Symmetry® Episode Risk Groups®

Optum Symmetry® Episode Risk Groups ® (ERG®)

Optum Symmetry® Episode Risk Group ® (ERG®) is a risk assessment solution that predicts current and future health care usage for individuals and groups. Episode Risk Groups creates individual risk measures that incorporate episodes-of-care methodology, medical pharmacy claims information, and demographic variables.

Through accurate assessment of current health care risk for individuals and groups, ERG helps managed care and underwriting organizations enhance the efficiency of underwriting and boost the effectiveness of network and care management programs. The Society of Actuaries recognizes ERG as one of the best risk assessment tools for predicting future health care costs.

Episode Risk Groups gives your organization:

• Predictive risk assessment based on sound methodology
• Clinical relevance offering clinicians a basis for understanding different patient conditions and overall level of risk
• Retrospective, prospective, and actuarial & underwriting risk models
• Administrative practicality: diagnostic and procedural information health plans collect as part of claims transaction process will support ERG methodology
• Systematic and logical clinical approach to creating episodes of care enhances understandability
• Better understanding of variations in medical costs and practice and how they relate to differences in health risk
• Single, comprehensive solution for health risk assessment and episode-of-care methodologies
• More clinical detail, and reflects ETG 7.0 Severity

Episode Risk Groups is part of the Symmetry Suite of products supporting provider measurement, population and individual health care measurement, and clinical and financial trend analysis. The suite includes EBM Connect®, which measures patient and provider compliance to evidence-based guidelines; Episode Treatment Groups®, the market’s leading episode grouper; PCQ Connect, which provides comparisons of physician peer groups and performance; Procedure Episode Groups®, which categorizes surgical procedures to form consistent episodes of care for analysis of clinical specialists; and Pharmacy Risk Groups®, which uses prescription data and proprietary classification systems to understand and measure plan member health risk.