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Insurance Claims

Journal Article
EHR Implementation Guide – Identifying Frailty Using Existing Health Data: Challenges and Opportunities for Health Systems
The guide describes the range of ways that EHRs are being used to capture data on frailty and functional impairment and best practices for implementing algorithms using EHR data for population management and patient-centered care.
Nov 6, 2023
Report
Reviewing, Refining, and Validating Claims-Based Algorithms of Frailty and Functional Impairment: Final Report
The authors developed new claims-based frailty algorithms that were validated using patient assessment data from post-acute care providers. They then compared the performance of the new algorithms with existing claims-based frailty algorithms.
Nov 6, 2023
Journal Article
Development and Validation of Algorithms to Predict Activity, Mobility, and Memory Limitations Using Medicare Claims and Post-Acute Care Assessments
This study aims to create Medicare-based algorithms for predicting functional impairment, crucial for mortality and care use. Using machine learning and PAC data, memory and activity limitations were assessed with moderate success. While promising for PAC, broader older adult application is uncertain.
Aug 16, 2023
Blog
Russia's Frontlines, India's 'Power' Moves, Food Security: RAND Weekly Recap
This weekly recap focuses on dysfunction on Russia’s front lines, India’s regional diplomacy, stopping mass shooters who seek fame, and more.
Jul 21, 2023
Report
How Do Multiple-Loss Properties Drive Flood Insurance Costs?
Most natural disasters in the United States involve floods, and climate change is increasing their frequency and severity. More data on the properties that experience multiple flood losses can help inform decisions related to floodplain management, insurance, and mitigation efforts.
Jul 19, 2023
Journal Article
Comparison of Definitions for Identifying Urgent Care Centers in Health Insurance Claims
The objective of this study is to describe and validate two claims-based urgent care centers definitions.
Jun 30, 2021
Journal Article
Effects of Employer-Offered High-Deductible Plans on Low-Value Spending in the Privately Insured Population
This study uses insurance claims data and changes in plan offerings within firms over time to estimate treatment effects of high-deductible plans on spending on 24 low-value services received in the outpatient setting.
Feb 12, 2021
Journal Article
Impact of Consumer-Directed Health Plans on Low-Value Healthcare
Switching to a consumer-directed health plan is associated with reduced overall outpatient spending, but not with reduced spending on low-value healthcare services.
Feb 12, 2021
Journal Article
The Effect of Mandatory Insurer Reporting on Settlement Delay
This article examines this problem empirically, using a rich, national data set of closed automobile bodily injury claims.
Jan 22, 2021
Commentary
The Justice System and the COVID-19 Pandemic: Resources for Policymakers
From closed courts to increased risk for first responders, the COVID-19 pandemic has introduced new challenges for the justice system. RAND research provides insights that may be helpful as decisionmakers try and address some of these issues.
Apr 20, 2020
Commentary
Tapping Business Interruption Insurance Coverage to Assist Small Business During the Pandemic
Legislation has been introduced in several states that would require insurers to cover business interruption losses due to the COVID-19 outbreak. What are the advantages and disadvantages of such a law? If policymakers were to proceed with such an approach, then what design considerations should they keep in mind?
Apr 10, 2020
Report
Who Settles in Workers' Compensation?
The process of determining appropriate workers' compensation benefits can be costly and complicated. Changes in permanent disability benefits in Oregon provide a case study on the relationship between the expected value of the benefit and the probability of settlement.
Dec 23, 2019
Commentary
Allocating Costs for California Wildfires
Wildfires in California have caused and will likely continue to cause substantial losses for residents, businesses, and government agencies. It is important to distribute these losses in a manner that provides incentives to reduce their magnitude over time.
Jul 24, 2019
Report
The Role of Health Care Liens in Litigation and Recovery
This paper examines the different types of health care liens and trends in prevalence, as well as how liens have changed the landscape of claim resolution.
Nov 19, 2018
Research Brief
How Does Expanding Health Insurance Coverage Affect Workers' Compensation Costs?
The Affordable Care Act's expansion of coverage for people under age 26 led to a 1-percent reduction in uninsurance, equating to a 0.8-percent decrease in workers' compensation claim frequency, and a roughly 1-percent decrease in overall claim costs.
Nov 22, 2016
Report
Implementing a Drug Formulary for California's Workers' Compensation Program
This report supports the California Division of Workers' Compensation's efforts to establish a drug formulary by comparing existing workers' compensation formularies and analyzing options for designing and implementing the formulary.
Aug 25, 2016
Commentary
The High Cost of Hacks
The cyber insurance industry can play a critical role in informing corporations about effective security controls, monitoring the use of those controls, and therefore help reduce the probability and magnitude of breaches. But it may be squandering this opportunity.
Mar 9, 2015
Testimony
Targeting of SSDI Program Could Be Improved by Reducing the Variation in Initial Determinations
Though consistency in applying disability assessment criteria is intended, it is not easily achieved in practice. For many SSDI applicants, whether they are allowed or denied benefits depends upon the examiner to which their application is assigned.
Mar 20, 2012
News Release
RAND Corporation, Risk Management Solutions Launch New Company to Develop Liability Insurance Tools
The RAND Corporation, Risk Management Solutions, Inc. (RMS) and private investors have launched a company named Praedicat, Inc., that will provide consulting services and software to the property and casualty insurance industries.
Mar 14, 2012
Report
Collecting on Low-Value Claims Would Provide Medicare with Little Revenue and Substantial Reporting Costs
Effective January 1, 2012, Medicare will require insurers and self-insured companies to report settlements, awards, and judgments over $5K that involve a Medicare beneficiary. Over three years the $5K threshold will be phased out and all claims will have to be reported—but the potential revenue recovered from low-value claims may not be worth the reporting costs.
Jun 21, 2011

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Researcher Spotlight

Brenna O'Neill

Research Programmer

Brenna O'Neill (she/her) is a research programmer in the RAND Corporation's Research Programming Group. She works primarily in RAND Healthcare, and performs database management as well as analytic tasks including extracting, cleaning and maintaining large complex datasets, as well as performing…
Sara E. Heins

Policy Researcher

Sara E. Heins is a policy researcher at the RAND Corporation. Her research interests include substance use and dependence, injury, occupational health, health information technology, maternal and child health, and emergency medical services. Current RAND projects include assisting the Centers…

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