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June 23, 2011 1:25 PM   Subscribe

The FICO® Medication Adherence Score is a new metric launched by FICO, the credit scoring company, which uses "predictive analytics to forecast an individual’s likelihood of taking his or her prescription medication as directed." FICO claims this will help "improve drug adherence, boosting therapy effectiveness and reducing health care costs," but there's evidently nothing to prevent prospective lending agencies from buying the personal medical information, either. The Supreme Court today ruled this was entirely permissible as Free Speech.

"...Medical industry estimates show that as many as one-half of the 3.2 billion prescriptions in the U.S. each year aren’t taken as prescribed, and patients consequently run a greater risk of poor health outcomes and more frequent hospitalizations." Taking your pills a little later than you should or skipping doses? It can now hurt your credit rating.

Coming on the heels of MedFICO (previously on MeFi), not only is your personal health information available for purchase by financial companies, but conversely, your personal financial information is purchasable by medical care providers.
posted by darkstar (53 comments total)

This post was deleted for the following reason: poster's request. -- jessamyn



 
my FICO Medication Adherence Score for Vicodin and Percocet is approximately 5,000,000,000
posted by nathancaswell at 1:29 PM on June 23, 2011 [14 favorites]


hey, it says "as needed" on the bottle
posted by nathancaswell at 1:30 PM on June 23, 2011 [1 favorite]


Oops, that link for MedFICO should go to the MeFi thread, here.
posted by darkstar at 1:31 PM on June 23, 2011


"Well, according to the FICO® Medication Adherence Score™, your race and socioeconomic status show a high likelihood you will illegally divert any prescribed narcotics. No painkillers for that seven broken vertebrae and nerve pain, sorry."
posted by [citation needed] at 1:31 PM on June 23, 2011 [8 favorites]


How interesting. What if you can't afford the medicine you're prescribed? No doubt there's already a strong correlation between under-insuredness and low credit scores.
posted by contessa at 1:32 PM on June 23, 2011 [4 favorites]


I don't even understand how this is supposed to work. I mean, regular credit scores are fairly bullshit too, but at least there's quite a bit of data to mine for that. How are they getting the data on whether people are taking their prescriptions? I've never had a doctor try to determine if I took my pills.
posted by kmz at 1:34 PM on June 23, 2011 [1 favorite]


FICO’s analytics identify the potential future adherence risk of each patient by using data from a range of publicly available third-party data sources. Because the FICO Medication Adherence Score requires minimal information from the patient, and no prescription claims or sensitive health information, the score can be generated for members of any patient population.

So a completely made up number that will basically say poor people don't take their medicine. That sounds fantastic.
posted by monju_bosatsu at 1:34 PM on June 23, 2011 [22 favorites]


I don't even understand how this is supposed to work. I mean, regular credit scores are fairly bullshit too, but at least there's quite a bit of data to mine for that. How are they getting the data on whether people are taking their prescriptions? I've never had a doctor try to determine if I took my pills.

The surprise M. Night Shyamalan twist: your credit score and MedFICO are the same number
posted by theodolite at 1:35 PM on June 23, 2011 [4 favorites]


Every day. Every single freaking day now. Every morning I open metafilter or The Guardian and there's something so tragic, so obviously dystopian that I can only laugh.

There's nothing to counter-act this, no reasonable non-violent solution to the steady creep of rulings and musings and acts like this. All I can do is laugh at it all now.
posted by Slackermagee at 1:36 PM on June 23, 2011 [22 favorites]


You wouldn't just hand out medication to any scallywag with the brain pan of a common carriage driver now would you?
posted by The Whelk at 1:38 PM on June 23, 2011 [1 favorite]


your window of opportunity to be treated like a human being by the medical industry has been closed for a long, long time. the absolute best you can hope for is that you'll be a number on a spreadsheet somewhere because at that point there will be a single person who will be paid to care what column you're in.

to everyone else involved, you're a captive consumer from whom they can squeeze profit and they're only trying to maximize that profit in the face of your obviously errant behavior.
posted by radiosilents at 1:39 PM on June 23, 2011


Hm. Publishing the score may be covered by the first amendment - but I wonder if the decisions that would be based on that score will also be protected. I suspect if poor black people can't get insurance because this score is low for all poor black people, some class action lawyer is going to have a lot of fun with it.
posted by restless_nomad at 1:41 PM on June 23, 2011


April Fools! Right? Wait it's not? Oh dear god.
posted by pwally at 1:41 PM on June 23, 2011 [1 favorite]


darkstar : Medical industry estimates show that as many as one-half of the 3.2 billion prescriptions in the U.S. each year aren’t taken as prescribed

If they would just give me the damned ooooh-so-abusable-that-other-countries-have-it-OTC codeine when I go in for a serious but nonproductive cough, rather than a damned antibiotic as a placebo, they'd find me considerably more "compliant".


Slackermagee : All I can do is laugh at it all now.

Not true. You can deliberately poison their database.

Keep your real preferences to yourself, and make your public persona as random as possible. Simple example, register as a Republican (presuming you vote otherwise - And not like the primaries actually matter unless you live in NH or Iowa); Trade store "loyalty" cards with various friends, and shuffle them regularly; Apply for various offers you receive in the mail, then turn them down; List your occupation as "pimp" whenever asked.
posted by pla at 1:42 PM on June 23, 2011 [2 favorites]


How was this argued? I can't see how this doesn't come under the umbrella of HIPAA's privacy safeguards.
posted by Thorzdad at 1:42 PM on June 23, 2011 [1 favorite]


kmz, from what I understand, they get your personal prescription info from pharmacists who fill your prescription, say, for a 30 day supply. If you don't refill the prescription at the end of 30 days (suggesting you've stopped taking your meds) or refill it after 34 days (suggesting you skipped a few doses for whatever reason), they correlate it to a higher likelihood that you may have health complications because of it.

One of the chief health complications is hospitalization. And one of the chief causes of filing bankruptcy, for example, is hospital bills. Ergo, if you regularly sip or neglect your meds, you're a greater credit risk. It makes perfect sense, from a cold-blooded sociopathic standpoint.
posted by darkstar at 1:43 PM on June 23, 2011 [8 favorites]


There's nothing to counter-act this, no reasonable non-violent solution to the steady creep of rulings and musings and acts like this.

Have you been having troubled feelings? A constriction feeling in your civil rights? Depressed about your nation's laws and governance? Ask your doctor if Apathzone is right for you! Apathzone will help you forget that pesky rule of law, Civil Rights, or the possibility of hope and let you get back to living your life as a resource drone.

Note: Apathzone only works provided you take it continuously. Apathzone has been known to increase odds of suicide, selective memory, delusions and violent behavior. Failure to take Apathzone may affect your credit score.
posted by yeloson at 1:45 PM on June 23, 2011 [3 favorites]


I'm tired of seeing statistics be used for evil.
posted by madcaptenor at 1:46 PM on June 23, 2011 [1 favorite]


I bet they're already spooling up the ties into the supermarket rewards card databases - diet is medical compliance. If you eat the wrong foods, you are out of compliance, and a risk to your HMO and your creditors.
posted by Slap*Happy at 1:46 PM on June 23, 2011 [2 favorites]


It's positively heartwarming to know that the free speech rights of Corporate Americans are being upheld.
posted by acb at 1:48 PM on June 23, 2011 [3 favorites]


This explains a lot. Last time I bought a car, I was told that my credit score was "the highest I've ever seen." I assumed at the time that was a good thing. Now I know that my credit score was shooting up smack.
posted by It's Raining Florence Henderson at 1:50 PM on June 23, 2011 [4 favorites]


kmz, from what I understand, they get your personal prescription info from pharmacists who fill your prescription, say, for a 30 day supply. If you don't refill the prescription at the end of 30 days (suggesting you've stopped taking your meds) or refill it after 34 days (suggesting you skipped a few doses for whatever reason), they correlate it to a higher likelihood that you may have health complications because of it.

Thank you national pharmacy chain for autofilling my scrips whether I need them or not and thereby protecting my credit score.
posted by immlass at 1:52 PM on June 23, 2011


Thorzdad : I can't see how this doesn't come under the umbrella of HIPAA's privacy safeguards.

Simple - It has no basis in reality, so it doesn't violate anyone's privacy.

Just as with their oh-so-quality "credit" scores, you'll have people doing things totally antithetical to the underlying concept just to boost their score; For example, I've always paid my bills on time, lived within my means, and refused to carry any debt (except my mortgage, and a car for as short a period as possible); Needless to say, my credit rating sucked - Until I started charging everything I buy through a handful of plastic, which magically turned my same financial habits into a high credit rating.
posted by pla at 1:52 PM on June 23, 2011 [4 favorites]


what
posted by BeerFilter at 1:52 PM on June 23, 2011 [1 favorite]


And yet I have in my possession more medical data points on my cat than on my own body.
posted by RobotVoodooPower at 1:53 PM on June 23, 2011 [3 favorites]


For that matter, they may also simply correlate creditworthiness with the kind of meds you're taking. Have you ever been prescribed meds for high blood pressure, diabetes, anxiety, etc.? I could imagine them saying that folks with significant health issues are less creditworthy.

Normally lending agencies wouldn't know about your personal medical record, but I could well imagine them drooling over the possibility of being able to incorporate your actual health (notwithstanding the regularity of your prescriptions) into the analytics for your financial creditworthiness.
posted by darkstar at 1:54 PM on June 23, 2011


Taking your pills a little later than you should or skipping doses? It can now hurt your credit rating.

I'm not sure I understand this. The linked FICO article doesn't mention any interaction between the "Medication Adherence Score" and individual credit ratings, although the corporate PR-speak it's written in is so vague that it's not clear what the MAS will be used for at all. It'll be used for marketing, certainly, but it seems creepy and patronising rather than actually oppressive.
posted by A Thousand Baited Hooks at 1:54 PM on June 23, 2011


I can't see how this doesn't come under the umbrella of HIPAA's privacy safeguards.

Indeed it does. Perhaps I'm missing something, but there is nothing in that second link about the selling of anything other than provider-identified prescription information to drug companies for marketing. It says nothing about credit companies or protected health information (PHI). There's no way HIPAA or HITECH would allow the handing off of your personal, identifiable health information to a credit company.

Indeed, if your doctor wants to find out what medications you've been prescribed by other healthcare providers, by law he or she must get your explicit permission to do so. So, you know, let's calm down.
posted by middleclasstool at 1:55 PM on June 23, 2011 [2 favorites]


Ahem. The Supreme Court ruling had nothing to do with the FICO Medication Score. From the Supreme Court article:

When filling prescriptions, Vermont pharmacies collect information, including the prescribing physician's name and address; the name, dosage, and quantity of the medication; the date and place where the prescription was filled; and the patient's age and gender. Pharmacies sell this "prescriber information" to data-mining companies, including the three appellants in the case: IMS Health, Verispan (now SDI), and Source Healthcare Analytics.

The patient's name and personal identifying information doesn't seem* to be part of it.

* - It probably is in there illegally, violating HIPAA, here lawsuit lawsuit lawsuit...
posted by Mister Fabulous at 1:57 PM on June 23, 2011 [4 favorites]


This is why I buy pills from the guy on the streetcorner. Sure, it costs more, but the privacy it affords me is worth it.
posted by dortmunder at 1:59 PM on June 23, 2011


I believe this does not come under HIPAA privacy safeguards because they are using exclusively non-medical data to predict medication compliance. Essentially, they are using the same data that they use to predict credit compliance. FICO is marketing this to pharma companies, because non-compliance costs them money in foregone sales. Legal perhaps, but no less evil.
posted by pavi at 1:59 PM on June 23, 2011 [1 favorite]


I am not being snarky or disingenuous when I say I am glad I believe in divine healing.


I see absolutely no reason whatsoever for FICO to know anything about what any of us take or for how long.
posted by St. Alia of the Bunnies at 2:01 PM on June 23, 2011


Am I the only one who was certain that this was going to be a link to The Onion before clicking it?
posted by Jacqueline at 2:02 PM on June 23, 2011 [2 favorites]


This New York Times piece seems to have more information about it:
FICO officials say insurance companies and other health care groups will use the score to identify those patients who could benefit the most from follow-up phone calls, letters and e-mails to encourage proper use of medication. By the end of the year, an estimated two million to three million patients will have been given a FICO medication adherence score and a total of 10 million patients are expected to be scored during the next 12 months, the company said. Those estimates are based on current negotiations with health care companies who plan to use the scoring system.

The FICO medication score is based on publicly available data, like home ownership and job status, and does not rely on a patient’s medical history or financial information to predict whether he or she will take medication as directed. So, like a credit rating, it can be compiled without a person’s knowledge or permission.
posted by Bukvoed at 2:04 PM on June 23, 2011 [3 favorites]


HAHAHA good one George Saunders.
posted by (Arsenio) Hall and (Warren) Oates at 2:06 PM on June 23, 2011


But what about as needed meds? And jeezum crow, I am not allowed by my insurance company to refill my prescription until 28 days have passed; I now need to schedule my prescription pick up on day 28 or my credit takes a hit? Christ, I hate this country. "Go back to the USSR, commie!" my sociopathic little suburban grade school peers used to shout at me back in the Reagan era. If I could go back to the USSR circa maybe 1970, I probably would at this point. At least the healthcare was pretty good.
posted by Frowner at 2:06 PM on June 23, 2011 [1 favorite]


The FICO medication score is based on publicly available data, like home ownership and job status, and does not rely on a patient’s medical history or financial information to predict whether he or she will take medication as directed. So, like a credit rating, it can be compiled without a person’s knowledge or permission.

So basically it tries to determine how well off you are and whether you're employed and uses that to determine whether you'll buy your medication? I don't think that tells much more than your credit score itself would.
posted by middleclasstool at 2:14 PM on June 23, 2011 [2 favorites]


From the same NYTimes piece:
The score was created using data from a large pharmacy benefits manager that provided information for a random sample of nearly 600,000 anonymous patients with diabetes, heart disease and asthma. Using the data set, FICO was able to track the patterns of patients who filled and refilled prescriptions and those who didn’t. The company used the data to identify the variables most associated with medication adherence and developed a risk score on a scale of 0 to 500.
So this isn't score based on your behaviour, it's a score based on behaviour of other people like you. That's how this doesn't break privacy laws; it's a prediction, like an actuarial life-expectancy table. It is not like a credit rating, based on your personal history.
posted by bonehead at 2:15 PM on June 23, 2011 [1 favorite]


Ah, so it appears that this and the Supreme Court case are not exactly related. The SCOTUS case is based on datamining of a different sort. That's a relief - If I could edit the link description, I would. Mods may wish to close the thread, since my description is misleading, I fear.
posted by darkstar at 2:20 PM on June 23, 2011


Oh Canada...
posted by justsomebodythatyouusedtoknow at 2:20 PM on June 23, 2011


Yeah. I'm going to say that the "medication compliance" stuff in the press release is bullshit. This might be about "phone calls, letters, and e-mails," but in the form of targeted marketing by pharmaceutical companies. According to the pharmaceutical manufacturers link on this page, "Consumer marketing challenges pharmaceutical manufacturers to identify, acquire and motivate all patients. However, experienced marketers know that different patients require different tactics and levels of investment."

Marketers can get your name and address from a direct marketing agency, and plug it into the FICO program. They then get your likelihood of your needing their drug ("fine tuned to the brand level"). They can also see the likelihood that you'll acquire their brand of the drug, stick with that brand, and continue to need and use that medication over time ("acquisition, conversion and compliance and persistency"). This is based both on information regarding your clade, and yes, if available, your personal prescribing history.

FICO suggests that such information could be used in general campaigns, or direct mail to individuals. I'm gonna say that such information probably couldn't be used by doctors to improve compliance.
posted by evidenceofabsence at 2:23 PM on June 23, 2011 [2 favorites]


Characteristics that FICO names, which are used to determine the score: age, gender, retail purchase behavior (including prescription purchase history, if available), "geo-credit profiles," and income/wealth indicators. From my link above.
posted by evidenceofabsence at 2:25 PM on June 23, 2011


Your actual medical history, health status, and whether or not you fill or pick up prescriptions? Those things don't play a role at all in determining your FICO Medication Adherence Score, as far as I can tell.

This is also not tied to your FICO credit score, so the scenario that Frowner put forth above wouldn't happen, I don't think. It's a gauge to see whether or not you'll actually be compliant in taking your medication as a patient, based on your data like your income level, home ownership, marital status, age, and gender.

It's definitely problematic, especially since it doesn't take your own medical history into account. People with different diseases tend to be differently complaint with respect to medication; if a score like this were to be at all accurate, it would take your health status into account. Of course, that would probably violate HIPAA, so it likely can't be done without patient consent and lots of legal wrangling.
posted by k8lin at 2:26 PM on June 23, 2011


This isn't a "Joe is less likely to take his meds because we're checking his medical information" thing

it's more:"

"White males making $75,000 per year living with their mothers in Oregon are less likely to take their meds. Joe fits that criteria, so therefore he is less likely to take his meds."
posted by blue_beetle at 2:31 PM on June 23, 2011


Can't we get to the end of this road and have everyone completely quantified and the actuarial statistics to be perfected to such a precise degree that the profits made from the insurance game have been completely removed from the equation because the gamble is removed from the equation. You can't bet against your customer's claim that they'll get sick if you know both that they will and when. You'll cut the coverage right before the expected time, or ratchet it up so they effectively pay out of pocket, and then suddenly, there isn't such an industry as insurance.
posted by TwelveTwo at 2:38 PM on June 23, 2011


but I wonder if the decisions that would be based on that score will also be protected

Of course, just the same way they're protected with regards to your credit score - there are strongly worded prohibitions against using the information in unacceptable ways and it's completely and totally impossible to prove when it happens.

And given FICO's incredibly responsible history of handling personal financial data and correcting mistakes when called upon I am sure this Will Go Well too. *sigh* How depressing.

I honestly have no issue with the intelligent use of statistics in health care or using data to improve projections and outcomes, but how does this remotely belong in the purview of FICO? If they have actuarial tables indicating likely compliance and success rates based on a lot of demographic data, great, I see that as a very worthwhile product. But when you start talking about it as a score you build for a SPECIFIC PERSON it seems outright terrifying.

More troubling to me is that it sounds like FICO is going to follow their history with their credit rating score - The exact details of how your FICO credit score is built is a closely-held trade secret - and churn a number out of a black box and hand it over to decision makers, completely without any accountability for how the number is arrived at. That is not a move in a positive direction for health care in my opinion.

I'm all in favor of improving outcomes but predictive data that can't be understood in the context of how it was arrived at? That's not science.
posted by phearlez at 2:38 PM on June 23, 2011


Signed up for the white paper. Looks like "prescription purchase history, if available," is for health insurers, who might, of course, charge higher rates for customers who are statistically less likely to comply.
posted by evidenceofabsence at 2:40 PM on June 23, 2011 [1 favorite]


No. It's marketing.
posted by bonehead at 2:40 PM on June 23, 2011


I wonder what the accuracy of the index is. I hope they did some sort of cross-validation.

For that matter, I wonder what the accuracy of the credit score index is.
posted by demiurge at 2:41 PM on June 23, 2011


This post is deeply misleading, both about Sorrell v IMS and on the uses of MedFICO. (The misstatements about today's SCOTUS ruling are perhaps understandable, since it's a digression, but it's just not true the your credit rating will take a hit when you miss your meds.) So this looks a lot like a post full of inaccurate fear mongering.

WHAT
THE
FUCK
DARKSTAR?
posted by anotherpanacea at 2:48 PM on June 23, 2011


Wait a second...the index is allegedly able to predict the likelyhood of people NOT doing something? How does one have a positive proof of a _lack_ of action that doesn't leave any evidence?

Suppose I don't take a medicine after being prescribed to do so...hence, if the condition that is to be addressed by the medicine worsens, the conclusion is that I didn't take the medicine? What if the medicine wasn't effective (or universally effective) to begin with?
posted by elpapacito at 2:50 PM on June 23, 2011


anotherpanacea, dude, I just gave my mea culpa a few comments above. The pile-on really isn't necessary. Mods, feel free to close the thread.
posted by darkstar at 2:55 PM on June 23, 2011


I am glad I believe in divine healing.

You just wait, your local megachurch will be rolling out a Prayer Compliance Score any day now.
posted by hattifattener at 3:02 PM on June 23, 2011


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