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.
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.
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
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
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
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
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
Our team has run 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