- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
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 engaged
Davenport 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 concerns
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 gap
CVS 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.
reach rate for patients identified
engage with a pharmacist
return on investment
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
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
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
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
Site of care
Engaging with members to educate about in-network care that helps lower utilization costs.
- Low acuity procedures
- ER reductions
- Physical therapy
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.
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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