What Is a MARA Risk Score?

October 9th, 2018

The Milliman Advanced Risk Adjusters (MARA) tool uses each member’s medical and prescription drug claim history to predict the individual’s relative healthcare cost risk, as compared to an average population risk.

In recent years, traditional medical underwriting has been replaced by the risk-adjustment process. Payers now try to identify high-risk patient populations so they can mitigate the associated costs through various care-management programs. This has created a need for new risk-assessment and risk-scoring tools. EBMS has chosen MARA to complement its data-driven approach to benefit plan evaluation and management.

“MARA can provide us with category risk scores for different health services – like inpatient, outpatient, ER, and prescription,” explains Laura Rookhuizen, a healthcare informatics analyst with EBMS. “This level of detail means we can help our clients make more strategic decisions.”

Laura also points out that risk stratification for care- management purposes can be quite complex. For example, it’s well known that each year, only a small percentage of plan members incur high spending. In fact, the top 5 percent of spenders can account for up to half of all healthcare dollars. However, a 2018 issue brief from the Health Care Cost Institute points out that there is high turnover among these top spenders – it found that, during each year studied, more than three of five top spenders were not top spenders during the previous year.

“That’s why it’s important to use a prospective model of risk scoring,” Laura explains. “We want to focus on predicting which individuals may incur high costs in the near future, because they may benefit from care interventions in the present time.”