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.

Medical Information Bureau (MIB)

MIB is kind of a credit reporting agency for insurance companies. MIB maintains a database for Members to exchange confidential information of underwriting significance when an individual applies for life, health, disability income, long-term care or critical illness insurance.  According to MIB, its primary mission is detecting and deterring fraud that may occur in the course of obtaining life, health, disability income, critical illness, and long-term care insurance.  To obtain a copy of your MIB Group consumer file, contact: 1-866-692-6901 or visit http://www.mib.com/html/request_your_record.html.

According to MIB Group, you will not have a consumer file with them if you have not applied for individually underwritten life, health, or disability income in the past seven years.

Medical Identity Theft

Medical personnel have been steeling our identity.  They have been selling them the organized crime.  Some offices are asking for photo ID to prevent this type of theft.

Excerpts from the news story on AMedNews.com:

Keeping information safe

Physician offices can help prevent medical identity theft by asking patients to provide photo IDs.

Gynecology & Laparoscopic Surgeons in Raleigh, N.C., began checking each patient’s driver’s license at registration after receiving warnings of identity theft from hospitals and calls from insurance companies asking for patient verification.

Lisa Roberts, MD, a gynecologist at the practice, has only encountered one case of identity theft, as a medical student, when an uninsured patient tried to use someone else’s ID. “To my knowledge we haven’t had a problem like that,” she said, noting that the office policy of checking driver’s licenses may deter such acts.

Kimberly Melton, the practice’s manager, said, “Word does get out that you’re checking IDs.”

At first, patients resisted, asking why the office needed to see a driver’s license. But once office staff explained the move was designed to prevent identity theft, “it’s become common, and patients are more willing,” Melton said. But she said it’s difficult to reduce the number of health care staff with access to patient Social Security numbers since that is how a patient who needs surgery or lab work is identified.

At Raleigh, N.C.-based WakeMed Health and Hospitals, employees at registration desks ask patients to provide a photo ID such as a driver’s license or passport.

“Certainly there are times when they don’t have those, and we register them anyway,” said Heidi McAfee, WakeMed’s director of patient access.

If patients don’t provide Social Security numbers, the hospital asks for a phone number, address and date of birth, then sends an electronic query to a company to confirm the information. To reduce the chances of someone overhearing patient information, the hospitals added white noise above some registration booths and enclosed or partially enclosed some with walls and plastic glass.

The hospital group also is looking to change computer displays for its billing employees so they see only the last four digits of Social Security numbers, McAfee said.

Glenn Martin, MD, director of medical informatics for Queens Health Network in Queens, N.Y., said his network adapted a smart card system in August 2003 to prevent patient confusion and misidentification, given that more than 100 languages are spoken within a 10-mile radius of Queens Hospital.

Although the cards, which contain photos, lab results and other information, were not designed with medical identity theft in mind, they may add another layer of protection, Dr. Martin said.

Identity thieves prey on patients’ medical records

All someone has to do is date the right person and they can get all the info about me they would ever need.

“Need free health care, hunny?  Just pretend to be this person.”  Don’t worry about the mounds of paperwork that poor sucker will have to endure to unravel their own medical history from the thieves.  Talk about a nightmare…..  I’d rather have them just steal my credit card number.  At least I wouldn’t have to worry about the doctor or nurse reading my medical history and give me the wrong blood type, or think I have diabetes, gout, heart disease, etc.

Read the full article from USAToday here.

Want to find out what is in your medical records?  Ask, but don’t be surprised of the doctor or hospital isn’t helpful.  For help go to Health & Human Services (HHS). To view your privacy right click here.

I was able to learn a lot from the USAToday article, Patients often struggle for access to medical records.