Certified Risk Adjustment Coder (CRC)

Which statement is TRUE regarding predictive modeling?

1. Predictive models are only used to identify patients who develop comorbidities due to a lack of care.

2. Health plans often use predictive modeling to anticipate potential future diagnoses for an individual patient.

3. Predictive modeling identifies needs a patient had in the past that was not provided.

4. Providers can use predictive modeling to identify when additional staff is required.

The correct answer is: Health plans often use predictive modeling to anticipate potential future diagnoses for an individual patient.

Predictive modeling plays a crucial role in healthcare by leveraging historical data to anticipate future health outcomes. The statement indicating that health plans often use predictive modeling to anticipate potential future diagnoses for an individual patient highlights the primary function of these models. These models analyze patterns from past medical data, socioeconomic factors, and other variables to predict the likelihood of future health events, enabling proactive healthcare management. This approach allows health plans to allocate resources more effectively and implement interventions that can lead to better patient outcomes. For instance, if a predictive model suggests a high risk of diabetes for a patient, the health plan can initiate preventive measures or increased monitoring to mitigate that risk. Other choices address different aspects of predictive modeling but do not convey its primary application accurately. For instance, the first option restricts the use of predictive models to only identifying patients with comorbidities due to lack of care, which is too narrow. The third option misinterprets predictive modeling's function by focusing on past needs rather than future predictions. The fourth option discusses operational staffing needs but is not directly related to patient diagnosis forecasting. Thus, the emphasis on using predictive modeling to anticipate future diagnoses is what makes this statement true.