Did You Take Your Meds Today?

Posted  by Bridgette

Did You Get Your Prescription Filled?

Are You Following the Directives of Your Doctor?

“I am from the government, and I am here to help you.”  I want to tell you what to eat,  how to live, and  I want to interfere in your life as much as possible. We know you aren’t responsible adults and can’t be depended upon to take your medicines.

Have you eaten your damn  peas today? 

Was this one of the hidden items in Obamacare that we’d find out about after we read it?  How do you like being given a score on whether or not  someone thinks you’ll adhere to taking a prescription drug according to your doctor’s orders?   Questions go unanswered…what will they do with these scores?  Who will have access to the scores?  Why won’t we know our score?   Will you like  receiving a personal reminder from the government to make sure you are taking your meds?   Who takes the hit if you don’t take your meds?  Will Obamacare punish you or your doctor?

Lots of questions… Welcome to one aspect of the Unconstitutional Obamacare:  Medical FICO Scores.

New Medical FICO Score Sparks Controversy, Questions

Jeremy M. Simon

Thursday July 28, 2011

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.

Talking Medicine Bottle

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.

Welcome to the Nanny State!

This is just the Beginning!

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18 responses to “Did You Take Your Meds Today?

  1. Wondering who paid FICO to do this. Are they being paid from the Stimulus package or is it part of Obamacare? How much have we the taxpayers paid this company to invade our privacy? Who are they contracted with?

    Also the fact they say they are using census information..census information on families isn’t available to the public for years. The government only released the 1930 census last year, I believe. How can this company get access to that information?

    Was a special law written for FICO to give them permission to access our information? They say they are using public information. How many people will be downloading all of the information for 10 million people?

  2. This is being done to lower health costs for whom exactly? Who will benefit from this information? They already have a good idea as to why people don’t take their meds, but this is not what they are measuring.

    Who will be hired to make those contact phone calls to the bad irresponsible people? Will people be getting calls from India? What will they do with that information once they have made the call or sent an email?

  3. Good post. I think this is a lead up on those lil chips they want to put in pills to track if you have taken your meds..I do believe this is what that is. Then, we can all be chipped. So smooth…down the hatch. Like tracked cows.

    • And like in “Logan’s Run”, they can set a self-destruct so that when we reach our expiration date–the amount of time Nanny or Big Brother decided to allocate to us–kablooey! One less drain on gummint revenue.

  4. You better believe that we should be able to opt out, but so far we’re still waiting for SCOTUS to tell us whether we can opt out of Obamacare. Thanks for posting this, Bridgette! It’s amazing. About Mr. Shellenberger: http://www.linkedin.com/pub/david-shellenberger/4/268/409

    David Shellenberger
    Senior Principal at Fair Isaac
    Location
    San Francisco Bay Area
    Industry
    Pharmaceuticals
    David Shellenberger’s Overview
    Current
    •Senior Principal, Healthcare Practice at Fair Isaac Corporation
    Past
    •Director, Global Analytics Product Development and Consulting at Fair Isaac Corporation
    •Marketing Director, Strategy Science at Fair Isaac Corporation
    •Analytic Capabilities Management at Fair Isaac Corporation
    Education
    •San Diego State University-California State University
    •University of California, Berkeley
    •University of California, San Diego

    What one would expect from a guy who lives in San Francisco, purview of San Fran Nana Pelosi. A guy who went to BERKELEY.

    Nanny state on steroids, with shades of Big Brother. This has already begun in another area. Has this ever happened to you? Your insurance company sends a robocall to your phone. If you’re not home, the computer leaves a message, telling you to call your health insurance company back. If you don’t call back, the robocalling computer just keeps calling you day and night. If you finally answer, then the computer launches into a spiel about how the records show you haven’t had a certain preventive screening test lately. Then it plays a recording about how important this test is and how dire the consequences will be if you don’t get it. If you then hang up, without going through the entire spiel, the robocalls start again. If you answer again, to get them off your back, you must sit through an inquisition. It’s not enough that they’ve reminded you about the test being due. No, they ask you if you’ve had the test and it’s not in their records. Say, no, and then it asks if you’ll call today to set up the test. If you say no, then it asks if you’ll call this week to set up the test. It goes on and on until you give a timeframe for setting up this test. Expect them to call back after that time has elapsed to continue to HARASS YOU. I haven’t yet investigated to see if there’s an opt-out on this harassment, but it’s disconcerting, to say the least. This will only get worse under Obamacare. Expect to be hounded, harassed, and bullied forevermore. With these people gathering data to use against you.

    If all this is so innocent, they why wouldn’t the company give the contract to the reporter? They cleverly evade: “What won’t happen, FICO says, is your insurance taking a hit because of a low score. ‘No decision is being made [YET] as to whether someone is getting access to health care,’ says Shellenberger.”

    ACCESS to health care isn’t the same as you having to pay WAY MORE for your health care if you don’t behave as nanny demands.

    Did you notice this: “But gender and age are two factors in the Medical Adherence Score.” Gender and age. NOT race and religion? Why two factors and not the other two? If gender and age influence compliance with preventive care and taking one’s meds, then wouldn’t you say RACE and RELIGION also influence? So they plan to target by sex and AGE, but not by race. Wouldn’t you say it’s highly likely that race can also predict whether someone takes care of his or her health, because different cultures have different philosophies about such things? Consider WHO is more likely to be obese, one of the main factors that Michelle Obama, nanny in chief, is concerned about. So why not use race, too? BECAUSE if they plan to punish people who have low scores, they want to rig the results to favor the groups they prefer to favor. Oh, they’re so sneaky. They won’t show the process for how they arrive at these scores (such transparency!) but they will use these scores against you and you won’t be able to prove whether or not they’re fairly derived. And no reporter (if any cares to report on this) will be able to show fundamental bias in the process. AND they won’t even let you know your score. You won’t be able to gather any evidence to defend yourself against any punishment being meted out on account of these scores. They’re not doing this for nothing. They’re doing it because in the end, the pharmaceutical company and the insurance company will use it to increase their bottom line. It’s the same reason cars have those computer chips that spy on you–so the insurance companies can use any data in them against you to keep from paying your claim. Sounds like Mr. Shellenberger is part of “BIG PHARMA”. It’s amazing how certain “rich folks” manage to not be demonized.

  5. Shellenberger also doesn’t say, for example, whether they’ll try to make you pay more if you don’t heed their warnings or if, say, their records say you didn’t take your meds correctly and you developed some terrible condition as a result, they’ll try to make you pay the entire cost that results from YOUR folly. It will be like a preexisting condition. They’ll warn you. You don’t take your medicine, so why should everybody else pay for your more expensive care?

    I heard some woman, a vegan, on O’Reilly the other night. Arguing why the government should MANDATE what you eat or don’t eat. IF you CHOOSE to eat fast food, for example, then, she said, why should everybody else pay for your health care? That’s exactly the point. WE SHOULDN’T. They’re the ones who set it up to force everybody else to pay for everybody else. That’s what communism is and that’s why it’s fundamentally wrong and unfair. But this is what progressives want. They want to make everyone dependent and they want to make everyone responsible for everyone else, so no person is responsible for himself. That’s freedom and they hate freedom. And they hate the consequences of free choice. They hate choice (except when it comes to killing babies in the womb).

    She doesn’t like freedom because then she would have no argument (if people were responsible for what happens to them on account of their life choices.) Their only recourse would be to throw themselves upon the charity of others–which is BOUNDLESS, btw.

    Progressives want to pick and choose the “vices” they prefer to punish, based upon their own philosophy. Get HIV because of promiscuous sex? You’re a victim. Be white and eat fast food–PUNISH HER!

    She argues that even now, before Obamacare takes effect, we all “have to” pay for others who don’t have insurance or don’t care for their own health. No, we don’t.

    The hospitals that CHOOSE to accept not-for-profit status in return for NOT PAYING TAXES have to pay for the indigent. That’s their choice. They could choose otherwise and turn away people without insurance. But there are still plenty of other charity hospitals that care for the uninsured.

    Shellenberger, in the past, could argue that if you don’t want this score kept on you, all you have to do is change insurance companies. But that’s why Obamacare is unconstitutional. It forces us into this invasive system, whether we want it or not.

    We the People probably did PAY for this system that invades our privacy and which is probably unconstitutional. Thanks to FOX Business for reporting on this.

  6. Found another story and a link about FICO Medication Adherence Scores:

    http://www.businesswire.com/news/home/20110623005735/en/FICO-Analytics-Predict-Likelihood-Patient-Adherence-Prescription

    This one’s cute. It contains a link to another page that talks about “conversion TACTICS” they can take against people who don’t “adhere”. http://www.fico.com/en/Products/Scoring/Pages/FICO-Medication-Adherence-Score.aspx

  7. Oh, gee. Here’s a story about these scores that comes right from Barry’s old employer–U of Chi-town law school: http://uchicagolaw.typepad.com/faculty/2011/07/is-fico-scoring-patients-therapeutic.html

    This writer says, “Medical Adherence Scores sound frighteningly Orwellian and Kafkaesque. Critics raise concerns about patient privacy and the unreliability of FICO scoring in general. They rightly note that patients are people, not automatons, which means even the best algorithms will make mistakes. Patients without cars or roommates have wondered whether they might face discriminatory treatment and whether the Medical Adherence Scores would be used to set insurance premiums.”

    Wow. That sounded awfully fair and balanced. Not what I expected. Wait! What? Oh, yes, the predictable comes to pass. The writer goes on:

    “Alas, it isn’t appropriate for FICO’s critics to dismiss Medical Adherence Scores by comparing our new reality to a perfectly virtuous world. A ban on the use of FICO scoring in medicine wouldn’t eliminate a common dilemma: The best treatment plan for, say, congestive heart failure, may require vigilant follow-through by the patient. But if such compliance is unlikely, the optimal treatment may be another therapy altogether. Organ transplants represent a particularly stark choice. Transplants have great potential to improve the lives of recipients, but a lack of follow-through by a patient and her caregivers may expose the recipient to life-threatening risks and result in the waste of a very precious resource that could have saved another person’s life.

    A physician must have some criteria for deciding which type of patient she is treating. The patients themselves are not always reliable sources for this screening. Few patients will admit to their doctors (or to themselves) that they are unlikely to follow through.

    When physicians do not know a patient well, they sometimes rely on proxies that are more distasteful than car ownership in assessing the odds of follow-through. Some physicians rely on the equivalent of old wives’ tales. But as I detail in chapter eight of my brand new book, Information and Exclusion, recent research on health disparities suggests that junk science decisionmaking may be the least of our worries. One study in the American Journal of Transplantation identified a greater propensity among nephrologists to refer children from affluent families to transplant surgeons. The physicians assumed that wealthier parents would be more likely to comply with rigorous postoperative recovery protocols. A separate study in Social Science & Medicine found that the physicians surveyed viewed African Americans as less likely to comply with treatment regimens. Such racial profiling by physicians may contribute to disturbing phenomena like doctors’ tendency to prescribe narcotic pain medication far more readily to Caucasians than African Americans. … To be sure, FICO’s Medical Adherence Scores are imperfect. We know that many errors in consumer credit databases go undiscovered, and getting even acknowledged errors fixed can require substantial perseverance. But at least FICO’s predictions will be based on hard data that patients can access, and the law can ensure that factors like race and national origin are not used as inputs into the algorithm.”

    And there is the answer to my question about why race isn’t an “input” into the “algorithm.” Sounds FAIR to me. Where this writer gets the idea that the medical scores will be accessible to the patient is beyond me. Or that the algorithm will be sound science. How can it be, if all factors are not “inputs”?

    Right off the bat, we have someone at U of Chicago law school arguing for denying one non-compliant person an organ transplant. Isn’t that special?

    EAT YOUR PEAS AND TAKE YOUR MEDICINE, SCOFFLAWS. BIG BROTHER AND BIG NANNY ARE WATCHING YOU.

  8. And those lovely drugs that destroy other organs ? kidneys, liver etc….made to take those too ? Sounds scary…

    • Yes, good point, Renee. If a doc prescribes, you must take. Read recently that those statin drugs are linked to ALS (Lou Gehrig’s disease). If it turns out that a company forces you to take meds you’d prefer not to take, will you then be able to sue Barry personally for Obamacare, and also the doctor, and also the insurance company that badgered you? Will the doctors be forced to prescribe what Cass Sunstein decides you MUST take?

      • Statins like Zocor, Lipitor, and on and on. Especially higher dosages POTEINTIATES the effects of certain other drugs (Diltiazem for one) that tend to clog the kidneys and destroy them. Now the Cardiologists and others are recommending drastic reduced dosages of statins. Do not take my word, consult your doctors. The high dosage(s) of statins tend to build up or accumulate in your bodies and cause serious damage to vital organs.

      • Miri, Did you read where there is a little girl missing with the surname of Cass now ? odd.

        Cass Sunstein
        Made me think of this.

  9. It’s likely unconstitutional. If a person is competent, they make choose what to ingest or not ingest. It is a function of your autonomy and liberty, and the gov’t can’t compel you to do it. It’s a deprivation of liberty without due process – maybe they could compel people on an individual basis by order of a judge because of some unusual circumstance.
    Also You have right to be free from unwarranted invasion of privacy.
    The reason only age and gender were a factor and not race or religion is because race and religion are a protected class which warrants strict scrutiny to use it as a basis of discrimination under Equal Protection. It’s a high standard to overcome, gender is an intermediate standard – important state interest, age is lower – legitimate state interest. race and religion would never pass muster
    lastly, there may be an issue of delegation to a private company to carry out a function which has such a profound effect. I don’t think the gov’t even has the right to do this, so they can’t delegate what tey don’t have. but they also can’t improperly delegate something. it seems to be a quasi judicial function, in that your score directly affects a property interest (money, insurance). hmmm. there’s a lot more, but i don’t have time right now.

    I just thought of this, but my memory is fuzzy – Remember when Obama moved the Census to be under the executive. he did right? This is probably why. If it is under the executive he has more authority over what is done with it. sounded innocuous at the time so nobody paid attention to the particulars of what it meant. it didn’t seem to mean much as far as what the census bureau does. but presidents have more substantial control over executive agency rather than an independent. it might have enabled him to give the info to FICO. still,i am sure it is an invasion of privacy issue. we had a reasonable expectation to privacy and to the use of that info.

  10. Now Gov’t Trying to Ban Sale of Your Supplements
    Friday, 29 Jul 2011 Snips

    Sen. Orrin Hatch blasted a new bill that health experts are calling a government takeover of the vitamin industry.

    New legislation proposed by Sen. Dick Durbin, D-Ill., earlier this month would crack down on the testing, labeling, and sale of dietary supplements nationwide

    “I don’t know why we should add more regulation when what we have on the books is working,” Hatch, a Utah Republican, told Newsmax.

    The increased regulation almost certainly will deny many Americans easy, affordable access to the natural health products they rely on daily, experts warn.

    “This unnecessary power grab would benefit FDA regulators and pharmaceutical companies by taking their competitors off the market, and it would harm the American public,” says Michelle Minton, director of the Insurance Studies Project at the Competitive Enterprise Institute, a Washington D.C. watchdog group.

    Sens. Durbin and Richard Blumenthal, D-Conn., quietly submitted the Dietary Supplement Labeling Act of 2011 over the July 4th weekend.
    Despite its innocuous title,
    the bill would force a massive reclassification of food additives and dietary supplements to be managed by the Food and Drug Administration.

    Durbin’s bill was made public on the same day the FDA issued proposed new guidelines that would alter the way the agency approves and polices vitamins and dietary supplements.

    “Regulatory hurdles such as these are a means by which government bureaucrats get in the way of individuals’ ability to make their own decisions about their healthcare,” warns Minton.

    The combination of the two anti-supplement initiatives would force natural health manufacturers to submit to expensive government testing, adopt new labeling, and compete for market share with well-funded pharmaceutical makers who already have long-standing and mutually lucrative relationships with the FDA, health industry insiders say.

    http://www.newsmax.com/Newsfront/vitamin-supplements-fda-ban/2011/07/29/id/405365

    • Natural healing is a religion. If one’s children cannot have Christmas parties at school then how can this garbage fly ?

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