- Programs & Services
Cutting-Edge Analytics and Behavioral Science Enable Personalized Interventions
Chronic conditions account for the vast majority of health care spending in the United States — 90 percent according to estimates from the Centers for Disease Control and Prevention. They affect six out of every 10 Americans, and a high proportion are managing more than one condition.
|CVS Health is leveraging its analytic expertise, multi-channel outreach capabilities, and its more than 9,900 retail stores to support plan members with chronic conditions through its new program Health Advisor.|
Part of the Transform Chronic Care suite, Health Advisor utilizes broader data resources and advanced analytics to uncover insights on member needs with a special focus on those individuals most likely to drive preventable medical costs. By thoughtfully crafting each intervention using proven behavioral science techniques, Health Advisor is designed to significantly improve the effectiveness of each engagement for a positive impact on health outcomes. Highest-risk members receive proactive one-on-one interventions, either telephonically or, if they use CVS Pharmacy, in their neighborhood store. The program also employs email, text/SMS messaging, direct mail, social media, and other channels to reach members.
Personalized Care Plan
Health Advisor uses a real-time view of the member's data, encompassing pharmacy and medical claims as well as lab results, to create a personalized care plan that enables identification of the next best action to improve outcomes or close gaps in care. Advanced algorithms take into account estimates of health and insurance literacy, social determinants, and provider relationship history to gain insights on the risk of non-adherence, future medical expenses, and likelihood of hospitalization or emergency room (ER) use.
Health Advisor can help address more than 100 chronic conditions. The program goes beyond supporting medication adherence to promote lifestyle changes and appropriate preventive care — such as vaccinations, condition-specific screenings, closure of gaps in care — as well as optimization of treatment and site-of-care selection. Projected results include higher rates of flu vaccination, reduction of avoidable ER visits, reduced use of high-cost labs, and optimized medication utilization.
How Health Advisor Helps Members Change Behavior
reduction in unnecessary ER visits
vs. non-participating group
|Member claims are sent to advanced analytics engine||Predictive modeling applied, individualized insight identified||Member identified as using ER for non-emergency care needs||Communication preference applied, outreach sent via one or multiple channels: direct mail, email, SMS|
Members deemed highest risk are assigned to Pharmacist Panels for one-on-one engagement, either telephonically or face-to-face, in our pharmacies. This unique service was developed to provide extra support to those members most at risk of adverse events or higher medical costs. Pharmacists who engage with patients are specially trained with a focus on both clinical and behavioral factors. The goal is not only to intervene in regard to a specific recommended action, but also to establish an ongoing relationship of trust, and uncover obstacles that may be keeping the member from complying fully with condition management measures.
Member data is reviewed on a regular basis for opportunities to improve care. Engagement prompts are based on the personalized care plan, and appear on the pharmacist’s schedule and at the register when a member comes into their CVS Pharmacy to pick up a refill. We adjusted pharmacy staffing and scheduling to prioritize the pharmacist’s time for counseling sessions, which typically take about 15 minutes.
Local Care Delivery
By making care convenient and easy-to-access, we can help members comply more consistently with recommended management regimens. With Health Advisor, the personalized care plan identifies where care may be falling short or requires additional guidance.
|Pharmacists can connect members to appropriate services at MinuteClinic or the CVS HealthHUB, potentially enabling same-day gap closure.|
MinuteClinic and HealthHUB locations provide easy access to care and are staffed and equipped to handle many screening functions, as well as address lifestyle issues. HealthHUB locations have an expanded team of clinical professionals including licensed practical nurses. The stores are also staffed by Care Concierges who help members navigate care services and resources. Electronic health record (EHR) connectivity helps maintain continuity of care with other providers.
Patients with chronic conditions can also benefit from digital solutions, wearable devices, and mobile apps to help monitor symptoms — such as blood pressure and activity levels — and help support positive behavior change. We can provide telephonic counseling and education on issues related to condition management such as the use of these digital tools and apps, as well as symptom management and lifestyle changes. We can also educate the member about telehealth services, which can be a useful option for a range of conditions. For example, members at high risk of avoidable ER visits may find a telehealth visit a convenient alternative.
All these solutions are easier to access and can be less burdensome for members than a trip to the hospital or an appointment with a physician.
Guaranteed ROI for Transform Chronic Care
Health Advisor is one of three Transform Chronic Care programs. The suite also includes next-generation Pharmacy Advisor and Transform Diabetes Care, both of which now incorporate advanced analytics for targeting interventions and one-on-one engagement through Pharmacist Panels as well as other enhancements.
Health Advisor Results
In line with our commitment to bring transformative change to health care in the U.S., CVS Health is guaranteeing a 2:1 return on investment (ROI) for clients who implement one Transform Chronic Care program, with incremental ROI for opting in to additional programs.
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.
Conditions for 2:1 ROI guarantee apply. May not be available in all states or for all lines of business; subject to applicable state law.
Data source: CVS Health internal analytics, unless otherwise noted.
CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.
This page contains trademarks or registered trademarks of CVS Pharmacy, Inc. and/or one of its affiliates.
Image source: Licensed from Getty Images, 2020.