Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The unintended consequences of population health algorithms

Betty Rabinowitz, MD
Policy
December 4, 2020
Share
Tweet
Share

The results of a 2019 research article in the journal Science uncovered significant racial bias in commonly used population health algorithms used to identify and assign care to patients with complex, active health needs. Using a large clinical data set, the researchers showed that Black patients are considerably sicker than white patients at any given risk score. They demonstrated that remedying this disparity would more than double the percentage of Black patients receiving enriched services like care management (from 17 percent to over 46 percent).

The problem at the core of these results is that many of the algorithms used across the health care industry to predict risk, future utilization and cost, rely predominantly on data regarding the same patient’s prior utilization and cost. These predictions are based on the patient’s health insurance claims in the past. At the same time, the researchers found that at any given level of health, Black patients generate lower costs than white patients – on average, $1,800 less per year. They were also able to show that Black patients have a very different utilization pattern than white patients with fewer inpatient surgical and outpatient specialist costs and more costs related to emergency visits and dialysis. It is thought that the presence of significant barriers explains these differences to access to health care and reluctance and mistrust of the system that leads patients to avoid care. There is also ample evidence that physicians’ biases in allocating and referring patients for care could contribute. Therefore, it is understandable why an algorithm that is solely reliant on costs to predict risk for future costs will underestimate the true medical need of these patients.

The study is compelling in its findings and extremely well thought out and executed. It highlights some of the known pitfalls of deploying population health platforms that rely on single-source data and a single predictive risk algorithm.

Historically, most of the commercially available algorithms were deployed by health plans, and for many years utilized the only data available to these plans, which was adjudicated claims data. Thankfully, healthcare organizations can now deploy contemporary population health platforms that can ingest and analyze multi-sourced data, which helps create a broader and more accurate view of patients’ true burden of illness and risk. Combining electronic health record (EHR), health information exchange (HIE), and social determinants of health (SDOH) data creates a rich tapestry of information that is less likely to introduce the kind of racial bias that is described in this study. It is also why population health platforms provide clinical teams with more than one risk algorithm they can apply to cohorts of patients and individual patients, mitigating some of the risks of embedded bias in an individual algorithm.

The Science article is timely and extremely important as our society and the health care industry struggle to identify and uproot the racial disparities in the way care is provided to all patients. Simultaneously, clinical teams need to recognize that all algorithms have limitations and unintended biases and that there is never a substitute for sound clinical judgment when it comes to clinical decisions about patients’ complex needs.

Betty Rabinowitz is chief medical officer, NextGen Healthcare. She can be reached on Twitter @DrBettyR.

Image credit: Shutterstock.com

Prev

Who are the doctors who end their own lives? [PODCAST]

December 3, 2020 Kevin 1
…
Next

A physician shares stories online and is now a published author

December 4, 2020 Kevin 0
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Who are the doctors who end their own lives? [PODCAST]
Next Post >
A physician shares stories online and is now a published author

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Betty Rabinowitz, MD

  • The whole person care model is seeing its day in the sun

    Betty Rabinowitz, MD
  • The future of general internal medicine is bright

    Betty Rabinowitz, MD
  • Men’s mental health: We treat just the tip of the iceberg

    Betty Rabinowitz, MD

Related Posts

  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • Why whole person care is needed for better population health management

    Trisha Swift, DNP, RN
  • How social media can help or hurt your health care career

    Health eCareers
  • Sharing mental health issues on social media

    Tarena Lofton
  • The unintended consequences of free medical school

    Anonymous
  • The consequences of celebrity endorsements in health care

    Sheindel Ifrah

More in Policy

  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • The lab behind the lens: Equity begins with diagnosis

    Michael Misialek, MD
  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • A surgeon’s late-night crisis reveals the cost confusion in health care

    Christine Ward, MD
  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician
    • Hope is the lifeline: a deeper look into transplant care

      Judith Eguzoikpe, MD, MPH | Conditions
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Residency as rehearsal: the new pediatric hospitalist fellowship requirement scam

      Anonymous | Physician
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • The hidden bias in how we treat chronic pain

      Richard A. Lawhern, PhD | Meds
  • Recent Posts

    • Measles is back: Why vaccination is more vital than ever

      American College of Physicians | Conditions
    • When errors of nature are treated as medical negligence

      Howard Smith, MD | Physician
    • Physician job change: Navigating your 457 plan and avoiding tax traps [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden chains holding doctors back

      Neil Baum, MD | Physician
    • Hope is the lifeline: a deeper look into transplant care

      Judith Eguzoikpe, MD, MPH | Conditions
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...