Summary

Impact Pro is a commercial healthcare risk-prediction algorithm developed and marketed by Optum. It was trained on insurance-claim-derived medical-cost data to predict each patient's future healthcare needs, and automatically enrolled high-risk patients in proactive care management.

Obermeyer and colleagues (Science, 25 October 2019) audited the algorithm at one academic hospital across 49,618 patients (43,539 white and 6,079 Black, 2013–2015). At the same risk score, Black patients carried about 26% more chronic illness than white patients; removing the bias would have raised the share of Black patients auto-enrolled from 17.7% to 46.5%. The authors placed the class of similar cost-based algorithms at about 200 million Americans a year.

Mechanism

The algorithm predicted healthcare cost rather than healthcare need. Because of unequal access to care, Black patients with the same conditions accrued roughly $1,800 less in annual healthcare spending, so the model learned to under-estimate their need. Enrolment in care-management programmes followed the risk score directly. No affected patient was notified, and downstream illness and death were never counted at population scale.

Oversight and remedy

On the day of publication the New York Department of Financial Services and Department of Health wrote to UnitedHealth Group calling the outcomes discriminatory and unlawful in New York; the letter did not lead to formal enforcement. Optum first called the findings misleading, then in 2020 worked with the researchers on a correction that reduced bias by about 84% on a 3.7-million-patient replication dataset. Whether the correction reached the deployed product has not been verified; the product was still marketed in 2026. Federal agencies issued a joint statement on discrimination in automated systems in 2023. No class action has been filed.