In The Media

At Santa Barbara Actuaries, we take pride in our ongoing research and publications. The following is a sample of research projects and publications in which the associates of Santa Barbara Actuaries have been involved. 

Textbooks

Healthcare Risk Adjustment and Predictive Modeling

Provides a comprehensive guide to healthcare actuaries and other professionals interested in healthcare data analytics, risk adjustment and predictive modeling.

Managing and Evaluating Healthcare Intervention Programs

Since its publication in 2008, Managing and Evaluating Healthcare Intervention Programs has become the premier textbook for actuaries and other healthcare professionals interested in the financial performance of healthcare interventions.

Group Insurance

A comprehensive treatment of all aspects of group insurance in the United States and Canada, both life and health, with emphasis on the actuarial aspects of this important field of insurance.

Articles and Publications

Economic Impact on the Healthcare System using an FDA-Cleared Mild Brain Injury/Concussion Assessment Device

Escalating awareness of the short and long-term consequences of traumatic head injury, even when mild, has resulted in an increasing burden to the health care system to the extent of $76.5 billion annually. This
white paper demonstrates potential cost reductions, shared between payers and patients when the BrainScope® One medical device is integrated into the patient care pathway.

A Comparative Analysis Of Chronic And Nonchronic Insured Commercial Member Cost Trends

Chronic and nonchronic cost trends between 1999 and 2002 published by The North American Actuarial Journal

Integrating Claims-Based and Survey-Based Data to Estimate Program Savings

An innovative approach to evaluating overlapping medical intervention programs

Understanding the impact of five major determinants of health (genetics, biology, behavior, psychology, society/environment) on type 2 diabetes in U.S. Hispanic/Latino families: Mil Familias - a cohort study

A study to determine the influence of the 5 major determinants of human health (genetics, biology, behavior, psychology, society/environment) on the burden of T2D for Latino families

Racial and Ethnic Disparities in the Burden and Cost of Diabetes for US Medicare Beneficiaries

An examination of the burden and cost of diabetes among fee-for-service Medicare beneficiaries

Principles for Assessing Disease Management Outcomes

The Disease Management Association of America convened a Steering Committee to suggest a preferred approach for DM program evaluation

Assessing the Value of Diabetes Education

Measuring the financial impact of diabetes self-management education, published by The Diabetes Educator

Impact of Cost on the Safety of Cancer Pharmaceuticals

A chapter, Impact of cost on the safety of cancer pharmaceuticals, by Fitzner and Oteng Mensah in a recent book, Cancer Policy: Pharmaceutical Safety, aims to inform readers about the economics associated with the interplay between safety, costs of cancer treatment, and outcomes of cancer care.

Medication Days' Supply, Adherence, Wastage, and Cost Among Chronic Patients in Medicaid

A study conducted to determine whether 90- day refills at community pharmacies could improve adherence, minimize wastage, and control costs

Strategies to Help Manage the Impact of COVID-19 on Elective Surgeries

Using data to help health plans and employers plan ahead, control costs and improve quality

Testing Actuarial Methods for Evaluating Disease Management Savings Outcomes

Measuring cost savings from a 2 year DM program, published by the Society of Actuaries (SOA)

The Choices People Make (and Their Implications for Private Exchanges)

Choice overload - the concept that individuals struggle to make a good decision, or even any decision, when presented with too much choice - is a well-researched phenomenon in behavioral economics, and we would expect to see this in health plan decisions.

Effects of a Population Health Community-Based Palliative Care Program on Cost and Utilization

An evaluation of utilization and cost outcomes for a community-based palliative care program provided by nurses and social workers.

Mining Health Claims Data for Assessing Patient Risk

From the book, Data Mining: Foundations and Intelligent Paradigms, comes a chapter on applying data mining techniques to quantify patient risk

Economics of Malignant Gliomas: A Critical Review

A review to examine costs to patients with malignant glioma and their families, payers, and society.

Case Studies

Our team has ran several case studies on various healthcare and analytics initiatives. If you would like to learn more about any of the studies below, please feel free to request additional information. 

• Using machine learning models to outreach to members who may be leaning towards undergoing unnecessary medical procedures prior to them doing so

• Extending sales opportunities for ancillary benefits from employers to larger players such as health plans

• Increasing competitiveness in the Medicare Advantage marketplace through managing care more rigorously

• Identifying which Medicare Advantage members should be targeted for engagement into an advanced illness care management program and measuring financial outcomes created by the program

• Evaluating the financial outcomes arising from a type two diabetes program and determining whether the contractual financial performance guarantees are met

• Moving away from the traditional fee-for-service model as it is increasingly disintermediated from payer networks, and moving toward taking risk, specifically for cancer populations

• Designing a community care management program based on emergency medical personnel

• Using predictive modeling in the context of ACO financial outcomes and pricing

• Developing clinical outcome projection models and associated contract terms

Other Media

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