Risk Scoring Big Data and Data Analytics

Many healthcare organizations currently utilize a Risk Scoring program as part of doing business. Health insurance companies, for example, calculate one Risk Score for each member to reserve for risk-adjusted payments to Medicare Advantage and Health Insurance Exchange plans. While the calculation of one Risk Score per member is effective for the distribution of risk-adjusted payments, it lacks insight into a member’s medical needs. The current methodology fails to provide a complete picture of members’ health and serves as more of a reactive than preventative tool.