Population Health

Engaging more members to help improve their health and help reduce your spend

Getting plan members involved is critical to improving their health, but COVID-19 has made that challenging over the past two years as lack of access and safety concerns caused many members to delay care.

  • Only 50% of patients are highly engagedDavenport TH, Hongsermeier T, Mc Cord KA. Using AI to improve electronic health records. Harvard Business Review 2018. https://hbr.org/2018/12/using-ai-to-improve- electronic-health-records.
  • 41% of U.S. adults delayed or avoided medical care due to COVID-19 concernshttps://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm

The cost of low engagement and delayed care is significant for payors:

  • 33% of members have site of care gap(s)
  • $1,575 average savings per closed site of care gapCVS Health Analytics, 2022. Data from January-September 2020. Savings projections are based on CVS Caremark data. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. P1011130222

Identifying and engaging more members with population health solutions

To get members with specific health conditions back on track, you can employ configurable population health solutions that focus on identifying the right opportunities to enable proactive engagement and create individualized member interventions, helping to reduce spend and improve health outcomes.

47%
reach rate for patients identified		 73%
engage with a pharmacistCVS Health Analytics, 2022. Pilot results from study of two large health plan client populations. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. Client-specific modeling available upon request. P1011040122		 2:1
return on investmentGuarantee based on return on investment (ROI) that is subject to terms and conditions. Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.
47%
reach rate for patients identified
73%
engage with a pharmacist4
2:1
return on investment5

Identifying areas of impact and engaging with members in specific focus areas for a better experience that helps lower your costs

Identifying areas of impact

  • Monitoring chronic disease states
  • Identifying specific care opportunities
  • Promoting preventive screenings

Engaging with members in specific focus areas

  • Using data that you provide with CVS Caremark comprehensive targeting logic to connect with members and deliver more options to meet their needs within our unmatched ecosystem

Process flow graphic of how members are identified and how we close gaps in care. Heading: Using advanced analytics, we identify the right intervention and close gaps in care for each member. First, we identify the member’s needs using claims, demographic data, historical engagement and member-provided information. Next, we use advanced analytics to classify risks and assess health outcomes, and then sort into segments. Then, we pinpoint care gaps that help drive lower medical costs. We then engage the member with personalized interventions tailored to their conditions and preferences. We follow up to close gaps in care, emphasizing member education and support and identify social determinants of health barriers if appropriate. Next, we coordinate with providers using real-time communication and alerts to keep the entire care team in the loop. The The end result is improved health outcomes for members and lower costs for clients.

Choosing areas of focus that complement your benefits strategy

We can apply analytics to uncover your best opportunities, or you can choose the focus areas that have the most impact for you

Adherence

Member connections help them stay on drug therapy and avoid complications, while we help you save on medical costs.

  • First fill counseling
  • Late to fill
  • Refill reminders
  • Proactive adherence review
  • Gaps in care

Drug savings

Reaching out to providers to alert them about prescription savings and drug safety opportunities that impact members.

  • Therapeutic duplication
  • Condition management
  • Age appropriate
  • Dose optimization
  • Specialty and drug interactions

Medical cost avoidance

Increasing member and provider outreach to boost engagement in preventive, clinical opportunities.

  • Encouraging condition screening
  • Helping prevent unnecessary readmissions
  • Vaccinations

Site of care

Engaging with members to educate about in-network care that helps lower utilization costs.

  • Low acuity procedures
  • ER reductions
  • Physical therapy
  • Labs
  • Radiology

Reaching out with individualized interventions in convenient ways for members and providers

To deliver optimized engagement through intelligent and proactive outreach, your highest-risk members receive high-touch interventions — including 1:1 interactions with pharmacists about their specific condition — while lower-risk members receive care opportunities that are tailored to their preferences and risk profile.

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Population Health

The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted.

Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request.

Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan. CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.

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