Additional information
by Urmi K. Doshi (Author)
Knowing how to write a SQL statement is no longer enough to succeed in health informatics. AI can generate the syntax - but it cannot tell you whether the answer is correct. That requires domain expertise - and this book builds it.
Healthcare Analytics: Comprehensive Guide is the definitive desk reference for data professionals working in managed care, health plans, and population health programs. With 31 chapters and over 100 real-world analytics scenarios, it bridges the critical gap between programming syntax and the deep domain knowledge required to produce results that actually hold up in front of a CFO, a quality director, or a CMS auditor.
What you will master:
- Claims and Enrollment Fundamentals - Inpatient vs. outpatient billing, claim adjudication gates, member months, coordination of benefits, continuous enrollment logic, voids and reversals.
- Quality and Population Health - HEDIS measure construction from denominator to rate, CMS Star Ratings end-to-end pipeline, 30-day readmission prevention, and risk stratification models that identify rising-risk populations before costs escalate.
- Risk Adjustment and Regulatory Compliance - CMS-HCC RAF score calculation, RAPS/EDPS encounter submission, retroactive payment cycles, and RADV audit preparation.
- Financial and Network Analytics - PMPM medical cost trend decomposition, MLR calculation, Value-Based Care shared savings, fee schedule analysis, and out-of-network leakage detection.
- Advanced Domain Analytics - Pharmacy adherence (PDC), PBM spread pricing detection, oncology cost decomposition, maternal care episodes, and behavioral health parity analytics.
- Data Architecture and Advanced SQL - Star schema design, SCD Type 2 joins, claims lag management, window functions, recursive hierarchies, and query optimization for enterprise-scale datasets.
This guide gives you the framework, the logic, and the confidence to turn raw claims data into defensible, actionable answers
Number of Pages: 278
Dimensions: 0.58 x 11 x 8.5 IN
Publication Date: April 27, 2026
