Randall P Ellis
Biographic Data
| ID | 1732535 |
|---|---|
| NAME | Randall P Ellis |
| GIVEN NAMES | Randall P |
| FAMILY NAME | Ellis |
| SIGNATURE | ELLIS R P |
| AFFILIATIONS | Boston University |
| ORCID | 0000-0003-2176-5347 |
| VERIFIED | Yes |
| TOTAL WORKS | 14 |
| TOTAL CITATIONS | 14 |
| WORKS AS AUTHOR | 14 |
| WORKS AS EDITOR | 0 |
| FIRST PUBLICATION YEAR | 1983 |
| LATEST PUBLICATION YEAR | 2024 |
| H-INDEX | 2 |
A Novel Machine Learning Algorithm for Creating Risk-Adjusted Payment Formulas
In this study, by automating DXI clustering within clinically specified hierarchies, this algorithm built clinically interpretable risk models in large datasets while addressing diagnostic vagueness and gameability concerns
Development and Assessment of a New Framework for Disease Surveillance, Prediction, and Risk Adjustment
In this diagnostic modeling study, the new DXI classification system showed improved predictions over existing diagnostic classification systems for all spending and utilization outcomes considered
Primary healthcare effects of a well-designed anti-corruption program
Mispricing in the Medicare Advantage Risk Adjustment Model
The Centers for Medicare and Medicaid Services (CMS) implemented hierarchical condition category (HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees' expected health care costs. We use Verisk Health's diagnostic cost group (DxCG) Medicare models, refined "descendants" of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal 2 mispricing errors resulting from…
Risk Selection, Risk Adjustment and Choice
Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting…
Bending the Cost Curve? Results From a Comprehensive Primary Care Payment Pilot
BACKGROUND: There is much interest in understanding how using bundled primary care payments to support a patient-centered medical home (PCMH) affects total medical costs. RESEARCH DESIGN AND SUBJECTS: We compare 2008-2010 claims and eligibility records on about 10,000 patients in practices transforming to a PCMH and receiving risk-adjusted base payments and bonuses, with similar data on approximately 200,000 patients of nontransformed practices r…
Risk-adjusted Payment and Performance Assessment for Primary Care
BACKGROUND: Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. RESEARCH DESIGN: Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected pr…
Formal Risk Adjustment by Private Employers
This paper explores explanations for why few private employers have adopted formal risk adjustment. The lack of data, challenges of using highly imperfect signals, and absence of market power are not compelling explanations. Alternative strategies that reduce selection problems are clearly important. The central argument is that U.S. health markets are not in equilibrium, but rather are changing rapidly. Since many agents-consumers, employers, he…
Supply-Side and Demand-Side Cost Sharing in Health Care
In health markets, the price paid by insured consumers when health care services are demanded can be set separately from the price paid to providers when services are supplied. This fact suggests two alternate strategies for controlling the costs of health care: demand-side cost sharing, where patients must pay more in co-payments or deductibles, and supply-side cost sharing, which seeks to alter the incentives of health care workers to provide c…
Employee Choice of Health Insurance
A new specification of health-insurance-plan choice is developed that uses a nonparametric functional form for the loss function used to evaluate insurance premiums and uncertain out-of-pocket expenditure. The approach is implemented on data resulting from one firm's implementation of a new health plan with three distinct health insurance options. Health expenditure differences greater than 500 percent are observed, indicating extremely strong bi…
The revenue generating potential of user fees in Kenyan government health facilities
Cost sharing and the demand for ambulatory mental health services
Cost sharing and the demand for ambulatory mental health services
What Happened to Nuclear Power
Supply-Side and Demand-Side Cost Sharing in Health Care
In health markets, the price paid by insured consumers when health care services are demanded can be set separately from the price paid to providers when services are supplied. This fact suggests two alternate strategies for controlling the costs of health care: demand-side cost sharing, where patients must pay more in co-payments or deductibles, and supply-side cost sharing, which seeks to alter the incentives of health care workers to provide c…
The revenue generating potential of user fees in Kenyan government health facilities
What Happened to Nuclear Power
Cost sharing and the demand for ambulatory mental health services
Cost sharing and the demand for ambulatory mental health services
The revenue generating potential of user fees in Kenyan government health facilities
Employee Choice of Health Insurance
A new specification of health-insurance-plan choice is developed that uses a nonparametric functional form for the loss function used to evaluate insurance premiums and uncertain out-of-pocket expenditure. The approach is implemented on data resulting from one firm's implementation of a new health plan with three distinct health insurance options. Health expenditure differences greater than 500 percent are observed, indicating extremely strong bi…
Supply-Side and Demand-Side Cost Sharing in Health Care
In health markets, the price paid by insured consumers when health care services are demanded can be set separately from the price paid to providers when services are supplied. This fact suggests two alternate strategies for controlling the costs of health care: demand-side cost sharing, where patients must pay more in co-payments or deductibles, and supply-side cost sharing, which seeks to alter the incentives of health care workers to provide c…
Formal Risk Adjustment by Private Employers
This paper explores explanations for why few private employers have adopted formal risk adjustment. The lack of data, challenges of using highly imperfect signals, and absence of market power are not compelling explanations. Alternative strategies that reduce selection problems are clearly important. The central argument is that U.S. health markets are not in equilibrium, but rather are changing rapidly. Since many agents-consumers, employers, he…
Risk-adjusted Payment and Performance Assessment for Primary Care
BACKGROUND: Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. RESEARCH DESIGN: Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected pr…
Risk Selection, Risk Adjustment and Choice
Interest has grown worldwide in risk adjustment and risk sharing due to their potential to contain costs, improve fairness, and reduce selection problems in health care markets. Significant steps have been made in the empirical development of risk adjustment models, and in the theoretical foundations of risk adjustment and risk sharing. This literature has often modeled the effects of risk adjustment without highlighting the institutional setting…
Bending the Cost Curve? Results From a Comprehensive Primary Care Payment Pilot
BACKGROUND: There is much interest in understanding how using bundled primary care payments to support a patient-centered medical home (PCMH) affects total medical costs. RESEARCH DESIGN AND SUBJECTS: We compare 2008-2010 claims and eligibility records on about 10,000 patients in practices transforming to a PCMH and receiving risk-adjusted base payments and bonuses, with similar data on approximately 200,000 patients of nontransformed practices r…
Mispricing in the Medicare Advantage Risk Adjustment Model
The Centers for Medicare and Medicaid Services (CMS) implemented hierarchical condition category (HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees' expected health care costs. We use Verisk Health's diagnostic cost group (DxCG) Medicare models, refined "descendants" of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal 2 mispricing errors resulting from…
Development and Assessment of a New Framework for Disease Surveillance, Prediction, and Risk Adjustment
In this diagnostic modeling study, the new DXI classification system showed improved predictions over existing diagnostic classification systems for all spending and utilization outcomes considered
Primary healthcare effects of a well-designed anti-corruption program
A Novel Machine Learning Algorithm for Creating Risk-Adjusted Payment Formulas
In this study, by automating DXI clustering within clinically specified hierarchies, this algorithm built clinically interpretable risk models in large datasets while addressing diagnostic vagueness and gameability concerns
Business (12 works) · Healthcare Policy and Management (12 works) · Economics (10 works) · Actuarial science (8 works) · Health care (8 works) · Medicine (7 works) · Finance (5 works) · Payment (5 works) · Public economics (5 works) · Primary Care and Health Outcomes (4 works)