Companies are selling patient 'risk scores' to hospitals, insurers

Some firms are starting to collect data and sell "risk scores" to providers and payers that aim to identify which patients might misuse opioids, according to Politico.

Five things to know:

1. Information source LexisNexis sells health plans a tool that flags pharmacies, providers or patients with abnormal patterns in data that could be indicative of an opioid problem.

2. The companies glean the data from insurance claims, digital health records, housing records and other information sources without patient consent, according to Politico. Confidential algorithms then assign each patient an addiction risk score on a scale.  

3. Sometimes, the risk scores are entered into patients' health records, in hopes clinicians may use them to inform prescription decisions.

4. For example one company, Milliman, offers to provide a list of patients at high-risk for opioid misuse to payers. The payers then can give the information to clinicians. Cigna and UnitedHealth Group's Optum use risk scores, according to the report.

5. Some patient advocates argue the risk scores would keep some patients from getting necessary prescriptions. Sharona Hoffman, professor of bioethics at Case Western Reserve University in Cleveland, told Politico the accuracy of the algorithms is not guaranteed. In addition, overestimating or underestimating patients' risk scores could lead health systems to focus on the wrong patients or allow some patients to slip through the cracks.

For the full Politico report, click here.

Editor's note: This article was updated Feb. 6.

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