Paper proposes embedding medical concepts from claims data for better risk adjustment models.
problem Lack of efficient representation of medical histories in risk adjustment models.
method Semantic embeddings of medical concepts from diagnostic, procedure, and prescription codes.
result Embedding-based models outperform commercial risk adjustment models in prospective risk score prediction.
Study assesses health plan risk measures for Solvency Capital Requirement.
problem Assessing risk measures for health plans to meet Solvency Capital Requirement.
method Three-part regression model with three GLMs for claim counts, episode allocation, and severity.
result Reduction in regression models compared to traditional methods.
The distribution of health care payments to insurance plans has substantial consequences for social policy. Risk adjustment formulas predict spending in health insurance markets in order to provide fair benefits and health care coverage for all enrollees, regardless of their health status. Unfortunately, current risk a…
Two machine learning models detect anomalies in ER claims, saving up to 40% in improper payments.
problem Improper health insurance payments from fraud and upcoding.
method Two machine learning models: an upcoding model based on severity code distributions and a random forest model for claim sorting.
result Random forest model saved 12% to 40% in improper payments compared to a baseline approach.
Deep Claim predicts payer responses from claims data using deep learning.
problem Predicting payer responses from claims data to improve healthcare performance.
method Learning complex dependencies in claim inputs to create a compact representation, then using deep learning to predict responses.
result Deep Claim improves claim denial prediction by 22.21%.
In the modern healthcare system, rapidly expanding costs/complexity, the growing myriad of treatment options, and exploding information streams that often do not effectively reach the front lines hinder the ability to choose optimal treatment decisions over time. The goal in this paper is to develop a general purpose (…
Framework improves health by planning actionable treatment processes.
problem Developing objective treatment processes in clinical settings.
method Surrogate Bayesian model combined with ML for personalized health improvement.
result Computed treatment processes are actionable and consistent with clinical knowledge.
The paper develops a valuation framework for GLWB-LTC contracts with Levy dynamics and stochastic interest rates.
problem Valuation of GLWB-LTC contracts with financial guarantees, longevity protection, and health-contingent LTC payments.
method Coupling a recombining Hull-White trinomial tree with an IMEX finite difference scheme, incorporating a seven-state health model.
result Hybrid tree-IMEX method delivers stable long-maturity prices consistent with simulation benchmarks.
New AI model optimizes personalized care for elderly residents.
problem Limited care workforce impacts health outcomes and quality of life.
method Bandit algorithms for personalized care planning.
result Improves care quality and health outcomes through personalized care planning.
Machine learning models outperform traditional actuarial methods in predicting health insurance costs.
problem Improving accuracy in health insurance pricing to identify concession opportunities.
method Developed and evaluated two machine learning models at the patient and employer-group levels.
result Machine learning models outperformed traditional actuarial models by 20% in predicting costs.
Managing patients with chronic diseases is a major and growing healthcare challenge in several countries. A chronic condition, such as diabetes, is an illness that lasts a long time and does not go away, and often leads to the patient's health gradually getting worse. While recent works involve raw electronic health re…
The vision for precision medicine is to use individual patient characteristics to inform a personalized treatment plan that leads to the best healthcare possible for each patient. Mobile technologies have an important role to play in this vision as they offer a means to monitor a patient's health status in real-time an…
Paper introduces score embedding for Twitter sentiment analysis of health care issues.
problem Analyzing public opinion on health care plans using social media.
method Score embedding, a neural network model for word representations.
result Score embedding effectively captures sentiment and outperforms existing methods.
Estimates causal effect of managed care plans on NYC Medicaid spending.
problem Generalizing causal estimates to a target population not well-represented by randomized studies.
method Conditional cross-design synthesis estimators combining randomized and observational data.
result Estimates causal effect of managed care plans on health care spending.
One of the main issues affecting the Italian NHS is the healthcare deficit: according to current agreements between the Italian State and its Regions, public funding of regional NHS is now limited to the amount of regional deficit and is subject to previous assessment of strict adherence to constraint on regional healt…
This study compares community detection algorithms for delineating health service areas.
problem Delineating health service areas to improve health care services.
method Comparative analysis of community detection algorithms on hospital-patient discharge networks.
result Infomap algorithm produced the best delineation of health service areas.
A new model improves homogeneity in burn patient reimbursement.
problem Incomplete homogeneity checks for burn patients using LOS as a proxy.
method Cost-sensitive decision tree model considering patient-level cost and severity of burn.
result Identified groups with increased homogeneity compared to current HRG groups.
VisitHGNN predicts visit probabilities between neighborhoods and POIs using graph neural networks.
problem Estimating visit probabilities between neighborhoods and POIs for urban planning.
method Heterogeneous, relation-specific graph neural network (VisitHGNN) trained on mobility data.
result Strong predictive performance with high fidelity to observed travel behavior.
Paper introduces balanced payment systems to improve liquidity and risk management.
problem Managing liquidity in payment systems and economy is a persistent challenge.
method Introduces interbank balancing method to private payment systems and others.
result Demonstrates effects of balancing on a small example and constructs a balanced subsystem.
The paper assesses fairness in AI for financial services, using statistical methods.
problem Unintentional bias and insufficient model validation in AI applications.
method Statistical methods for imbalanced data treatment and bias mitigation.
result Fairness evaluation metrics applied to a credit card default payment example.
A new method streamlines digital payment programming using smart contracts.
problem High costs and security challenges in programming smart contracts for digital payments.
method Transforming digital currencies into token streams and using configurable templates to generate specialized smart contracts.
result Reduces payment programming costs and enhances security, self-enforcement, adaptability, and controllability.
Game theory applied to financial networks, focusing on debt repayment strategies.
problem Understanding financial stability in interconnected systems.
method Modeling financial systems as networks, analyzing utility-maximizing strategies under priority-proportional payments.
result Existence and uniqueness of payment profiles are not guaranteed, even under fixed strategies.
Stablecoins offer efficient settlement but externalize costs and risks.
problem Comparing stablecoins to card networks in retail payments.
method Unified analytical framework (CLEAR) across five dimensions.
result Stablecoins are advantageous in closed-loop and high-friction contexts but structurally disadvantaged as open-loop instruments.
This paper considers the optimal dividend payment problem in piecewise-deterministic compound Poisson risk models. The objective is to maximize the expected discounted dividend payout up to the time of ruin. We provide a comparative study in this general framework of both restricted and unrestricted payment schemes, wh…
The paper evaluates dynamic hedging strategies for various financial products.
problem Pricing derivative products with dynamic hedging and issuer-tailored risk.
method Unified constrained discrete stochastic dynamic programming framework with sequential local minimizing strategies.
result Demonstrates flexibility of the unified framework through numerical examples.
Research examines motivations and factors influencing retailers' payment method choices.
problem Understanding motivations and factors affecting retailers' payment method choices.
method Qualitative and quantitative analysis of various factors including regulatory constraints, merchant service providers, and demographic variables.
result Lower interchange fees and regulatory constraints make card payment adoption financially feasible for merchants.
This paper uses deep learning to classify different types of cracks from acoustic emission events.
problem Classifying different types of cracks from acoustic emission events.
method Combining deep neural networks with Bidirectional Long Short Term Memory and statistical analysis.
result Achieves 92% accuracy in classifying different types of cracks.
The paper examines clearing payments in financial networks to prevent cascaded defaults.
problem Cascaded defaults in financial networks under the proportionality rule.
method Analysis of clearing model under pro-rated payments, derivation of necessary and sufficient conditions for clearing payments, convex optimization problems for computation.
result Clearing payments can be computed by solving convex optimization problems, reducing overall system loss by lifting the proportionality rule.
Paper introduces PHI to identify structurally distinct payment patterns in UK municipal procurement.
problem Vulnerability of public procurement to error, fraud, and corruption in high-volume transactions.
method Introduces Payment Heterogeneity Index (PHI) using Gaussian Mixture Model (GMM) and non-parametric statistics.
result Identifies a significant cohort with structurally distinct payment patterns, improving procurement oversight.
EHR-MPC optimizes sepsis treatment using digital twins and inference-time control.
problem Optimal sepsis treatment policies are contested and difficult to adapt during inference.
method EHR-MPC decouples learning patient dynamics from treatment optimization, enabling inference-time control over learned digital twins.
result EHR-MPC achieves comparable off-policy performance and improved simulation performance compared to RL baselines.
Model predicts wound and episode-level readmission risk and time to re-admit.
problem Identify patients at high risk of re-admission to prevent wound recurrences and reduce healthcare costs.
method Data-driven analysis of wound care and episode-level patient data.
result Model achieves high recall and precision for predicting re-admission risk and time.
A new model calculates optimal clearing payments in dynamic financial networks.
problem Determining fair clearing payments in networks with potential defaults.
method Extends Eisenberg-Noe model to multiple time periods, solving linear programs for optimal payments.
result Proves the model satisfies the priority of debt claims requirement and finds unique optimal payments.
Payments data and machine learning improve nowcasting accuracy for macroeconomic indicators.
problem Lagged indicators in linear models are insufficient during crisis periods.
method Non-traditional payments data, nonlinear machine learning, and tailored cross-validation.
result Improved macroeconomic nowcasting accuracy up to 40% during crises.
Blockchain helps secure payments between AI agents.
problem Ensuring secure payments between untrusted AI agents.
method Systematized four-stage lifecycle for A2A payments on blockchain.
result Challenges remain in weak intent binding, misuse, and limited accountability.
Social media provide a platform for users to express their opinions and share information. Understanding public health opinions on social media, such as Twitter, offers a unique approach to characterizing common health issues such as diabetes, diet, exercise, and obesity (DDEO), however, collecting and analyzing a larg…
Optimal student loan repayment strategies vary based on loan size.
problem Finding the most cost-effective repayment strategy for federal student loans.
method Analyzing the impact of different repayment strategies on total cost for varying loan sizes.
result Optimal repayment strategies depend on the loan balance, with different approaches for small, large, and intermediate balances.
Agent-to-agent finance aims to manage payments and trust for AI agents.
problem Managing financial interactions between autonomous AI agents.
method Develops agent-to-agent finance concept and explores blockchain solutions.
result Agent-to-agent finance can address coordination frictions in financial markets.
Study risk-minimizing insurance investments with taxes and expenses.
problem Determining optimal insurance investments in the presence of taxes and expenses.
method Introduced tax- and expense-modified risk-minimization, derived strategies, linked to decompositions, and established equivalence to artificial market approach.
result Equivalence to artificial market approach and consistency with classic risk-minimization.
New bandit model for healthcare intervention planning.
problem Maximizing patient health with limited monitoring resources.
method Developed Collapsing Bandits model and derived optimal policies.
result 3-order-of-magnitude speedup in algorithm performance.
We propose a model in which dividend payments occur at regular, deterministic intervals in an otherwise continuous model. This contrasts traditional models where either the payment of continuous dividends is controlled or the dynamics are given by discrete time processes. Moreover, between two dividend payments, the st…
The paper tackles robust control for insurance contracts under uncertain transition rates.
problem Maximizing utility in insurance contracts with uncertain transition rates.
method Novel robust utility maximization problem under bounded cumulative transition rate uncertainty, using worst-case scenario analysis.
result Existence and uniqueness of worst-case and best-case reserves for insurance contracts.
The paper analyzes multivariate payments in multi-state life insurance using Markovian state processes.
problem Analyzing joint effects of life annuities and death benefits in a multi-state framework.
method Introduces multivariate present value of future payments, derives differential equations and moment generating functions, and focuses on pair-wise covariances.
result Derives Hattendorff type results for pair-wise covariances in a disability model.
AI task delegation faces incentive collapse with unbounded payments as AI accuracy rises.
problem Incentive collapse in AI-assisted task delegation schemes.
method General impossibility result and sentinel-auditing payment mechanism.
result Sentinel-auditing mechanism enforces positive human effort at finite cost, independent of AI accuracy.
The study reveals fundamental limits of fraud detection in card payment networks.
problem Fraud detection in card payment networks is challenging due to structural information impairments.
method Formalized card authorization as a sequential decision problem with delayed feedback, derived minimax regret lower bound.
result Improving issuer reporting quality or reducing censorship can yield larger reductions in the regret floor than increasing model complexity.
Mobile payment incentives optimized using merchant transaction networks.
problem Optimizing marketing campaigns with limited budgets.
method Graph representation learning on transaction networks.
result Effective modeling of merchant sensitivity to incentives.
This paper concerns an optimal dividend distribution problem for an insurance company with surplus-dependent premium. In the absence of dividend payments, such a risk process is a particular case of so-called piecewise deterministic Markov processes. The control mechanism chooses the size of dividend payments. The obje…
Ability for accurate hospital case cost modelling and prediction is critical for efficient health care financial management and budgetary planning. A variety of regression machine learning algorithms are known to be effective for health care cost predictions. The purpose of this experiment was to build an Azure Machine…
We develop an axiomatic theory of balance functions (future value functions) in the theory of interest that is derived from financial considerations and which applies to general regulated payment streams, including continuous payment streams. Balance functions exist and are unique up to an initial choice of deposit and…