How Can 4 Simple Questions Accurately Predict the Right Healthcare Plan?

October 10th 2017 | Larry Colley, M.D.

MyClearview asks the user 4 questions, and then applies mathematical and statistical models to estimate the cost of medical services an individual or family will consume in the plan year. Most users complete the process, including review of the results, in less than 5 minutes. The questions call for top-of-the-head responses without research. The user tells us who will be covered and gives a personal assessment of likely use on a 5-level scale. Next the user tells us if any events or conditions from two short checklists are thought to be likely during the coming coverage year.

Our goal is to get a good sense of likely cost from as few questions as possible. The fewer the better, because time and tedium deter use. The conditions and events lists are as succinct as possible while still being comprehensive. They “cover the waterfront” in terms of organ systems and causes of major illness. The questions and algorithm were developed by a physician who is an expert in health outcomes who has developed patented analytics applied to health insurance.

MyClearview first predicts whether the individual (plus spouse and dependents as applicable) will be high, medium or low users of covered medical services during the coming plan year. The user makes a high-level characterization of his/her propensity to consume and then clicks all that apply from a list of anticipated events and a list of anticipated conditions. An algorithm then quantifies the anticipated utilization in terms of both dollars and percentile. The ‘conditions and events’ list covers many organ systems and causes of major illness. When we ask for ‘conditions.’ we are covering cardiovascular, respiratory, immune, and nervous systmes, and cross-organ system items (cancer, multiple office visits, diagnostics). ‘Events’ covers reproductive/urogenital and endocrine systems, with cross-checks for surgery, hospitalization, high cost, and frequent prescription drug usage.

What did we intentionally leave out? From the standpoint of organ systems, we ask nothing specific about the integumentary system (skin), musculoskeletal system or gastrointestinal systems. Our concern here was that they would invite affirmative responses for minor cost drivers: sprains, strains, rashes, reflux, etc. The costly conditions associated with those systems are either unpredictable (e.g. broken bones) or covered by cancer, immune system or services. With respect to traditional underwriting questions, we left off specific mention of back pain, depression and arthritis. These conditions are incredibly prevalent and the way the carriers used them for underwriting was to predict “worst case” cost, not expected cost. The significant majority of people with those conditions are low-to-moderate utilizers. So, we think it’s more appropriate to let surgery, hospitalization and multiple/expensive drugs identify the likely high cost people.

Finally, why don’t we ask for age and sex? Both of course correlate with higher or lower utilization and cost. But they don’t operate independently from conditions and events. For example, women in the commercially-insured age category cost on average a bit more than men. That’s mostly driven by reproduction which we ask about specifically. And, yes, cost is expected to increase with age, but it does not increase independently of the propensity to consume, and conditions or events we ask about. Stated differently, the older person is more likely to give affirmative responses to our questions. But we don’t want to assume that an older person who self-reports low propensity to consume and foresees no events or conditions should map to a higher percentile of cost/utilization. A 60-year-old can be a 10th percentile user just like a 30-year-old can be, and we don’t want to automatically assume otherwise.

We believe that our 4 simple questions result in more informed employees who are more satisfied with their healthcare plan selection. A better understanding of the healthcare selection process results in higher High Deductible Health Plan/Health Savings Account selection of at least 15-20% and often much more.

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