As health marketplace exchanges grapple with unforeseen member risks and minimal claims history, socioeconomic data provides a new lens
ATLANTA – 9/27/2016– Health plans in the Individual Exchange Market have been flooded with new members as a result of the Affordable Care Act’s prohibition against plans excluding members based on pre-existing conditions. Because the plans typically know very little about these new members, they are limited in their ability to assess these members’ health risk and intervene to prevent poor health outcomes. EveryMove, through its Tandem engagement product, has found a way to assess member risk – without using medical and pharmacy claims data – to proactively and more accurately target a health plan’s members with greater specificity for intervention and digital engagement: the LexisNexis® Socioeconomic Health Score from LexisNexis Risk Solutions.
In order to validate the value of using socioeconomic data to assess risk, Tandem provided the basic identity data (name, gender, date of birth and address) for 5,000 of a customer’s members to LexisNexis Health Care as part of a study. LexisNexis Health Care ran the socioeconomic risk model and generated a health score for each member. Tandem did analysis and validation of the model output and performance through comparison against claims data. The results validated the use of the LexisNexis Socioeconomic Health Score’s ability to predict health risk without medical claims data. Specifically, for overall risk, EveryMove reported that members in the top 10 percent of the LexisNexis Socioeconomic Health Score had significantly higher risk than average, and the bottom 10 percent had significantly lower risk than average.
“One of the biggest challenges facing the payer market is how to maintain costs while driving revenue as they bring on new members – many of whom were previously uninsured or had very little claims history,” said Kathleen Mosbaugh, Vice President and General Manager, Clinical Solutions, LexisNexis Health Care. “The EveryMove study proves that the LexisNexis Socioeconomic Health Score can assess the risk that payers and related health care organizations today are so desperately seeking.”
The LexisNexis Socioeconomic Health Score leverages over 250 clinically validated socioeconomic attributes found within public records data that correlate with health outcomes to provide health care entities with a picture of unforeseen future risk. Once a health plan’s member file has been run against the socioeconomic model, a socioeconomic health score is delivered at the individual member level, which is indicative of the health risk they pose over the next 12 months. These scores can be easily integrated with existing workflow platforms.
In addition to analyzing how the LexisNexis Socioeconomic Health Score fared in scoring overall risk, Tandem analyzed and reported results for the following conditions:
- Cardiovascular conditions
- End Stage Renal Disease (ESRD)
- Musculoskeletal conditions
- Gastrointestinal conditions
- Respiratory conditions
- Metabolic conditions
- Mental Health and Substance Abuse (MHSA)
For the first seven conditions (Diabetes through Respiratory conditions), Tandem reported the members in the top 10 percent, according to the LexisNexis Socioeconomic Health Score, had significantly higher risk than average, and the bottom 10 percent had significantly lower risk than average. For the rest of the population (those that had other conditions but none of the 10 conditions already analyzed), Tandem reported that members in the top 10 percent, according to the LexisNexis Socioeconomic Health Score, had higher than average, and the bottom 10 percent had lower than average risk. For the Metabolic and Pregnancy conditions, Tandem reported that members in the top 10 percent and bottom 10 percent, according to the LexisNexis Socioeconomic Health Score, had no significantly different risk from the average. For the MHSA condition, members in the bottom 10 percent, according to the LexisNexis Socioeconomic Health Score, had significantly higher risk than average and the top 10 percent had significantly lower risk than average.
“With the help of the LexisNexis Socioeconomic Health Score, Tandem can deliver on its promise of being a targeted health action driver by helping health plans identify and engage the right people to take the right actions that improve quality and reduce cost,” said Russell Benaroya, Co-founder and CEO, EveryMove. “Because our model is pay for performance it is critical that we bring solutions like this to the table to help increase the likelihood that our engagement is appropriate and effective.”
About LexisNexis Risk Solutions
LexisNexis Risk Solutions (http://www.lexisnexis.com/risk/) is a leader in providing essential information that helps customers across industries and government predict, assess and manage risk. Combining cutting-edge technology, unique data and advanced analytics, LexisNexis Risk Solutions provides products and services that address evolving client needs in the risk sector while upholding the highest standards of security and privacy. LexisNexis Risk Solutions is part of RELX Group plc, a world-leading provider of information and analytics for professional and business customers across industries.
Our health care solutions combine proprietary analytics, science and technology with the industry’s leading sources of provider, member, claims and public records information to improve cost savings, health outcomes, data quality, compliance and exposure to fraud, waste and abuse.
Tandem (https://hellotandem.com/) is a health action driver. We work with health plans to drive specific health actions among specific members to meet specific near term business goals. Tandem’s delivers these highly targeted health actions through offers that are designed to maximize conversion. Tandem is a pay for performance service tied to delivering a concrete ROI to our customers. Tandem was developed by EveryMove, a pioneer in health consumer engagement.
(203) 504-8230, ext. 131
Mary Alice Johnson
LexisNexis Risk Solutions