What is your Medical Adherence Score?

November 21, 2011 11:00 PM

 BY Jennifer Lewke, CBS News 6

 

ALBANY – If you own a home and a car are you more likely to take your medication?  The company behind the credit score thinks so.  FICO is using basic information about us all to calculate how likely we are to take our medications and it plans on selling that information to health insurance companies and doctors.   

The Medication Adherence Score is used to determine the likelihood you’ll take your medications even before the prescription is written.  Getting patients to take their medications is a big problem for most Doctors.  The president of the Albany County Medical Society, Dr. Peter Sosnow says “In order to take it, you have to have it, in order to have it, you have to buy it and medicines are expensive.”  Although Dr. Sosnow is intrigued by the idea of a “Medical Score” he still has a lot of questions. “We really have more tools to approach the challenges of providing good healthcare than just this score and this tool–however, I want to keep an open mind, I’m very, very curious as to what kinds of things they plug in to get the number,” says Sosnow.

FICO tells CBS 6 all they need from a doctor or an insurance company is the name and address of a patient.  The company then calculates a score between 0 and 500 for each patient based on demographics like gender, support, age and stability: the higher the score the better.  Some of FICO’s basic findings: women are less likely to take their medicine than men, as are people who live alone as opposed to those in a stable live-in relationship.  According to FICO, young people in their 20’s are traditionally less compliant than those in their 50’s and 60’s and folks who own a home and car, tend to be more apt to fill their prescriptions than those who don’t. 

Dr. Sosnow says he’d take the information at face-value, “I’d look at it and I would know my patients and then I’d look at the scores and say “isn’t that interesting” and I may actually figure out some useful application I can’t think of right now” he says. 

FICO says if providers know who is less likely to fill a prescription; they can send reminders, make phone calls and push those who need to regulate their conditions with medication to actually take it, before the patient become even sicker and more expensive to the whole system. But Dr. Sosnow is concerned this score may not just be about getting more people to fill their prescriptions but getting doctors to write more of them too. He says, “What’s being said about it and what’s being written about this is that this will allow for marketing strategies, marketing for whom? Is marketing what compliance is about? You know selling more drugs?”

And there’s also the other big question: will insurance companies raise the rates of those who are determined to be less likely to take their medications?  FICO says written into every contract is a clause that prohibits this Medication Adherence Score from being used to underwrite policies or make medical decisions. 

What questions do you have? My questions are: Besides the contract, what’s to stop insurance companies from doing it anyway?  If I go from owning a home to renting one, will my score do down?  WHY?  How can I get my score?  What if there is incorrect information on my MedFICO file, how do I dispute it?

Comment if you have other questions?

 

Medication Adherence Score

Credit Scores Go Behavioral

New scores seek to predict your behavior

10/27/2011 From James R Hood @ Consumeraffairs.com

Will you take your medicine tomorrow?  You may not know but Fair Isaac thinks it does.

The company that invented the FICO credit score is now branching out and adopting some of the behavior-prediction methodologies used by Web advertisers, but with potentially more far-reaching effect.

After all, if you don’t like a behaviorally-targeted ad, you can just skip it.  But Fair Isaac will be selling its new behavior scores to insurance companies, lenders and others whose decisions can have a big effect on your finances, your employment prospects and even your health.

The Medication Adherence Score is Fair Isaac’s latest product.  It tries to measure the likelihood that you’ll take your prescriptions on time.  How can it know that?  Good question.

The company is understandably not very forthcoming about its methods but says it draws conclusions based on massive amounts of data it gathers about each of us, including such seemingly benign data as how long we’ve lived at the same address, whether we own a car, our marital status, employment, and so forth.

Can this be legal?

You might think this can’t possibly be legal.  Well, so far it is.  In fact, some of the new scores don’t even fall under existing laws that require credit-rating companies to disclose what they know about us.

That’s not likely to last long though, as politicians and regulators are even now beginning to paw the ground and snort loudly as they get a whiff of what’s afoot out in the wild world of data-gathering.

In fact, much of the data that Fair Isaac, Experian and other companies are gathering isn’t even about us personally.  It’s based on massive aggregations of data that, in theory anyway, tell us how people like us are likely to act.

For example, one new Experian score seeks to measure disposable income.  It doesn’t go line by line through each household’s income and outflow but bases its predictions on an analysis of large numbers of people whose situation is roughly equivalent.

Privacy advocates don’t like any of this very much.  They say it’s invasive and may not even be accurate.

But the credit companies say it actually “empowers” consumers by making it easier for lenders, employers and others to snoop around in our affairs.

That may be a tough sell if Congress ever gets around to putting on one of its show trials but for now, the business of nosing around in your affairs is booming.

New medical FICO score sparks controversy, questions

Below is an article about Medical FICO scoring.  I haven’t hear anything about this in quite awhile.  It seems they have changed what the score means.  I would keep an eye on this new scoring to see what they might try and morph it into.  Please read and let me know what you think FICO is up to.

——————————————————————————————————————

Company says its formula can predict whether you’ll take your prescription properly

By Jeremy M. Simon

Within the next 12 months, whether you like it or not, about 10 million Americans are expected to be scored — much like a credit score — on how likely they are to fill a prescription and take all the pills the doctor ordered, on schedule.

FICO, creator of the widely used credit score that predicts whether you’ll borrow responsibly, is now rolling out its new Medication Adherence Score.

FICO based its score on a formula that predicts whether you will take your prescription drugs. FICO says that since correct use of medication is important for patients, medical providers, insurers and pharmaceutical companies, the Medication Adherence Score will help achieve that goal. They predict it will improve therapy effectiveness and reduce health care costs.

The company says those who score low can be targeted for extra reminders and educational efforts, with the goal of making patients more likely to complete their prescribed regimens.

“It’s very important to identify those people who may need that additional education and that additional help,” says Dave Shellenberger, senior principal consultant in FICO’s health care division. 

Critics aren’t so sure. Since the score uses information on patients’ employment, homeownership and living situations, they say that in the current economic environment, the Medication Adherence Score may unfairly target people who have found themselves in challenging financial situations. It could also, they say, open the door for a new way for insurance companies to charge different prices for different scores. This happened in recent years to consumers buying auto insurance: The cost of those policies are now likely based on an auto insurance credit score.

What’s in the score?
FICO launched the Medication Adherence Score on June 23, 2011. To create the scoring algorithm, FICO looked at data from a random sample of several million anonymous patients provided by a large pharmacy benefits manager. FICO observed patients who filled (or refilled) their prescriptions and patients who failed to, with the company then identifying those variables that best predicted medication adherence. For the Medication Adherence Score, those variables include age, gender, family size and asset information — such as the likelihood of car ownership — data also used by direct marketing companies. FICO says that with only a patient’s name and address, it can pull the remainder of the necessary information from publicly available sources. 

The scores range from 1 to 500. “The higher the score, the higher the likelihood a patient will be adherent to a drug regimen,” FICO’s Shellenberger says. FICO says patients who score 400 or higher are likely to take medication as prescribed, while those who score below 200 are at high risk of not taking medication. According to FICO, patients who earn a low score may receive a medication reminder in the form of an email, letter or phone call from their doctor — tactics that would be too costly to apply across the board.

FICO says those who wouldn’t want to receive notices should contact their health care providers and ask about their opt-out policies. High scorers who appear likely to take all their meds probably won’t be contacted. 

FICO: No insurance implications
What won’t happen, FICO says, is your insurance taking a hit because of a low score. “No decision is being made as to whether someone is getting access to health care,” says Shellenberger. That’s because companies can’t use the Medication Adherence Score when deciding whether to provide health insurance and how much to charge for it. “The score was not designed, tested or validated to serve as an underwriting tool. And, underwriting is not an allowable use of the score under the terms of our client contracts,” Shellenberger says.

FICO declined a request for a copy of the contract. FICO says consumers can find out if they have scores by asking their health care providers. 

Age, gender taken into account
Who’s likely to score low? Shellenberger notes that older patients are typically better about taking their medication than younger patients — until those older patients begin to reach their 80s and 90s — and men typically are a little better about taking medication than women. “One hypothesis is that women tend to be caregivers and take care of others rather than care for themselves to the extent that they should,” he says.  

It’s against the law for FICO to factor some information into its more familiar credit scoring formula. It’s forbidden from considering, for example, your race, religion, national origin or sex. In addition, it voluntarily does not consider your age or salary. But gender and age are two factors in the Medical Adherence Score. FICO says that’s because the score only results in communication with a patient and only uses “publicly available third-party data sources, such as the U.S. Census,” Shellenberger says. None of your personal credit information — the data used to determine your FICO credit score, which is regulated by the Fair Credit Reporting Act — is used in the medical score, he says.

Whatever it includes, your own personal Medication Adherence Score is coming. FICO estimates that by the end of 2011, 2 million to 3 million patients will have been given a FICO Medication Adherence Score, with a total of 10 million patients expected to be scored during the next 12 months. As a patient, you probably won’t be informed of your actual score, however. 

A very real problem …
FICO and medical industry experts both say that medication noncompliance warranted the creation of the new scoring system. According to FICO’s press release, medical industry estimates show that up to half of the 3.2 billion prescriptions in the United States annually aren’t taken as prescribed, with nonadherence “cited as the primary cause for 10 percent of hospital admissions and 23 percent of nursing home admissions each year.” It’s also costly. According to a company fact sheet, the cost of medication nonadherence to the U.S. health care system totals an estimated $290 billion a year.

Pharmacists agree that nonadherence represents a challenge. “We recognize that adherence to medication has been a problem for 40 or 50 years. And the ability to identify people who would most benefit from interventions would provide pharmacists and others an advantage in their ability to target services to where they are needed the most. No one would argue about that,” says Lucinda Maine, chief executive of the American Association of Colleges of Pharmacy (AACP) in Alexandria, Va.  

Patients are unreliable medicine-takers for a variety of reasons. “Some people don’t understand the condition that they have. Some people might have high blood pressure but they’re not experiencing symptoms every day,” says Anne Burns, senior vice president of professional affairs with the American Pharmacists Association in Washington, D.C. Such a lack of symptoms could discourage patients from consistently taking their medication, causing their health problems to return.

As a result, “programs like this are starting to appear in the marketplace,” Burns says.

… But is the score the answer?
While there’s general agreement about the problem, not everyone thinks FICO has the solution. “There are many programs and assessments for patient adherence currently available and whether this algorithm is better than any others has yet to be seen,” says Dr. Richard Perry, an assistant professor of pharmacy practice at Long Island University.  

Experts stress that medication adherence is a complex issue, with many factors — some tied to a patient’s finances, culture or attitude — contributing to failures to take medicine.

For example, Dave deBronkart, also known as “e-Patient Dave,” a personal health data rights advocate based in Nashua, N.H., says financial problems once kept him from buying a prescribed medication.

When deBronkart left his last full-time job — but before his COBRA insurance kicked in to provide continued health benefits — he went to refill his prescription for generic blood pressure medication. “I was very short on cash,” deBronkart says. His prescription, which cost just $4 with insurance, nearly tripled in cost to $11. “All of a sudden, I don’t have insurance and the price goes up,” deBronkart says. Due to that jump in price, “I didn’t buy it,” he says, instead delaying the purchase until his COBRA took effect.  

Those types of situations may be increasingly common as more patients find themselves unemployed in the tough economy. That could mean low Medication Adherence Scores for otherwise responsible patients. “Apparently under this scoring model, you are at higher risk for not taking your medication and thus have a low score if you, among other things, don’t have a job, don’t own a home or a car and live alone,” says Tena Friery, research director with the nonprofit consumer group Privacy Rights Clearinghouse.

Although some critics have voiced concerns over the Medication Adherence Score and possible privacy issues, other experts say that privacy isn’t the problem. “Health plans already have information on what drugs you’re on and which ones you went to the drugstore and picked up or got through mail order. The third step, the piece they don’t know, is whether you took the drugs,” says Deven McGraw, director of Health Privacy Project at the Center for Democracy & Technology.

“I think it’s far less of a privacy concern than an age-old concern about how people can use health data to discriminate against people in the insurance marketplace or employment,” McGraw says.

What’s next?
Looking ahead, FICO says the Medication Adherence Score — like any of its scoring models — can be updated about every 18 to 24 months to make it work better. Just don’t expect too many details when the company does. FICO guards all its algorithms closely as proprietary information. “I don’t know whether they will ever allow researchers to look behind that green curtain of Oz to know what their analytic model is,” says the AACP’s Maine.  

And FICO also isn’t identifying additional scoring formulas it could create to predict other areas of everyday life. If it were to do that, however, Privacy Rights Clearinghouse’s Friery guesses that it could be some sort of “lifestyle” score. Since poor lifestyle choices can result in high health care costs, the score could be used to target individuals about health initiatives, such as weight loss or smoking cessation.

“Reports are that people of low income or those who live in certain areas are more likely to be overweight, to smoke, to be inactive. I assume that any future scoring, like the Medication Adherence Score, would not be based on an individual’s past behavior but rather certain factors that would put them into the high-risk category,” says Friery.

Although the “objective of lowering health care costs is certainly a good thing,” Friery says that with such a score, consumers may receive unwanted phone calls or other contact about services that don’t apply to them. “I can only hope that users of such scores would use caution in initiating these contacts. As a minimum, consumers should be given the right to opt out, to stop future contact, whether or not the targeted behavior applies to them,” she says.  

Published: July 28, 2011

Original article here.

Med FICO – update

It’s been awhile since I’ve seen anything about Med FICO on the internet.  Mostly just old postings getting new light.  I did find this artcle. Hope it does put some questions to rest or at least lets us all know our dislike of the Medical Scoring system is being heard.

—————————————————————————-

Is Fair Issac Back Pedaling on the Medical FICO Score?

By Kevin Gipson, New Orleans Consumer Attorney on Apr 19, 2008 in Consumer Protection, Credit Reporting

In a recent article entitled “medFICO:  A Killer Credit Score”  Wendell Sherk discusses the risks inherent in a healthcare system that could base its decisions on when to treat and who to treat on a proposed  FICO medical score.

CreditCards.com reports that since the initial announcement by Fair Isaac Company of its plans to develop a system for assigning a rating to potential patients based upon their likelihood of paying medical bills, the plan has met with criticism from consumer advocates that are concerned that the scores may be used to either deny treatment or pressure the less credit worthy patient to use credit cards to pay for medical treatment.  Others have questioned the legality of such a scoring system.

 

In an interview with Connie Prater of CreditCards.com, Fair Isaac spokesman Craig Watts said:  ”There is no score yet.  We’re talking with a startup company about developing some kind of score. It’s still in the discussion phase as far as I know.”

Currently, healthcare providers will report medical bills to credit reporting agencies such as TransUnion, Equifax  and Experian only when the medical bill is past due.  Under a medFICO system, healthcare providers would report the amount of outstanding debt owed and whether it is current to the credit reporting agencies, much like creditors currently do with mortgages and credit card debt.

Consumer advocates have expressed concerns that such a system would lead to those with low medFICO scores receiving substandard health care.

MedFICO Update

I’ve been a little disapointed that the MedFICO front is very quiet over the last year.  I have dug for info and it’s mostly rehashed info from other sources.

I did find a few interesting items. 

The problem would not be with the initial care give at the hospital.  Follow-up care could be the problem for patients with low MedFICO scores. 
There is nothing like getting the inital diagnosis of a terminal disease and then not getting follow-up care due to a number assigned you.  By the time you clean your score up and it goes up far enough so hosptial will talk to you – Your DEAD or already to End Stage of the disease.  It’s not like buying a house.

Another Article can be found here.   Healthcare Analytics, Inc. changed their name to Connance, Inc.  WHY?  The company is not using the term MedFICO, they are using the term, “Account Decisioning Tools”.  Talk about scrubbing the details out.  You almost have to know what to look for to find out what service they are selling.  Want to take a read of it?  Click here. 

If anyone has any more recent news let me know.

Examine patients first, credit second

Let’s all give a hand to Minnesota lawmakers.  clap. clap. clap.   Now Governer… SIGN IT!

Now what about the rest of you state lawmakers – can’t you see the problems or do we need to draw you a map?

To read the full article, click here.

MDs refer profitable patients to their ASCs

ASC = An Ambulatory Surgery Center can also known as outpatient surgery centers or same day surgery centers. 

This isn’t too surprising, but it’s not something policymakers will like, either. A new study of referral patterns in the Philadelphia and Pittsburgh metros suggests that physicians who are high-admitters to physician-owned ASCs send far more privately insured patients to those facilities, while sending Medicaid enrollees to hospital outpatient departments, in many cases. The study, published in Health Affairsand completed through the University of Chicago, looks at whether having a stake in an ASC affects the types of patients a physician would refer to a facility. Research found that for the top 50 percent of physician referrals to ASCs, 45 percent of Medicaid patients were sent to hospital outpatient departments, while 92 percent of privately insured patients were sent to physician-owned ASCs.

Folks, these numbers seem to pretty much clinch the argument that ASCs keep the best-paying patients for themselves, while blocking the poor from getting whatever benefits the specialized ASC services might offer. Looks like this could kick off some heated discussions on Capitol Hill.

To get more information on the study:
- read the Health Affairs report
- read this Modern Healthcare article (reg. req.)

———————————————————————-

They (Doctors) are already screening us by our health insurance type.  Why not let them continue to screen us by our ablility to pay and our payment history.   Will the Hippocratic Oath change from “First do no harm” to “First , Check the credit score and insurance, THEN do no harm”.  Look here for the NIH version of the Hippocratic Oath.  Want to read the Original Greek Oath or translation, go here.

NOVA produced a great peice, “The Hippocratic Oath Today: Meaningless Relic or Invaluable Moral Guide?”  Most medical schools have changed the original oath to suit their ends.  For example, only 14 percent of modern oaths prohibit euthanasia, 11 percent hold convenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version.  What oath did your doctor take? 

What can we do about MedFICO

Obtain your MIB records!!!
Use HIPAA to your advantage!!!

MIB RECORD REQUEST

Send the following to any HOSPITAL that shows a date of service within the past 6 years.

Name

Address

SS#

DOB 

HIPAA Privacy Officer

( name of hospital)

address 

To whom it may concern;

With regard to my signed HIPAA authorization(s)

Under the HIPAA Privacy Rule you are required to disclose PHI to me upon my request to access PHI or for an accounting or certain disclosures of PHI about myself.

You were also allowed, under Incidental Disclosures, to use or disclose PHI incident to a use or disclosure permitted by HIPAA Privacy Rule so long as you had reasonably safeguarded against such incidental uses and disclosures and had limited them to the minimum necessary information.

Please withdraw my authorization under the HIPAA disclosure obtained for any and all PHI regarding any of my services as listed at your facility.

Date Of Service xx/xx/xxxx

The purpose of this withdrawal of authorization is to prohibit my PHI records from being provided to any type of credit data service or credit rating service as proposed under the “MedFico” plan. 

Very truly yours, 

SIGNED Name

Send this CMRR

‘MedFICO’ can check patients’ credit risk

Here is a Q and A between Chem May Yee, Star Tribune and John Ulzheimer, president of consumer education for Credit.com.

Star Tribune Article

I noticed that hopsitals already check your credit score.  I also understand they can’t do that without your permission.  Look at the intake forms you fill out and you should see in the fine print – you gave permission for them to check your credit score.  If you car needs a tune up you pay for it and don’t involve the insurance company – Can’t do that with medical coverage.  If you don’t like the estimate – go somewhere else or change the oil yourself – Can’t do that with medical coverage.

Medical Insurance and car insurance are not the same.  Think about it you have no choice - you could possible buy a new car, just not a new body.  If I was in a car accident I don’t have a choice of what hosital the ambulance was taking me to – but my car still has a choice of services and fees and I can make those decisions.

Who in their right mind would pay $79 for one Advil tablet?  Next time I’ll ask the nurse how much the Advil will cost me.  The problem …… the nurse doesn’t know – and why should they?  They are responsible for my care not billing.

Your wake up call!

Dennis Klienman sends out a newsletter.  Here is an excerpt on Medical Credit Scores.

“It looks like lenders, landlords, insurance companies and employers aren’t the only ones interested in credit scores these days – now the health industry is getting in on the act.  Credit industry giant Fair Isaac is working with Healthcare Analytics and Tenet Healthcare to create a new “MedFICO” score. This new credit score is intended to judge a person’s likelihood of paying their medical bills and could debut as early as this summer. Understandably, the new score is already raising concerns from consumer advocacy groups that fear it will be checked before patients are treated. They are afraid that people with low medical credit scores could receive lower-quality care than those with a higher MedFICO.  According to Stephen Farber, chairman and chief executive of Healthcare Analytics, that will not happen. Hospitals will check the score, which will be based on the patient’s medical bill payment history, only after the patient is discharged.  And under the Fair Credit Reporting Act, hospitals and doctors may report health care debts to credit reporting agencies but cannot indicate what they were for. Hospitals generally do not report delinquent accounts, but they do turn them over to collection agencies. In such cases, only the medical provider’s name and the amount owed should be listed. And even then great care must be taken so as not to reveal the type of care given, as would be the case with the Betty Ford Clinic, which is widely known for treating drug and alcohol addiction.
But can they be trusted?
Given the problems with the credit system in general – such as identity theft and inaccurate scoring data – consumer advocates question whether or not this information should be used as the basis for a new medical version. In an analysis of more than 500,000 individuals’ credit scores, the Consumer Federation of America says 29 percent were 50 points lower than they should have been.  They ask, “What’s going to happen if there’s a mis-scoring due to clerical error or when there are two people with names like Bob Jones who have similar numbers?” Insurance companies are already using a person’s credit score to determine their premiums now. What’s going to stop health insurance providers from doing the same thing once the new MedFICO score is available?  If you ever doubted the importance or legitimacy of your credit score being as high as possible, this should be your wake up call!”