Symmetry Pharmacy Risk Groups Overview

Powerful risk assessment solution

In addition to being able to provide risk measures for every member in a plan, PRG enables users to make timely predictions regarding those members highest in risk. Compared to medical claims, pharmacy claims data is available to users faster—typically within two weeks of the prescription fill date.

Measure member health risk

• Calculate relative health risk scores for members
• Develop markers for pharmaceutical treatments
• Determine the key factors driving relative risk
• Better predict future health care costs
• Better predict future pharmaceutical use

Pharmacy-based health risk assessment system

Using prescription data and proprietary classification systems to create markers of health risk that may indicate a patient's disease prevalence, severity, and comorbidities, PRG allows health care analysts and actuaries to more accurately predict future health care costs and pharmaceutical use.

Predictive accuracy

Pharmacy Risk Groups create markers of risk in the areas of disease prevalence, severity, and comorbidities, combine these markers with others that describe a member's age and gender, and weight them appropriately to provide a measure of each patient's potential need for future health care services.

Flexible Implementation

PRG provides a 'Partial Enrollment' feature utilizing one of four sets of weights corresponding to the member's length of enrollment, creating relevant risk scores for members who are enrolled 12 months, 9 months, 6 months, and even 3 months during the term of claims data.