The Guardian reports that a computer formula used to judge healthcare needs has “dramatic biases” against black patients, despite sometimes greater healthcare needs.

The finding is relevant in Arkansas. The assessment system is sold by Optum, which is used by the Arkansas Medicaid program. UPDATE: The state tells me on Monday, Oct. 28, that while Optum performs assessments in Arkansas, it uses a tool developed by MN Choices, not the tool Optum built.

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Thanks to Guy Lancaster for noting this report. From The Guardian:

Hospitals around the United States use the system sold by Optum, a UnitedHealth Group-owned service, to determine which patients have the most intensive healthcare needs over time. But the algorithm, which has been applied to more than 200 million people each year, significantly underestimates the amount of care black patients need compared with white patients, research published on Friday in Science magazine found.

The result is that less money is spent on care for black patients for the same level of needs, the article said.

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Reformulating these biases in the algorithm would more than double the number of black patients flagged for additional care, the study showed. In fact, when the company replicated the analysis on a different data set, they found black patients actually had 48,772 more active chronic conditions than white patients who had been ranked at the same level of risk.

The Arkansas Department of Human Services notes here that it uses Optum for assessments in the PASSE program, the Provider-Led Arkansas Shared Savings Entity. It’s a managed care system for behavioral health services and servoces for the developmentally disabled. Optum says it has assessed needs of some 66,000 people in Arkansas in a program that could save Medicaid $800 million.

The assessment process has been criticized by people covered by Medicaid, health providers and legislators.  The Verge wrote extensively last year about how the algorithm had cut health care in Arkansas generally.

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UPDATE: The Department of Human Services declined to comment on this news, saying it hadn’t seen the study.

Optum issued a statement later in the day:

“We appreciate the researchers’ work, including their validation that the cost model was highly predictive of cost. However, the use of the model by the health system customer and the conclusions of the researchers are misleading. The cost model is just one of many data elements intended to be used to select patients for clinical engagement programs, including, most importantly, the doctor’s expertise and knowledge of his or her patient’s individual needs.”

 

 

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