Predictive Modeling of the Total Joint Replacement Surgery Risk: a Deep Learning Based Approach with Claims Data

Total joint replacement (TJR) is one of the most commonly performed, fast-growing elective surgical procedures in the United States. Given its huge volume and cost variation, it has been regarded as one of the top opportunities to reduce health care cost by the industry. Identifying patients with a high chance of undergoing TJR surgery and engaging them for shopping is the key to success for plan sponsors. In this paper, we experimented with different machine learning algorithms and developed a novel deep learning approach to predict TJR surgery based on a large commercial claims dataset. Our results demonstrated that the performance of the gated recurrent neural network is better than other methods regardless of data representation methods (multi-hot encoding or embedding). Additional pooling mechanism can further improve the performance of deep learning models for our case.