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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.

Since the onset of the pandemic, we have all learned just how crucial supply chains are in our economy and daily lives; even more so, have we all learned how important pharmaceutical supply chains are, especially when considering the mechanisms of disease spread. Supply chains in the pharmaceutical industry are extremely complicated due to all the different entities involved in decision-making, including actors specific to the industry: regulatory organizations, insurance companies, and GPOs. This is what a recently awarded Northeastern University NSF grant project sets out to investigate.