Portable, personal health risk scores could boost public exchanges

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If Americans could determine a personal health score in the same way they do their personal credit score, improvements in insurance exchanges could easily follow, according to a recent op-ed.

Having a standardized, portable health risk score for every patient would make it much easier for payers to anticipate costs, Peter Orszag, vice chairman of investment banking at Lazard, and Timothy Ferris, medical director of the Massachusetts General Physicians Organization, in write in a piece for BloombergView. They also say that such insight would be particularly important for insurers on the Affordable Care Act exchanges, where difficulties predicting the cost of enrollees have led to several high-profile exits from ACA marketplaces.

Most payers already have some form of health risk scoring in place, the article notes. For instance, risk scores are assigned to plans in the ACA marketplaces. Risk scores maintained by Medicare Advantage have also been in the news due to whistleblower complaints about rigged scores designed to boost reimbursements.

Most consumers remain unaware that these scores even exist, however, because insurers generate and track them as proprietary information. Orszag and Ferris argue that by making these scores more accurate, reliable and portable, both patients and payers would get a more accurate picture of patients' health risks, improving visibility regarding future expected healthcare spending. The use of clinical and socioeconomic data could increase the reliability and accuracy of the scores, they write.

While the use of electronic health records has made clinical data more available than ever before, the authors admit that any push to aggregate that information would likely face resistance from patients and privacy advocates. Additional data consolidation will also be necessary before such information would be broadly available for generating risk scores, making claims data the likely best bet for near-term efforts, according to the article.