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Health insurance companies in Brazil have their data about claims organizedhaving the view only for providers. In this way, they loose the physician viewand how they share patients. Partnership between physicians can view as afruitful work in most of the cases but sometimes this could be a problem forhealth insurance companies and patients, for example a recommendation to visitanother physician only because they work in same clinic. The focus of the workis to better understand physicians activities and how these activities arerepresented in the data. Our approach considers three aspects: therelationships among physicians, the relationships between physicians andpatients, and the relationships between physicians and health providers. Wepresent the results of an analysis of a claims database (detailing 18 months ofactivity) from a large health insurance company in Brazil. The maincontribution presented in this paper is a set of models to represent: mutualreferral between physicians, patient retention, and physician centrality in thehealth insurance network. Our results show the proposed models based on socialnetwork frameworks, extracted surprising insights about physicians from realhealth insurance claims data.

A Social Network Analysis Framework for Modeling Health Insurance Claims Data