MSR2 Rising Risk: A New Dimension to Consider When Building Predictive Risk Models at Blue Cross and Blue Shield of Louisiana

Abstract

Health plans expend effort to try and predict the less than 1% of their members who will need extra support in order to maintain their health status by avoiding hospitalizations and emergency department visits. In care coordination, low risk predicts low cost and acuity while high risk forecasts increased cost and acuity. However, this definition of risk leaves out members who have improved or declined in health status over time.