Q: Who is providing the risk scores in MX Access?
A: Risk Scores are provided by MX Analyze and Inland Empire Health Plan (IEHP).
Q: Will I see risk scores for non-IEHP members?
A: No, if patients are not currently IEHP members then you will not see risk scores displayed in the “Member Risk Scores” table.
Q: How often are the risk scores updated?
A: MX Analyze risk scores are updated daily and IEHP risk scores are updated monthly.
Q: What risk scores will be displayed for MX Analyze?
A: MX Analyze risk scores include the probability the patient will have an inpatient admit within the next 12 months, the probability the patient will have an ED visit within the next 12 months, and a COVID-19 Mortality risk that identifies individuals who are at a greater risk of dying from COVID-19.
Q: What risk scores will be displayed for IEHP?
A: IEHP risk scores include the risk score, chronic condition count, probability of high total cost, probability of persistent high user, and CM Risk Stratification. To see the risk score descriptions, please refer to the Access Risk Score Description document.
Q: How are risk scores developed?
A: MX Analyze and IEHP risk scores are two separate sources that calculate risk scores independently. MX Analyze risk scores are powered by MX’s partner HBI Solutions, Inc. while IEHP risk scores are calculated by IEHP using the Johns Hopkins ACG System. To see more details related to the development of MX Analyze risk scores, please review the article How are risk scores developed in MX Analyze? To see more details related to the development of IEHP risk scores, please review the 2020 Hospital P4P Program Guide.
Q: What numerical values can I expect to see for the MX Analyze Risk Scores?
A: There are two different forms of risk score values you can expect to see for MX Analyze:
The MX Analyze IP Admit and ED Visit Risk Scores will be between 0 – 100 that show the probability of the event. For example, if a patient scores 70 for the risk of an ED visit, that patient is 70% likely to have an ED visit within the next 12 months.
The COVID-19 Mortality Risk Score will be between 0 and 25. A value of 0-4 indicates low risk, 4-12 moderate risk, 12-20 high risk, and 20-25 very high risk.
Q: What numerical values can I expect to see for the IEHP Risk Scores?
A: There are three different forms of risk score values you can expect to see for IEHP:
Risk Score and Chronic Condition Count have a minimum value/start range of 0, and there are no maximum values/end ranges.
The Probability of High Total Cost and the Probability of Persistent High Users will display numerical values between 0.00 to .99. If a patient has 0.95 displayed next to the probability of high total cost, that means the patient is 95% likely to be in the top 5 percent of the total high cost for IEHP in the next 12 months.
CM Risk Stratification will display high, rising, medium and low risk.