News Room

New Year’s resolutions are not commitments to change. If a person is committed to make positive and constructive changes, a specific date such as Jan. 1 is not necessary. Any day can do.

A new research in the INFORMS journal Manufacturing & Service Operations Management finds that Medicare Advantage (MA), the largest healthcare capitation program in the U.S., unintentionally incentivises health plans to cherry-pick profitable patients from traditional Medicare (TM). The study, “Can Big Data Cure Risk Selection in Healthcare Capitation Program? A Game Theoretical Analysis,” shows that even if the current MA risk adjustment design became informationally perfect through increased availability of big data, incentives would continue to persist for risk selection, primarily because of the way the current risk adjustment model is designed. Co-author SMU Assistant Professor of Operations Management Zhaowei She said, “No generic risk adjustment algorithm can solve the strategic prediction problem in risk adjustment without explicitly taking into account the underlying mechanism in healthcare capitation programs.” The study calls for practitioners and policymakers to change their views of seeing risk adjustment as a pure statistical and machine learning problem and to look more comprehensively at the human impact.

The company started the new year by reworking internal communication standards and clearing calendars of all recurring meetings with more than three people.