Objective: Blue Cross and Blue Shield of Louisiana (BCBSLA) developed an Impactability Score in 2019 to measure a high-risk member’s likelihood of being affected by an intervention. The score considers health history, utilization, and previous experience with preventive services. This research showcases BCBSLA’s newest model additions and tests the effectiveness of the Impactability Score, version 2.0.

Methods: These models were incorporated in the Impactability Score to allow for stratification of members by those who can be impacted by a timely, relevant clinical intervention. This second-generation score involves new features: new and more granular data elements to increase score accuracy, varying weights for certain metrics that drive impactability, and intervention-specific scoring for outreach channels such as onsite nursing, provider outreach and telemedicine. The Impactability Score has five categories: Low, Medium, Medium-High, High, and Very High. BCBSLA performed a 2-year pre/post assessment for three member populations: (1) those engaged in Disease Management (DM) program, (2) those passively engaged and (3) a control group of non-engaged members.

Results: Results showed that for DM-engaged high-risk members, highly impactable members have a greater decrease in cost in the post-period (-$407 Per Member Per Month (PMPM) ), compared to the control population (-$242 PMPM). For DM-engaged high-risk members, highly impactable members had greater decrease in post-period inpatient hospital admissions (-$92 admits per 1000), compared to the control population (-$54 admits per 1000 ).

Conclusions: Impactability Score, version 2.0, allows BCBSLA the ability to evaluate a patient’s likelihood of benefitting from a particular intervention, which in turn directs providers to the right member, at the right time. This results in members receiving the most appropriate intervention in a timely manner, ultimately maximizing care and reducing costs.