Physicians working under capitated arrangements must provide quality care and make money, i.e., manage the underwriting risk. Sometimes those ends can seem to be contradictory. To use capitation as a tool to provide cost-effective and quality health care, it behooves the physician to know what forces are at work that influence the results of this capitated environment. Several of those areas are under control of the physician directly and others are not. The physician must know what he or she can control and what cannot be controlled.
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Association of Parity with Type 2 Diabetes Mellitus in Japan.
Reprod Sci
December 2024
Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Tohoku University Hospital, 1-1, Seiryomachi, Sendai, Miyagi, Japan.
This study investigates the association between parity and type 2 diabetes mellitus (T2DM) in Japanese women, considering the clinical history of gestational diabetes mellitus (GDM) and menopausal status, which are known risk factors for T2DM. Overall, 30,116 Japanese women (6,588 premenopausal and 23,528 postmenopausal) were included in this cross-sectional study. They were divided into two groups according to menopausal status (premenopausal and postmenopausal women), and the association between parity and T2DM was evaluated using a multiple logistic regression model with possible confounders, including a clinical history of GDM.
View Article and Find Full Text PDFAn Outline of a Simple, Interpretable Epigenetic Composite Score for Mortality Prediction for Accelerated Underwriting.
J Insur Med
November 2024
Department of Psychiatry, University of Iowa, Iowa City, IA, USA.
Background.—: In principle, it is generally accepted that DNA methylation measures can be used to predict mortality. However, as of yet, no epigenetic metric has been successfully incorporated into underwriting procedures.
View Article and Find Full Text PDFDevelopment of a Predictive Hospitalization Model for Skilled Nursing Facility Patients.
J Am Med Dir Assoc
January 2025
Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA.
Objectives: Identifying skilled nursing facility (SNF) patients at risk for hospitalization or death is of interest to SNFs, patients, and patients' families because of quality measures, financial penalties, and limited clinical staffing. We aimed to develop a predictive model that identifies SNF patients likely to be hospitalized or die within the next 7 days and validate the model's performance against clinician judgment.
Design: Retrospective multivariate prognostic model development study.
Propensity score matching: a tool for consumer risk modeling and portfolio underwriting.
J Appl Stat
January 2024
Flock Specialty Finance, Data Science and Risk Management, Atlanta, GA, USA.
Researchers and practitioners in financial services utilize a wide range of empirical techniques to assess risk and value. In cases where known performance is used to predict future performance of a new asset, the risk of bias is present when samples are uncontrolled by the analyst. Propensity score matching is a statistical methodology commonly used in medical and social science research to address issues related to experimental design when random assignment of cases is not possible.
View Article and Find Full Text PDFArticle Synopsis
- Fetal alcohol spectrum disorder (FASD) is the most common congenital condition leading to developmental and intellectual disabilities globally, often going undiagnosed by healthcare providers.
- Life underwriters and medical directors need to recognize the signs of FASD to effectively evaluate and determine mortality risk associated with affected individuals.
- The report discusses three specific cases of suspected undiagnosed FASD, highlighting the increased mortality risks due to prenatal alcohol exposure and underscoring the importance of proper care for these individuals to ensure they can be insured.
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