Breaking the Black Box: Risk Scores by Artemis

Clients rely on risk scores to help them understand the risk of the population they serve so that they can better manage future utilization and costs. Most popular risk score solutions in the market keep their methods and assumptions behind lock and key—a proprietary “black box.” However, our clients have been wanting risk scores to provide a more holistic picture of their population health burdens. They want to better detect emerging health risk trends and understand the ways non-clinical factors (like SDOH) impact risk. And they want this to drive better health and business outcomes by deploying their plan resources more precisely through targeted interventions.  

We at Artemis love a good (and worthy) challenge, so our team set out to demystify risk scores for our clients and enhance their value by creating our very own, Artemis Risk Scores.

Artemis Risk Score features

The foundation for Artemis Risk Scores was built atop Wakely Risk Assessment models. These are developed and maintained by experts at Wakely Consulting Group, an HMA Company, a nationally recognized provider of actuarial solutions. Powered by Wakely, Artemis Risk Scores offer some important and unique advantages:

1. Hyper transparency: By providing visibility into the methodology as well as enrichments like risk strata and expected costs, clients are empowered with understanding so that they can make better, more informed decisions.

2. Simplicity: The inputs to the risk assessment models are straightforward and interpretable – age, gender, diagnosis codes, and national drug codes.

3. Frequent retraining: We all know healthcare costs and utilization patterns evolve rapidly. With annual updates, we’re confident our risk scores will be calibrated to the most recent trends.

4. Nimbleness: Having control over our risk scores means that we can make nimble updates while retaining enterprise-level quality and pass down the control to our clients, by providing flexible analytic options.

How Artemis Risk Scores help our clients

A risk score provides a numerical indicator of risk, based on 12 months of eligibility, medical, and pharmacy data. Our risk scores are benchmarked to a nationally representative dataset as well as to our client’s own population, so that it is easy to understand how “risky” a member is compared to the average American or enrolled member.  

With Artemis Risk Scores, our clients can take their understanding one layer deeper. For example, one of our clients wanted to know if a targeted orthopedic program would help reduce risk for their high-risk members. Previously, without an extensive claims analysis and some educated guesswork, it was hard to answer the question, “Are orthopedic diagnoses driving the risk calculations for high-risk members?” With new insight into the calculations ‘under the hood’ using Artemis Risk Scores, we were able to identify two members with similar risk scores in the high-risk category and quickly see that one member’s risk score was driven by a traumatic knee injury in the past year while the other’s was driven by a Crohn’s disease diagnosis—altogether unrelated to joint disease. This was just one data point that helped our client unpack the risk drivers for those in the high-risk category, so that they could modify their intervention strategy accordingly.

Paving the way for possibilities

Insights enabled by visibility into the underpinnings of risk score methodology are critical to empowering better, bolder decision-making. We are proud to launch Artemis Risk Scores not only because of its utility, but because of what it represents: transparency, optionality, and the ability to innovate in collaboration with our clients.

Want to learn how Artemis Risk Scores can transform your healthcare decision-making? Reach out to artemis@nomihealth.com for more information.

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