Data-driven approach to health care : applications using claims data

Abstract

Large population health insurance claims databases together with operations research and data mining methods have the potential of significantly impacting health care management. In this thesis we research how claims data can be utilized in three important areas of health care and medicine and apply our methods to a real claims database containing information of over two million health plan members. First, we develop forecasting models for health care costs that outperform previous results. Secondly, through examples we demonstrate how large-scale databases and advanced clustering algorithms can lead to discovery of medical knowledge. Lastly, we build a mathematical framework for a real-time drug surveillance system, and demonstrate with real data that side effects can be discovered faster than with the current post-marketing surveillance system.