Machine learning detects NASH patients from medical claims data.
problem Detecting undiagnosed NASH patients for screening and management.
method Gradient-boosted decision trees trained on administrative medical claims data.
result Model precision for NASH detection is significantly higher than NASH incidence.
ZiMM model predicts long-term blurry relapses from non-clinical claims data.
problem Predicting long-term blurry relapses after medical acts.
method Introduces ZiMM (Zero-inflated Mixture of Multinomial distributions) and a deep-learning architecture (ZiMM Encoder-Decoder) to learn from sparse, irregular patterns in claims data.
result ZiMM ED improves predictions over various baselines, including non-deep learning and deep-learning approaches.
Risk adjustment has become an increasingly important tool in healthcare. It has been extensively applied to payment adjustment for health plans to reflect the expected cost of providing coverage for members. Risk adjustment models are typically estimated using linear regression, which does not fully exploit the informa…
Study uses healthcare claims data to identify Covid-19 risk factors without prior selection.
problem Identify risk factors for severe Covid-19 cases.
method Fine-grained hierarchical information from medical classification systems used to analyze over 33,000 covariates.
result Method has better predictive ability than pre-specified morbidity groups.
Study identifies risk factors for subsequent suicide attempts in youth.
problem Uncertainty in suicide attempt identification from medical claims data.
method Integrative Cox cure model with regularization for survival analysis with uncertain events.
result Identifies risk factors for subsequent suicide attempts and distinguishes susceptibility from timing.
Rare diseases affecting 350 million individuals are commonly associated with delay in diagnosis or misdiagnosis. To improve those patients' outcome, rare disease detection is an important task for identifying patients with rare conditions based on longitudinal medical claims. In this paper, we present a deep learning m…
Is it true that patients with similar conditions get similar diagnoses? In this paper we show NLP methods and a unique corpus of documents to validate this claim. We (1) introduce a method for representation of medical visits based on free-text descriptions recorded by doctors, (2) introduce a new method for clustering…
LLMs help automate extraction of actuarial variables from unstructured claims data.
problem Manual processing of unstructured claims data is time-consuming and inconsistent.
method Two-stage processing architecture using LLMs, modular Python pipeline.
result LLM-based extraction achieved high accuracy and practical actuarial value.
Word embeddings are a popular approach to unsupervised learning of word relationships that are widely used in natural language processing. In this article, we present a new set of embeddings for medical concepts learned using an extremely large collection of multimodal medical data. Leaning on recent theoretical insigh…
DDPMs can reproduce medical image context, showing interpolation between samples.
problem Understanding DDPMs' ability to learn spatial context in medical imaging.
method Used stochastic context models (SCMs) to produce training data and assess DDPMs' performance.
result DDPMs can generate contextually correct images, interpolating between samples.
Graphical models improve actuarial judgment in insurance claims analysis.
problem Improving actuarial judgment in insurance claims analysis.
method Using graphical models to represent complex inter-dependencies and incorporate qualitative knowledge.
result Graphical models can be used to express and analyze non-life insurance claims data.
Study finds non-adherence to schizophrenia meds leads to earlier adverse events.
problem Impact of medication non-adherence on adverse outcomes in schizophrenia patients.
method Survival analysis, causal inference methods (T-learner, S-learner, nearest neighbor matching), different amounts of longitudinal information.
result Non-adherence to schizophrenia meds advances adverse events by 1 to 4 months.
Representation learning methods that transform encoded data (e.g., diagnosis and drug codes) into continuous vector spaces (i.e., vector embeddings) are critical for the application of deep learning in healthcare. Initial work in this area explored the use of variants of the word2vec algorithm to learn embeddings for m…
LMM predicts healthcare costs and risks with improved accuracy.
problem Wasteful healthcare spending and inefficiencies in risk prediction.
method Generative pre-trained transformer trained on patient event sequences.
result Improves cost prediction by 14.1% and chronic conditions prediction by 1.9%.
Classification-as-a-Service (CaaS) is widely deployed today in machine intelligence stacks for a vastly diverse set of applications including anything from medical prognosis to computer vision tasks to natural language processing to identity fraud detection. The computing power required for training complex models on l…
Causal thinking improves healthcare decisions from EHRs.
problem Shortcuts in data lead to biased healthcare decisions.
method Step-by-step framework for valid decision making from EHRs.
result Valid decision making requires careful analysis of EHR data.
Enhanced conformal methods improve validity of LLM outputs.
problem Lack of conditional validity and high false rejection rates in LLM validity guarantees.
method Adaptive conditional conformal procedure and improved scoring function differentiation.
result Demonstrated improved validity and utility on real datasets.
Deep neural network predicts health costs better than traditional models.
problem Accurate prediction of healthcare costs for optimal cost management.
method Developed a deep neural network to predict future health care costs from health insurance claims records.
result Deep neural network outperformed ridge regression and Morbi-RSA models in cost prediction.
New method uses surrogate outcomes and single-record data to improve suicide risk modeling.
problem Lack of historical information in single-record patients hinders modeling rare medical events.
method Hybrid framework combining supervised and unsupervised learning to integrate concurrent and single-record data.
result Single-record data and concurrent diagnoses provide valuable information for improving suicide risk modeling.
Pediatric asthma is the most prevalent chronic childhood illness, afflicting about 6.2 million children in the United States. However, asthma could be better managed by identifying and avoiding triggers, educating about medications and proper disease management strategies. This research utilizes deep learning methodolo…
The dearth of prescribing guidelines for physicians is one key driver of the current opioid epidemic in the United States. In this work, we analyze medical and pharmaceutical claims data to draw insights on characteristics of patients who are more prone to adverse outcomes after an initial synthetic opioid prescription…
The paper advocates for interpretable, accountable, reproducible machine learning in medicine.
problem Black box models in medicine lack transparency and regulatory approval.
method Intrinsically interpretable modeling approaches and collaborative learning paradigms.
result Interpretable machine learning models can support clinical decisions and gain regulatory approval.
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…
Reinforcement learning improves insurance claims reserving by learning from all claim trajectories.
problem Traditional reserving models learn only from settled claims, missing valuable data from ongoing claims.
method Formulated as a Markov decision process, uses reinforcement learning to update OCL estimates sequentially.
result Soft Actor-Critic implementation achieves competitive claim-level accuracy and strong aggregate performance.
The study analyzes how bonus-malus systems and delayed claims settlement affect insurance companies' financial stability.
problem Analyzing the impact of bonus-malus systems and delayed claims settlement on insurance companies' financial stability.
method Examined a discrete-time risk model with time-varying premiums, evaluating two types of claims and settlement delays.
result Delayed settlement of by-claims leads to lower ruin probabilities under specific assumptions.
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%.
Improves medication name inference for telemedicine and conversational agents.
problem Challenges in mapping user-friendly medication names to standardized ones.
method Entity-boosted two-tower neural network for ranking SMN to DMP.
result State-of-the-art results achieved with improved attention-based ranking.
Measures faithfulness of LLM explanations to reveal hidden biases and misleading claims.
problem LLM explanations can misrepresent the model's reasoning process, leading to over-trust and misuse.
method Defines faithfulness in terms of concept influence and uses counterfactuals and Bayesian models to estimate it.
result Can quantify and discover interpretable patterns of unfaithfulness in LLM explanations.
The treatment effects of medications play a key role in guiding medical prescriptions. They are usually assessed with randomized controlled trials (RCTs), which are expensive. Recently, large-scale electronic health records (EHRs) have become available, opening up new opportunities for more cost-effective assessments. …
New method for individual claims reserving using machine learning.
problem Traditional claims reserving methods are limited in individual claim prediction.
method Restructured data utilization for CL prediction, using multi-period factors.
result Neural networks applied for individual claims reserving.
Two large medical dialogue datasets for improving healthcare.
problem Improving healthcare through better dialogue systems.
method Building two large-scale medical dialogue datasets: MedDialog-EN and MedDialog-CN.
result The datasets are the largest medical dialogue datasets to date.
Proposes guidelines for developing medical AI products.
problem Lack of clear pathways for regulating medical AI.
method Statistical risk perspective and deep understanding of machine learning methodologies.
result Enhanced development of medical AI products and regulations.
The tail of the distribution of a sum of a random number of independent and identically distributed nonnegative random variables depends on the tails of the number of terms and of the terms themselves. This situation is of interest in the collective risk model, where the total claim size in a portfolio is the sum of 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.
Optimizes insurance processing capacity to minimize costs.
problem Processing delays and backlogs in insurance claims.
method Optimal capacity selection to minimize delay-adjusted and fixed costs.
result Minimizes claims costs by balancing processing capacity and delays.
New model bridges pricing and reserving for insurance claims.
problem Incomplete claim data due to reporting and settlement delays.
method Develops an occurrence and development model to estimate both claims and premiums.
result Effective resolution of pricing and reserving inconsistencies.
Paper tackles medical question similarity using domain-relevant embeddings.
problem Identifying same-question pairs in medical contexts.
method Semi-supervised pre-training of a neural network on medical question-answer pairs.
result Our model achieves 82.6% accuracy on medical question similarity task.
This study compares the largest claims from two insurance portfolios using stochastic orderings.
problem Comparing the largest claims from two heterogeneous insurance portfolios.
method Used various stochastic orderings and established sufficient conditions associated with model parameters.
result Established sufficient conditions for comparing the largest claims from two insurance portfolios.
Automated system extracts medication regimens from medical conversations.
problem Extract relevant medication information from medical conversations.
method QA task approach, combined QA and Information Extraction, data augmentation, public embeddings, pretraining.
result Improved accuracy in extracting dosage and frequency from 54.28 and 37.13 to 89.57 and 45.94.
Model detects insurance fraud using social network analysis.
problem Fraudulent insurance claims by exaggeration or intentional damage.
method Network construction linking claims and parties, BiRank algorithm for fraud score computation, feature extraction from network and claims, supervised model building.
result Network features improve fraud detection performance.
In rare disease physician targeting, a major challenge is how to identify physicians who are treating diagnosed or underdiagnosed rare diseases patients. Rare diseases have extremely low incidence rate. For a specified rare disease, only a small number of patients are affected and a fractional of physicians are involve…
We consider trading in a financial market with proportional transaction costs. In the frictionless case, claims are maximal if and only if they are priced by a consistent price process--the equivalent of an equivalent martingale measure. This result fails in the presence of transaction costs. A properly maximal claim i…
Investor maximizes utility from an unknown claim using robust optimization.
problem Maximizing utility from an unknown contingent claim.
method Robust optimization with quantile formulation and variational inequalities.
result Optimal trading strategy and utility indifference price determined.
Model predicts individual insurance claim reserves using activation patterns.
problem Accurately predicting individual claim reserves in insurance contracts.
method Multinomial logistic regression to model claim activation and development.
result The model generates accurate predictions of total and per coverage reserves.
BERT learns claim descriptions to identify patent novelty.
problem Identifying novel patent claims among existing documents.
method Training BERT on concatenated claims and descriptions, scoring BERT's output.
result BERT identifies relevant X documents for patent novelty.
A GMM-based method generates new 3D structures from medical images.
problem Generating new medical images from limited data and different modalities.
method Gaussian Mixture Model (GMM) for point-cloud generation.
result Generated point-clouds closely match training samples from the same class.
Insurance companies must manage millions of claims per year. While most of these claims are non-fraudulent, fraud detection is core for insurance companies. The ultimate goal is a predictive model to single out the fraudulent claims and pay out the non-fraudulent ones immediately. Modern machine learning methods are we…
The medical field stands to see significant benefits from the recent advances in deep learning. Knowing the uncertainty in the decision made by any machine learning algorithm is of utmost importance for medical practitioners. This study demonstrates the utility of using Bayesian LSTMs for classification of medical time…