to The Hartford Courant: UnitedHealthcare launched a newer online program that allows 14 million of its members to compare current prices of medical services, including how much a patient will pay out of pocket. The program is specialized to show how much the insurer would pay, and how much the patient would pay based […]

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Wednesday Links

Why Prices Matter: Part I, Part II. IPAB, Obama’s Super-Legislature? Debt to the unlucky. The latest fashion accessory? Does the public wan to overturn health reform? Health care spending slows. No surprise: timing matters for ER care. Hacking Healthcare.

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What is the difference between DRGs, AP-DRGs, and APR-DRGs?

DRGs measures case mix for inpatient admissions. One question is how to define a more severe case.  Six dimensions along which case mix could be measured include: Severity of Illness. Extent of physiologic decompensation or organ system loss of function. Risk of Mortality. Likelihood of dying. Prognosis. Probable outcome of an illness including the likelihood […]

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