Its safe to say that at some point in our lives, weve cut short a 10-day dosage of antibiotics or maybe even taken the wrong dosage at the wrong time. Most of the time this misstep isnt a big problem, but sometimes it causes an infection to recur forcing another doctor visit to and a refill of the script.
One-off situations like this typically pose few individual long-range problems, but collectively they can wreak havoc on your health--especially if you are suffering with a severe or chronic condition like diabetes, cancer, heart failure or heart disease. Cumulatively, they cause a huge impact on the U.S. health care spend.
Now, thanks to a newly-created score, 10 million Americans will be scored on how likely they are to fill a prescription and complete the script as the doctor prescribed. The Medication Adherence Score, which was created by FICO (the architect of the widely-used credit score) and is HIPAA-compliant, is aimed at improving drug adherence, boosting therapy effectiveness and reducing health care costs.
FICO uses predictive analytics to forecast an individuals likelihood of patients taking their prescription meds as directed.
Non adherence is more prevalent than one may think: As many as half the patients with chronic diseases dont take their medication as prescribed, according to Dr. William Shrank, assistant professor of pharmacoepidemiology at Brigham and Womens Hospital.
When this happens, patients run a risk of poor health outcomes and more frequent hospitalizations, costing both patients and the health-care system a lot of money. According to a November 2010 report from the New England Healthcare Institute, this computes to about $290 billion annually--about 13%--of the total U.S. health care spending.
Thats quite a tab for the health-care industry and for consumers individually because the expense is passed down to the consumer in increased health insurance premiums and rising drug costs.
FICO says that its new tool can reduce cost by boosting therapy effectiveness and has the potential to deliver value to physicians, health care organizations, pharmacy benefit managers, clinical review organizations and pharmaceutical marketers by helping them improve patient outcomes, all while lowering costs.
Nothing else out there anticipates non adherence before it manifests itself, says FICOs Craig Watts. Every other solution pinpoints patients who are already exhibiting some non adherence problems and, beyond that, are already not feeling well.
Watts heralds the FICO tool for its forward-looking capability. Problems can be anticipated and headed off before negative health outcomes occur.
Much as a retailer uses a range of publicly-available, third-party demographic data to target a potential market, FICO uses an anonymous data base of source material that looks at a populations stability--owning a house, holding a job and for how long, whether a person is sick and lives alone--to generate information that can be applied to a specific patient population.
The tool will enable a provider to identify a data score for members of a patient population to determine a patients future medication adherence risk, giving pharmaceutical and health-care companies--and, ultimately physicians--a better handle on which patients have the potential to be nom compliant when taking meds.
This information can target high-risk patients and offer educational programs or mailings to help them understand the value of adhering to their prescription regimens, even directing them to financial assistance programs like Partnership for Prescription Assistance or RxAssist.
Money better spent benefits patients
Eric Newmark, program director of life sciences at IDC Health Insights, sees the score as a potential aid to physicians. It creates a situation that goes well beyond handing patients a piece of paper with a script without verbal instructions. This strengthens the pharmaceutical company /physician relationship, which is under pressure right now, Newmark says.
Beyond that, it has the potential to put a dent into the roughly $35 billion pharmaceutical companies lose on nonadherence, a number derived from the gap between prescribed prescriptions versus what is filled (for example a nine-month script that is only filled for three). Newmark says this is a huge cost to the industry which is ultimately passed down to patients.
Shrank praises any innovative effort that helps health-care professionals understand and predict who will not adhere to a medication regimen and labels it a great public health advantage in determining whos at risk and how to intervene. Still, he is not totally sold.
The concept is great, but its a black box, Shrank says. FICO hasnt published any results.
Shrank says there are numerous interventions for patientssome motivate, others reduce barriers, still others provide simple therapy or improve awareness and understanding. Without published results in a peer journal, its hard to say theres an improvement on what has already been done.
Also, because Shrank sees cost as a powerful barrier to medication adherence, especially today when so many people are out of work, he steers people to generics as an additional way to encourage patients to comply with their drug regimens.
Mark Cesarano, managing consultant at the Savitz Organization, agrees that fostering medication adherence is a good thing financially. The cost of drugs, especially when employers consider high- deductible health plans, is something that his clients always worry about, Cesarano says.
Some of my clients, those whose primary focus is the bottom line, would love this [solution]; others would consider it 'Big Brother.'"
Some clients&are protective of member privacy and dont want their members harassed; they are not real proponents of someone monitoring member behavior.
But Watts takes issue with a Big Brother characterization: the score in no way leads to patient discrimination, nor does it violate patient privacy. Per the contract, underwriting is not a permissible use of the score. There is no release of personal health information to any sources.
I applaud FICOs efforts, says Shrank, but with one disclaimer. Medical adherence is a complex issueone that cannot be fixed with one solution.