EDITOR'S NOTE: A version of this article was originally published in the August 2011 issue of Kiplinger's Retirement Report. To subscribe, click here.
One day in the near future, don't be surprised if your pharmacist pulls you aside to remind you not to skip doses of your medication. The pharmacist could be a caring soul, but more likely the drug-store computer has noted your low "medication adherence" score.
The company that created the credit score, which assesses the likelihood that you'll repay your loans, is now betting on whether you'll take your medicine as directed. Minneapolis-based Fair Isaac has developed the FICO Medication Adherence Score, which the company says can identify which patients are most likely to fail to pick up their prescriptions, skip doses or stop taking their medications altogether. The score will be determined by variables such as homeownership, age and job status.
Pharmacists, drug companies, insurance companies and doctors could use the scores to urge low-scoring patients -- through phone calls, e-mails, letters and face-to-face discussions -- to use their medications properly. For patients with low scores, a pharmacist, for example, "will spend a little more time to make sure they understand the disease and what will happen if they don't take their medicine," says Todd Steffes, vice-president for FICO's health care practice.
But some consumer groups are troubled by possible repercussions. As worthy as the goal is, says Tena Friery, research director at the Privacy Rights Clearinghouse, "It would be easy for insurance companies to take another step and use the score to deny coverage or set premiums."
According to the National Consumers League, about 75% of Americans do not always take their medications as directed. Failing to take medication correctly leads to about 125,000 deaths a year and close to $300 billion in annual costs from medical complications and hospital readmissions, the group notes.
Rebecca Burkholder, the league's vice-president for health policy, says there are several reasons for medication compliance problems. People sometimes forget to take their medications, especially if they are taking several prescriptions. Some don't like the side effects or don't believe the drugs are helping, she says. And others can't afford to fill their prescriptions or take the full dose. Patients are more likely to adhere to their medication schedule, Burkholder says, "once they understand the serious health consequences of not taking their medications as directed."
As for the FICO Medication Adherence Score, Burkholder says, "Being able to identify patients is one part of the picture. But we need to focus on ongoing communication."
FICO says it is basing an individual's FICO medication score on publicly available data, such as age, on-time payment history, the number of persons in a household, marital status and retail purchases. Steffes says a person's medical records or credit score will not be used to calculate a medication score. The company plans to score 2 million patients in the next six months and more than 10 million individuals in the next 12 months.
To create the system, FICO used data from a large pharmaceutical benefits manager. The company figured out who filled and refilled their prescriptions and who didn't, and attached non-medical characteristics to each patient. A score of 100 to 500 is assigned to patients with diabetes, hypertension, depression, asthma and high cholesterol. The higher the score, the more you're likely to take your medications as directed, the company says.
Steffes says the highest scorers tend to be middle-aged male homeowners with a stable payment history and several persons living in the household. "Middle-age women are less likely to adhere than middle-aged men," he says. "It's possible that they are spending time taking care of others." Renters tend to have lower scores than homeowners, and younger patients have lower scores than older ones. Patients who are late bill payers score lower than people who pay their bills on time, perhaps having to do with "organization" issues, Steffes says.
Health providers, pharmacy groups and others who sign up for the program will get a patient's score but not other data related to the patient, Steffes says. Unlike with a credit score, consumers will not be able to buy their medication adherence scores. "I don't know if they would find it useful," he says.
Deven McGraw, director of health privacy protection at the Center for Democracy & Technology, disagrees. "As is the case with the credit report, it could be based on information that is not true," she says. You may be taking your medication as required, but the pharmacist or health care provider may be treating you differently from others because you share some of the same characteristics of those in FICO's "predictive modeling." Even more ominous, McGraw says, employers "who are struggling with health care costs" at some point could use this data to make hiring decisions.
The FICO score is just a piece of a growing recognition of the risks of failing to take prescriptions as directed. Burkholder's group is embarking on a nationwide awareness campaign involving health care provider groups, pharmacists, caregivers, drug companies and government agencies to raise awareness among consumers and family caregivers. For more information on medication adherence and the campaign, visit the Web site of the National Consumers League at www.nclnet.org.
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