FICO, a company who assigns credit scores that rate the likelihood people being at a low-risk for defaulting on loans or credit is getting into the business of medicine, in a pretty creative way. During the next year they will be assigning people a FICO Medication Adherence Score (MAS) which asses whether or not a person is at high risk for not taking their medications as directed.
As pharmacists, we are all aware of the problem of non-adherence and what that costs our society (billions, 230 of them to be exact). Assuring that medications are being taken as prescribed can save our health-care a huge amount of money by decreasing hospitalization and mortality just by simply making sure that patients are taking their medicine, and I think that's great.
The first red flag you see (as you should) is patient privacy. The great (and bad which I'll get to) thing is that the score uses only publicly available information and does not work with insurance companies to get patient data. It does not use any medical information for the score instead they look at things you would think would go into a credit score like homeownership, job status, age, marital status, car ownership and gender. People who are older, married, have had the same job and house for a long time and females are patients who would be considered "low risk" for missing medications. While single young adults (or patients over 80) who don't own a home or have just bought a home are considered to be higher risk. The reason they use these criteria is for no reason, in fact they found that things that determine credit ratings are pretty accurate in providing a MAS as well.
The score ranges between 0-500, which differs from the FICO score which ranges from 300-850 to prevent confusion between the scores, with 0 being "high risk" and 500 being "low risk". The score was created by using data from a pharmacy benefits manager that provided a random sample on 600,000 people (anonymous of course) with asthma, diabetes and heart disease and tracked through the company who refilled their medications and who didn't.
Now my opinion. I think this has potential to be a great tool for all health care professionals to ensure medication adherence. This will help us tackle a problem that seems so easy to fix- patients just taking the medications!!! I think the pros of this seem pretty obvious: decrease hospitalizations, decreased morbidity and mortality which decreases cost. Done. But there are cons to this score. Using broad criteria like age and gender is not going to be full proof. A 26 year old who just bought a house who makes $100,000 a year (see where I'm going? it's not me, I'm a resident I'm far far away from 100K) with his new job doesn't mean he's going to have that young person attitude of "I'm not doing anything anyone tells me". He just happens to be young and he can't help where that lands him. Also, a 40 year old married woman isn't enough information for a company to assume they will adhere to their medications. Another problem is, so now you've got these scores for your patients, how do you contact all the ones who need to be reminded? That can be quite a burden when you fill 600 scripts a day. Fortunately, computerized reminders can be utilized to make this process very adaptable without a lot of man power to keep it up, so businesses/governments don't have that expenditure. The biggest problem I see is people not wanting to be rated or if they have to be, do not want to be called/reminded to take their medications. For this problem I'm not sure what we would do, I do not like patients being able to "opt out" of receiving reminders because that counteracts exactly what were trying to fix. It just might have to be a case of "if you're going to pay for insurance to help you with your meds, then you have to deal with them reminding you." We do have to remember that they are trying to make money and cut costs as well.
Overall I think this is not the best score, but we are definitely on the right track and I foresee only good things coming from this. What are your thoughts?