A “Credit Score” for Medication Adherence?

In June of 2011, FICO—originator of the credit score in 1956—introduced a medication adherence score model that predicts patient adherence to prescription medications. Approximately 3 million Americans were to have an adherence score by the end of 2011 and an additional 10 million are expected to have one by 2012.  If proven a predictor of adherence, this new score has the potential to revolutionize prescription drug marketing and may have sweeping implications for the insurance industry.

Most Americans are familiar with credit scores—often referred to as FICO scores. The FICO scoring system was created by Fair Isaac and Company and is used to predict the likelihood of a consumer to repay a loan. The lower the FICO score of the consumer, the greater the risk of default to the lender.

Years ago FICO scores became a key tool for banks and financial institutions in marketing credit cards and loans. What quickly became apparent was that the consumers with the lowest scores were generally the most responsive to credit offers.

The FICO score revolutionized credit by enabling lenders to reach a balance between risk and an acceptable cost to acquire new customers. The score eliminates the time and expense of marketing to potentially inappropriate consumers or to those unlikely to respond. It also short-cut the amount of information needed for lending decisions, spawning “instant credit” and rapid approval of auto loans. In a similar way, a medication adherence score could alert a healthcare provider immediately if a patient is at risk of being nonadherent, so appropriate steps to improve their adherence can start early.

Medication adherence is a major issue for patients, employers, managed care and pharmaceutical companies and is a multibillion-dollar problem in the US. A score that predicts medication adherence can help pharmaceutical companies in two key ways:

  • For brands with medication adherence programs, they can target the programs to patients who actually need help with medication to more efficiently produce better healthcare outcomes
  • New patients can be acquired who are more likely to be adherent to medications

This is all good. But where banks and financial institutions found that the FICO credit score became a predictor of responsiveness to direct marketing, it is not yet known if the medication adherence score will have a similar predictive quality with respect to direct marketing. It is also to be determined whether a medication adherence program delivered to patients who have a score is more effective at increasing medication adherence vs. traditional programs delivered to patients without a score.

In managed care, there is continual pressure to make patients more accountable for their health and well-being, and the adherence score has the potential to stratify insurance pricing based on adherence. It could be used to exclude patients from coverage much like credit scores are used in underwriting property and casualty insurance, and also has the potential to impact how life insurance is underwritten.

Early adopters will be the first organizations to start reaping the benefits of medication adherence scores to improve patient healthcare outcomes and strengthen their brands. When it comes to medication adherence scores, is your company making things happen or watching what happens?

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