Improving Prescription Drug Risk Assessment Tools
Assessment tools that assign risk scores to insureds—or potential insureds—based on their prescription histories are increasingly used by actuaries and others within health insurance organizations to assess future health risk.
Prescription drug and diagnosis-based risk assessment tools (the latter, a category of tools that key off diagnosis codes and are often used in conjunction with or instead of prescription drug tools) are used in areas as diverse as new business and renewal underwriting for small and medium-size groups, utilization and disease management, trend analysis, comparisons between blocks of business, and provider compensation, according to Tia Sawhney writing in Contingencies.
