myRisk Predictor®

Predictive Analytics To Assess Risk

myRisk Predictor is an innovative assessment tool developed to identify injured workers who are at high risk for potential abuse and misuse of prescription medications. By combining predictive modeling with historical data and unique algorithms developed by our team, a customized risk score is produced for each patient. Data analyzed by myRisk Predictor include:

  • Financial and demographic data such as monthly drug spend, patient age, age of claim.
  • Medical data such as ICD-10 codes, billing for intrathecal pain medication, TENS units.
  • Alerts for potential fraud, waste or abuse such as multiple prescribers, multiple pharmacies, out-of-network transactions.
  • Guideline non-compliance such as multiple and excessive opioid use, opioid use beyond six months.
  • Fiscally irresponsible prescribing such as routine use of “brand medically necessary” prescriptions.

 

Identifying at-risk individuals earlier in the claims process provides the unique opportunity to intervene sooner with proactive clinical programs designed to drive down pharmacy costs and improve patient outcomes. Since perception of risk can vary between populations, myRisk Predictor® provides our clients with customization options based on their specific needs. Once individuals are identified, our clinical team can assess the individual by completing a One Drug Review or a detailed Drug Regimen Review and assist with developing an alternative treatment plan with the treating physician. With myRisk Predictor, we provide an effective way to reduce costs and keep your injured workers’ care a top priority.