I had a conversation with a pharmacist who took some time to cue me in to what’s going on in the world of “Medication Compliance Predictions” and the impact it has on the life and job of a pharmacist. To tell you the truth, I was absolutely floored at how much software and algorithms have gone into this process. If you read my recent post about Express Scripts, you’ll understand. The metrics that are being used today are over the top and there’s a lot of money being made “scoring” and selling those scores to anyone who has the money and wants the data.
Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy
That’s right, if you pay cash you are now considered an “Outlier” by the software firms that collect and sell data on prescriptions. Pharmacists are now seeing patients being given “5 star ratings” on their compliance. Where does this data come from? There are many sources available. First off they can buy your credit card data from MasterCard and any other charge card company and some of these transaction have more than 100-200 fields of data about you available. We all know about the “reward” programs and how those are gate keepers to mine data and sell it, but it appears now that credit card transactions are also in the picture.
Here’s paragraph from an article that’s more about the pharmacist worrying about their 5 Star rating given to them as employees who are dealing with the 5 Star ratings of the Outlier patient. One thing to make clear in all of this is the fact that this is not normal monitoring, see if someone has not filled a prescription , etc. this is flawed data that contains metrics that go over the top. Read this, “find those outlier patients that ruin your numbers”…there’s the wrong with the focus. You may be doing fine taking your medication but the metrics are not being hit, again, the data is flawed.
“For example, Michelle Farrell has begun looking at the medication possession ratio data report in her QS/1 system and looking to tie that back to her star ratings. Brent Dunlap looks at the EQuIPP dashboard to gain insight into outlier patients who are causing their numbers to dip and who may have health issues they can help with. And Brian Beach runs a report out of Kelley-Ross’s PioneerRx system when something doesn’t look right in EQuIPP. “We’ll use our ability to drill down into our data to look at an adherence metric like proportion of days covered, for example,” says Beach. “We see which patients we are not hitting our benchmarks with, and then we’ll reach out to the patient or the provider to try to resolve any issues.” For Beach, this is all about providing value by showing that the pharmacy is being proactive in its interventions that benefit patients, and can even help prescribers meet benchmarks, too.”
The pharmacist went on to tell me that people who pay cash all the time get “one star” and they have to go through this process to talk about why they only have one star. This is one more way to work on the war on cash with making patient “outliers” who use cash. So what’s really wrong with this system? Why are patients being called “outliers” until they can prove their innocence? That’s exactly what we having going on here. Again this not normal medication compliance monitoring, it’s all about getting the pharmacists up to a higher score by going after bogus rated “Outliers” that the software creates. It’s the methodologies used and the context. So good luck getting “patient engagement” here with using the data to find “the bad guys” if you will.
All those who pay cash are given the “non compliance” ding which is not fair, only because their data can’t track everything. Again we are not disputing monitoring those with chronic conditions to see if they are filling their prescriptions here as the issue as that’s pretty normal anymore to take a quick look and see but rather the “scoring” of those at a one star level who pay cash.
The sad reality here is that it’s all about “stars” when you review all the material and not about medication compliance as the way the model is written. Most pharmacists I know reach out and help patients with or without stars. I’m sure patients love being scored with one star if they can’t track the payment cycle of their prescription. How do you engage with this? You don’t as it falls into “excess scoring” of both patients and pharmacists, same battle doctors have had for years and only the data sellers get rich. Education is still a much better route without having to make billions selling patient prescription data. These scores, outlier or not, get sold to insurance companies.
In many pharmacies the pharmacists can’t consult with you face to face until they are certified and have taken this Outcomes MTM certification course, which of course costs money. Nope, they are not qualified on their own to talk to you the patient face to face on their own anymore, they need to be certified to do that and this company is making money. CVS is a big user of the Equipp program so you can be assured they have a lot of “Outlier” patients with only one star:) Be ready for the pharmacist push to be more prevalent as the pharmacists “have” to make those numbers. If you paid cash at Walgreens for your last prescription, you’re screwed on this 5 star rating. If they bring you all in house using credit cards, CVS has a lot more data to mine and apps to create to even get more of your data:) So with your future visits to CVS if you pay cash, be aware that you will become one of their “Outliers”. BD