Business Analytics: Emerging Practice and Research Issues in the Health Insurance Industry

• Published in: Production and operations management 2024-02, Vol.33 (2), p.432-455
• Main Authors: Terekhov, Maxim A, Demirezen, Emre M, Aytug, Haldun
• Format: Article
• Language: English
• ISSN: 1059-1478; 1937-5956
• DOI: 10.1111/poms.13976

This paper summarizes emerging practice and research issues in the health insurance industry. We provide an industry overview, epitomize business analytics applications, and outline current and emerging problems of interest to key stakeholders and researchers in information systems, operations management, and healthcare management. Specifically, we focus on three areas of research that are of importance to the health insurance industry as well as the healthcare system: (i) management and evaluation of intervention programs, (ii) creation of effective provider networks, and (iii) emerging issues such as the impact of a pandemic, patient communication and steering, and technological innovations in health care. We lay out brief details of how each of these problems can be formulated, where the data can be acquired (public and/or proprietary data sets), and provide guidance for solving them. For several of these problems, we provide models that span causal modeling, predictive modeling, and prescriptive modeling.