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dc.contributor.author
Santana, Vagner Figueredo de
dc.contributor.author
Appel, Ana Paula
dc.contributor.author
Moyano, Luis Gregorio
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dc.contributor.author
Ito, Marcia
dc.contributor.author
Pinhanez, Claudio Santos
dc.date.available
2020-01-30T19:23:45Z
dc.date.issued
2018-09
dc.identifier.citation
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
dc.identifier.issn
2214-5796
dc.identifier.uri
http://hdl.handle.net/11336/96261
dc.description.abstract
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.
dc.format
application/pdf
dc.language.iso
eng
dc.publisher
Elsevier
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dc.rights
info:eu-repo/semantics/openAccess
dc.rights.uri
https://creativecommons.org/licenses/by-nc-nd/2.5/ar/
dc.subject
healthcare
dc.subject
complex networks
dc.subject
medical claims
dc.subject
big data
dc.subject.classification
Otras Ciencias de la Computación e Información
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dc.subject.classification
Ciencias de la Computación e Información
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dc.subject.classification
CIENCIAS NATURALES Y EXACTAS
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dc.title
Revealing Physicians Referrals from Health Insurance Claims Data
dc.type
info:eu-repo/semantics/article
dc.type
info:ar-repo/semantics/artículo
dc.type
info:eu-repo/semantics/publishedVersion
dc.date.updated
2020-01-29T22:37:00Z
dc.journal.volume
13
dc.journal.pagination
3-10
dc.journal.pais
Países Bajos
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dc.journal.ciudad
Amsterdam
dc.description.fil
Fil: Santana, Vagner Figueredo de. Ibm Research; Estados Unidos
dc.description.fil
Fil: Appel, Ana Paula. Ibm Research; Estados Unidos
dc.description.fil
Fil: Moyano, Luis Gregorio. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
dc.description.fil
Fil: Ito, Marcia. Ibm Research; Estados Unidos
dc.description.fil
Fil: Pinhanez, Claudio Santos. Ibm Research; Estados Unidos
dc.journal.title
Big Data Research
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/url/https://www.sciencedirect.com/science/article/pii/S2214579617302952
dc.relation.alternativeid
info:eu-repo/semantics/altIdentifier/doi/http://dx.doi.org/10.1016/j.bdr.2018.03.002
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