Addressing diabetes care challenges

Approximately 34 million American adults have been diagnosed with diabetes.¹ On average, managing diabetes costs more than $9,600 a year per patient, and costs for a plan member with diabetes are 2.3 times higher for payors than for someone without diabetes.² Traditional diabetes management programs, which have changed little in the past decade, have resulted in only 23 percent of U.S. patients with diabetes achieving comprehensive diabetes and cardiovascular risk factor goals. Members who do not have their condition effectively managed are susceptible to a higher risk of serious complications and severe symptoms.³

Opportunities for Diabetes Management

The gap in achieving risk factor goals and the growing prevalence of diabetes has led industry experts to advocate for changes in diabetes management programs.

To better help those with diabetes overcome crucial lifestyle and care management challenges, recommended programs should include:⁴

• Machine learning for connected care to tailor diabetes management
• Checkmark A suite of available tools, including devices and apps
• Checkmark Access to care and creating a positive provider response

Next-generation Transform Diabetes Care meets members wherever they are in their condition journey to improve their health and reduce overall costs.

Our Transform Diabetes Care program is highly effective in helping members considered as being at a higher risk for complications. However, each member with diabetes has unique needs and they require different levels of support and engagement. Based on the learnings from our legacy program, we evolved Transform Diabetes Care to be even more targeted to each member’s specific profile. By using advanced analytics and a broader set of individualized interventions, next-generation Transform Diabetes Care meets members wherever they are in their condition journey to improve their health and reduce overall costs.

People with Diabetes Need More Comprehensive Support and Guidance

Among members with diabetes:

• 29% would benefit most from glucose monitoring⁵
• >60% follow a poor diet and/or lack an exercise regimen⁶
• ~50% do not get recommended screenings⁷
• ~47% aren’t optimally adherent to prescribed medications⁸
• ~28% aren’t on the best-fit medication regimen⁹

Engaging Members with Diabetes

Next-generation Transform Diabetes Care offers a customized, clinical, and convenient approach — the three C’s — to help improve member health through better control of the disease and lifestyle and care management challenges.

Next-generation Transform Diabetes Care provides:

• Customized Diabetes Care Experience Advanced analytics help identify and prioritize tailored interventions using comprehensive member data, including prescription claims, medical claims, lab results, and blood glucose levels.
• Complete Clinical Support Members are engaged across five clinical areas that are designed to help improve A1C and improve other health outcomes: monitoring blood glucose, lifestyle and comorbidity management, guideline-driven screenings, taking the right medication, and adherence to medication.
• Convenient Care Delivery Whether members prefer remote outreach such as email, texting, telephonic, or face-to-face interactions with pharmacists and care team consultations, we can reach them where and when they need support. Members have access to local clinical support through CVS HealthHUB services, CVS Pharmacy, MinuteClinic, certified diabetes care and education specialists (CDCESs), and a digital app.

Integrating all these factors, next-generation Transform Diabetes Care delivers more individualized care based on a member’s unique needs.

Delivering Customization, Higher Value, and Better Outcomes

Next-generation Transform Diabetes Care is designed to deliver greater value for payors and better outcomes for members. This approach prioritizes the most valuable intervention — the next best action a member can take for the biggest positive impact on A1C levels and medical costs — as well as a comprehensive communication plan tailored to the member’s unique health situation and communication preferences.

A member’s next best action could be getting a recommended screening, counseling on the use of the appropriate site of care — such as an in-network lab or urgent care facility rather than the emergency room — and discussing changes in the medication regimen including resolving gaps in care and dosage adjustments. For medication changes, members are encouraged to review any recommendations with their health care provider. When members take actions and close the gap, their profile is updated and the entire cycle starts over again.

Each intervention is intended to make it easy and clear for members to know exactly what they need to do at any given point to best manage their condition.

With the broad support and effective outreach of next-generation Transform Diabetes Care, enrolled and fully compliant members with previously uncontrolled A1C levels may experience up to 1.9 percent average A1C reduction. Robust and regular reporting allows clients to evaluate program performance along the way. Metrics include operational factors such as engagement rates, behavior change, clinical outcomes, and financial value.

Offering Comprehensive Clinical Support

A comprehensive view of member data enables an individualized approach to glucose monitoring. Using advanced analytics we evaluate each member’s unique needs and identify those who would — and would not — benefit from receiving a glucometer and counseling on its use. Members who are controlling their A1C levels appropriately may not need a meter. By only offering meters to those who appear to need them, we help lower costs for payors and keep things simple for members who are managing well already. We offer various options including on-formulary Bluetooth glucometers to keep costs low for clients and members, as well as other connected meters that may be needed for members at a higher risk of complications.

Ongoing Support Combined with Convenient Access

Members with diabetes benefit from ongoing support and in the current health care environment, some may be avoiding physician office visits. Office visits can be even more challenging for members in rural areas, who may have to travel two to three times longer to see a specialist than someone living in a more populous region.¹⁵

In contrast to traditional condition management programs that largely rely on telephonic outreach, next-generation Transform Diabetes Care utilizes multiple engagement channels, including face-to-face counseling at CVS Pharmacy, MinuteClinic and our expanding network of CVS HealthHUB locations, as well as text, email, and telephonic outreach. CDCESs provide health coaching while registered dietitians can be accessed for nutrition counseling. In addition, enrolled members receive vouchers for two annual MinuteClinic visits to facilitate recommended screenings and check-ups.

Members identified as most at risk for costly complications are assigned to a Pharmacist Panel, a service available at all of our more than 9,900 CVS Pharmacy locations.

Specially trained pharmacists proactively reach out to these members based on recommended next best actions identified in the member’s care plan. Counseling prompts appear at the pharmacy register when the member picks up a prescription, or the pharmacist may reach out telephonically. Best-in-class documentation systems improve consistency of messaging, and electronic health record (EHR) connectivity helps to coordinate support across all channels and the member’s care team.

Next-generation Transform Diabetes Care is one offering of a suite of Care Management Solutions, which also includes Health Advisor and Pharmacy Advisor. Each program was developed to help reduce health care costs while helping members on their path to better health.

With a customized, clinical, and convenient approach to diabetes, we evolved Transform Diabetes Care to lower costs while improving outcomes and the care experience for members.

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

Savings and 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.

All data sharing complies with applicable law, our information firewall and any applicable contractual limitations.

Image source: Licensed from Getty Images, 2020.

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