FICO Enters Healthcare Arena with Treatment Adherence Scores

Do you take your drugs as they are prescribed?  It turns out a lot of us don’t and that is a concern to the people in charge of our healthcare dollars. The California Association of  Health Plans estimates that costs for prescription for chronic diseases such as multiple sclerosis, rheumatoid arthritis, cancer, HIV and hepatitis will account for 50% of all drug costs by 2019.[i] If non-adherence of drugs for these diseases is reflective of the national numbers I found for this article, this could account for a tremendous waste of money.

Figuring out who might be adding to these costs has become a new niche in data analytics. Most of us are familiar with the analytics software company FICO, or at least with wanting to have a good FICO credit score, so we will qualify to buy a home, automobile, or get a new credit card. FICO scores determine much of financial lending practices in the U.S. and beyond. Founded in 1956, FICO continues to be a world leader in helping companies make predictive decisions about consumers, and is the most used credit score system in the world. According to its website, FICO works to help businesses in 90+ countries make better decisions that drive growth, profitability, and customer satisfaction. The company’s groundbreaking use of big data and mathematical algorithms to predict consumer behavior has transformed entire industries.

When I heard that FICO had also entered the world of health analytics, I was both curious to know more and alarmed. My inquiry as to how the company was compiling health data and what it was being used for was met by a very prompt reply from a member of FICO’s marketing team.

FICO, as mentioned, develops analytic software — programs that can help to make sense out of past patterns to make future predictions. In the financial world, that means FICO takes information about us and puts it through programming to predict what kind of risk we might be to the lender when we purchase things like homes, cars, and more. I understand this, but couldn’t figure out how the company would apply such programming to my healthcare data.

Again, from the FICO website I read:

“The FICO^® Medication Adherence Score helps health care organizations improve the effectiveness of their care, case and utilization management programs, and helps pharmaceutical manufacturers strengthen their programs for education and outreach. By identifying each patient’s propensity toward medication adherence over the next 12 months, this fully HIPAA-compliant solution helps direct activities to patients at highest risk of noncompliance, improving program efficiency and maximizing results.”

According to the marketing person at FICO, the company has been helping Medicare providers and payers (insurers) for at least five years make predictions about our adherence to our treatments.  FICO itself does not have access to our healthcare data, which answered one of my most pressing questions.

“FICO creates a predictive custom analytic program – when a person this age, with these characteristics, is doing this thing, what is their likelihood to do the next thing,” said the FICO rep, who preferred to not be named for this article.  “All we provide is the predictive analytics – FICO has experience with scores but not with health care.”

What FICO does with this ability to create predictive programs is give Medicare providers and payers a tool to run our health data through, to see if it appears we will be good patients and be adherent to whatever might be prescribed for us. The findings are also made available to pharmaceutical companies to help shape marketing campaigns, which is another arm of the non-adherence conversation. “How they make those scores depends on the data they (Medicare or the payer) have. It’s not like the credit score where across the board it is the same. (Unlike the standardized FICO Score) each company would have its own score and meaning for what that means,” said the FICO representative.

What these companies do with this information remains an unanswered question, but the problem of adherence is large, and needs to be addressed.

In the review study “Adherence and health care costs,” the researchers write, “Patient nonadherence to prescribed medications is associated with poor therapeutic outcomes, progression of disease, and an estimated burden of billions per year in avoidable direct health care costs.” But they also note, “Medication nonadherence is widespread and varied by disease, patient characteristics, and insurance coverage, with nonadherence rates ranging from 25% to 50%.” They also note that if more patients were to better adhere to their drug treatment, the costs for prescriptions might rise dramatically. It appears that making us more adherent to our treatments is truly a double-edged sword.

“The High Price of Low Adherence to Medication,” a white paper issued by Express Scripts, an integrated pharmacy benefit management service, states:  “When patients don’t take their medicines as directed, the consequences can include worsening health and added medical expenses. Yet researchers have found that more than half of the patients in many disease states are not adherent to their medication therapies. In the United States, the estimated direct and indirect costs of nonadherence totaled $337 billion in 2013, the most recent year for which figures are available. With total healthcare spending in the United States averaging $9,255 per person in 2013, about one dollar of every nine spent was wasted because patients didn’t take their medicines as directed.”

The question of medical adherence is obviously complex, and to know that FICO is putting its resources into better understanding it also tells me it is a lucrative share of the market. I am still left to wonder what companies hire FICO, and how are these adherence scores used for healthcare services. “It’s not at all like there is a huge database of medical adherence scores,” the FICO person stressed in our conversation.  All of which leaves me wondering who has this database, and what will be done with it in the future.

In the meantime, I will work harder to keep my adherence score up just in case I am being watched.

[i]

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today, or its parent company, Bionews Services, and are intended to spark discussion about issues pertaining to Multiple Sclerosis.