Document Type


Publication Date

January 2013

Publication Title




Issue Number





Quality of care, Claims data, Logistic regression, Diabetes


Business | Business Administration, Management, and Operations | Insurance | Other Business


We present a methodology for using health insurance claims data to monitor quality of care. The method uses a statistical model trained on the quality ratings of a medical expert. In a pilot study, the expert rated the quality of care received over the course of two years by 101 diabetes patients. A logistic regression model accurately identified the quality of care for 86% of the patients. Because the model uses data derived from patients’ health insurance claims it can be used to monitor the care being received by a large patient population. One important use of the model is to identify potential candidates for case management, especially patients with complicated medical histories.


This article was published in SpringerPlus, volume 2, 2013, and is also available online at this link.
© 2013 Bertsimas et al.; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.