In a move that clearly underscores the degree to which financial and actuarial imperatives influence American health care, FICO– the nation’s leading credit rating arbiters–announced earlier this summer that the company is developing a new line of business in monitoring and rating consumers’ compliance with pharmaceutical prescriptions.
In June, FICO (the Fair Isaac Corporation), launched the “Medication Adherence Score,” an application of predictive analytics that the company claims can accurately predict an individual’s likelihood of filling a pharmaceutical prescription and using the medication(s) as directed. The system is promoted as a remedy for the 3.2 billion annual prescriptions that go unfilled or not taken properly.
Industry analysts claim that non-adherence to medication regimens lead to hundreds of thousands of unnecessary deaths and preventable disabilities, and result in up to $300 billion in wasted healthcare spending. By tracking and predicting who is least likely to comply with a drug regimen, FICO hopes to strengthen clinician-patient communication, improve adherence to medical advice, and ultimately reduce the fiscal burden.
The entrance of the credit card rater into the practitioner-patient relationship has generated strong, often polarized opinions in health care circles.
The key issues were colorfully illustrated in a lively back & forth debate on our friend John Weeks’ Integrator Blog. In it, chiropractor Stephen Bolles criticized FICO for failing to recognize that medications, used as directed, are responsible for many unnecessary deaths, and moreover, that a person’s so-called “non-compliance” may reflect a conscious choice in favor of non-pharmaceutical, non-prescription alternatives (herb, nutraceutical, homeopathic, etc) to manage a particular disorder.
Instead of reflecting delinquency or lack of concern for one’s health, a decision not to comply could equally reflect an individual’s heightened concern and conscientiousness. FICO’s system only track the fact that someone does not follow orders, so to speak. It does not discern the “why” of it.
Dr. Bolles also argues that FICO’s move represents a further erosion of privacy in health care; a personal decision about how to remedy a health problem is now subject to monitoring and grading by a corporate interest. “Anyone who believes FICO won’t link credit and medication scoring in their predictive modeling is dreaming,” he writes.
Michael Levin, founder of Health Business Strategies, and a long-time thought leader in the holistic health movement, sees FICO’s system as a reaction–in some ways justfiable–to the economic pain corporations as well as federal payors are feeling as a result of uncontrolled health care costs.
“It’s simple math. Finite resources plus increasing consumption plus consumer misbehavior equals crisis,” Mr. Levin writes. “In using behavioral datasets to extinguish unwanted behaviors (in this case, medication non-adherence) which add costs to society, does not the overall costs to society decline, thus benefiting others?”
In other words, given that “someone else” is paying for an individual’s health care, doesn’t that “someone” have a right to know who’s a good bet and who’s a bad one?
This is one of many contentious issues now facing health care policy makers, clinicians and patients, and it’s not likely to go away any time soon.
