Description: Identifying and submitting all appropriate ICD-9 diagnosis codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage plans. Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by age/gender, geography, and population type and will assist plans in benchmarking the effectiveness of their own diagnosis code capture efforts.

Description: This article describes a method that can be useful when re-fitting a risk score model to a population of only moderate size. Learn how to use concepts like ridge regression to train a model with partial credibility.

Description: Analysis of possible mathematical relationships between hospital quality and hospital billed or allowed charges or other measures, using quality data as defined by the U.S. Department of Health and Human Services along with the Hospital Quality Alliance for their Hospital Quality Initiative.

Description: The influenza pandemic of 1918-20 is recognized as having generally taken place in three waves, starting in the northern spring and summer of 1918. This pattern of three waves, however, was not universal: in some locations influenza seems to have persisted into or returned in 1920. The recorded statistics of influenza morbidity and mortality are likely to be a significant understatement. Limitations of these data can include nonregistration, missing records, misdiagnosis, and nonmedical certification, and may also vary greatly between locations. Further research has seen the consistent upward revision of the estimated global mortality of the pandemic, which a 1920s calculation put in the vicinity of 21.5 million. A 1991 paper revised the mortality as being in the range 24.7-39.3 million. This paper suggests that it was of the order of 50 million. However, it must be acknowledged that even this vast figure may be substantially lower than the real toll, perhaps as much as 100 percent understated.

Description: Discussion of the separate and joint effects of obesity and diabetes on disability and mortality, and ways these effects can be used to improved insurance pricing and reserving, reverse the increasing rates of obesity and diabetes, and improve current projections of disability and mortality risks.

Description: Realizing the impact of medical errors on the U.S. health care system, the Health Section commissioned a research project to measure the annual frequency of medical errors and their total measurable direct and indirect cost to the economy.

Description: A review of the latest of a series of reports from Statistics Canada, covering data from various Canadian social benefits programs for 1971-1977.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.