FICO creates score to predict whether patients will take medication

Lori Johnston

A new score from FICO – whose well-known credit score weighs heavily in decisions about approvals for mortgages, car loans and credit cards – could influence how patients are treated when they’re prescribed medications for high cholesterol, depression, diabetes and other diseases. But patients probably won’t even see their own prescription scores.

The FICO Medication Adherence Score forecasts someone’s likelihood of taking medication over a 12-month period. It was formulated as a tool for health care providers trying to combat the estimated $280 billion problem created by Americans – particularly those with chronic diseases – who fail to take their medications and experience medical complications or hospital stays as a result.

“The costs pile up at a very rapid rate,” says Todd Steffes, vice president of the health care practice at FICO. “Staying on medications appropriately is a much less expensive solution than patients not taking care and suddenly incurring these larger costs through hospitalization and other procedures.”

FICO’s Medication Adherence Score ranges from 1 to 500, with the higher number being the best.

Americans not taking medications correctly

Three of every four Americans report they don’t always take their medications as instructed, according to a 2006 survey by the National Community Pharmacists Association and Pharmacists for the Protection of Patient Care. Five ways are most common:

• Never filling their prescriptions.

• Never picking up their filled prescriptions.

• Bringing their medication home but not following the instructions.

• Skipping doses.

• Stopping the medication before directed.

This multibillion-dollar problem represents 13 percent of total U.S. health care expenditures, according to a 2009 report by the New England Healthcare Institute. Half of the 3.2 billion prescriptions written each year in the United States aren’t taken as prescribed, leading to 10 percent of hospital admissions and 23 percent of nursing home admissions.

If tools such as the FICO Medication Adherence Score are effective, health costs could decline, which ultimately could lead to lower health insurance premiums, Steffes says.

The score: An individual number

The first-of-its-kind score will be generated on a patient-by-patient basis for physicians, health care organizations, pharmacy benefit managers, clinical review organizations and pharmaceutical marketers. By the end of 2011, up to 3 million patients will have been assigned a FICO Medication Adherence Score.

Once a patient’s name and address are provided, FICO uses third-party information, including the person’s age and gender, to come up with the score. Other factors that go into the score are a person’s estimated home value and income, based on the patient’s neighborhood or ZIP code. A person’s credit score isn’t part of the calculation, however.

Prescription history, provided by FICO business partner MedImpact, was used to develop and validate the initial scoring models. No specific prescription information or personal health information is used to generate individual medical scores, Steffes says.

The score is a number from 1 to 500. A 500 score means the patient is extremely likely to take medication over the next year. Most people fall between 100 and 400, Steffes says. FICO’s models have shown that men are a little more likely to take medication, and that older patients often do a better job taking their medication than younger patients.

FICO develops scoring models for five types of chronic diseases affecting nearly half of Americans (with plans to develop others):

• Type 2 diabetes.

• Hypertension.

• Asthma.

• Depression.

• High cholesterol.

At least one pharmaceutical client is using the score; FICO declined to provide the company’s name. Steffes says major health care companies have expressed interest in the score, which can be bought for as much as $1 or so apiece, depending on the number of scores purchased.

Steffes says the score isn’t intended for patients to view, and FICO does not plan to sell these scores to the public.

“There is nothing that stands in the way of a provider showing the score to a patient. But it’s hard to really understand why a patient would be that interested. If they knew that score, would they try to do anything differently to change it?” Steffes says.

Privacy advocates are concerned that patients won’t be able to see their prescription scores or even know these scores have been generated. In those cases, patients have no rights at all, says Tena Friery, research director for the Privacy Rights Clearinghouse, a nonprofit education and advocacy organization.

“I do think it is unfair to make these assumptions based upon broad-based data that doesn’t really apply directly to the patient,” she says. “People in financial trouble may be, according to this model, less likely to take their medicine.”

Unique tool for health care industry

The new FICO score may be helpful in identifying those at risk of not taking their medicine, says Mimi Johnson, director of health policy at the nonprofit National Consumers League. In the past, she says, the health care community has used questionnaires to help pinpoint ways to motivate people to take medicine, whether it’s swallowed, inhaled, injected or applied to the skin.

The National Consumers League is in the midst of a nationwide campaign to educate the public about the consequences of not taking medications. For example, someone with early stage diabetes is prescribed a pill to control blood sugar. If the medicine is not taken, the diabetes could progress, with the patient becoming insulin-dependent or blind or even needing a limb amputated. All of those consequences would be more expensive than the medication.

Despite the scoring model’s good intentions, Friery is concerned about the use of personal information by FICO to compute the prescription score. In addition, a low score — if shared with others — could create the perception that someone is in trouble financially, Friery says.

“I think these short cuts – three-digit numbers – can be rather Big Brother-ish. It does put people into categories where it’s not warranted,” Friery says.

FICO’s Steffes maintains that the score can help health care providers take action at a vital point – the beginning of the treatment process. Other tools, such as historical pharmacy data or patient surveys, can be difficult to use and may not yield honest results about a patient’s likelihood of taking medication, he says.

“It should give (consumers) more confidence, hopefully, that their provider is giving them the information they need to succeed,” he says.