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How focusing on clinical metrics for diabetes can improve results for both payors and members
As health care costs rise, plan sponsors continue to seek new ways to manage and reduce them. Building a solution to address chronic conditions can have a meaningful impact on a payor’s bottom line; diabetes is a great place to start. On average, people with diagnosed diabetes have medical expenditures approximately 2.3 times higher than members without diabetes.
These members often can use extra assistance managing their condition and to help curb disease progression. By supporting each member's full diabetes care journey, CVS Health can help improve outcomes and lower costs. Our diabetes care management solution is unique in the marketplace. And it delivers results — we guarantee a 2:1 return on investment.
Our offering addresses five clinical impact areas:
- Monitoring blood glucose
- Lifestyle/comorbidity management
- Medication optimization or reduction
- Medication adherence
- Preventive screenings
We use robust data to uncover more opportunities for improving member health:
Five clinical impact areas, from left to right, from members that have fewer gaps in care leading to members that have more intervention opportunities: When it comes to monitoring blood glucose, 14% of members could benefit from testing; Under the umbrella of lifestyle and comorbidity management, 39% of members needed help with nutrition, exercise, tobacco cessation or other areas; For medication optimization or reduction, 40% of members do not have an optimal regimen; Thinking about medication adherence, 41% of members have suboptimal adherence, meaning that they do not take their medication as directed; and Looking at the data, 88% of members do not get the screenings they should.
Many of today’s diabetes solutions take a one-size-fits-all approach – whether a member’s diabetes is well controlled or not – and address only two of five treatment areas. Our solution produces effective, customized support across all five impact areas, offering more individualized care across a broader spectrum. As a result, 86 percent of members with diabetes are supported with the right interventions for their gaps in care.
Better clinical outcomes by broadening focus areas
Some gaps in care are more important than others, and they vary by member. Our program prioritizes the most valuable intervention, which is the next best action a member can take for the biggest positive impact on A1C levels and medical costs. Using this data point, we craft a comprehensive communication plan tailored to the member’s unique health situation and communication preferences. Data shows a 9.4 percent incremental gap closure rate among our Medicare population, while the commercial population has seen a 27 percent incremental gap closure rate.
Leveraging an engagement model to personalize the member experience
While most condition management programs take a one-size-fits-all approach based on principles of population health, ours is highly personalized. We use member-specific data, including medical and pharmacy claims, lab values and other biometric and demographic information to inform a predictive model that helps identify and prioritize interventions.
Rethinking diabetes management
Care plans for diabetes vary widely, and not all members need to check their glucose multiple times a day. Although blood glucose meters were cutting-edge technology in the 1970s and ’80s, advancements in medications and a deeper understanding of diabetes have made other approaches possible.
For some members, self-monitoring blood glucose is necessary. For others, diabetes medication and regular bloodwork is key. Every member is different and sending meters to all members with diabetes is costly and ineffective. We work with members and their health care providers to determine what works best for their needs. Participants in our program have seen a 1.9 percent average A1C reduction, which is a key metric in managing diabetes regardless of meter usage.
Timeliness of chronic condition management
Member expectations for care have evolved. Members want care using their preferred channels, and want to access it when it makes sense for them. This is especially important in 2022, as many patients are resuming care after pandemic-related delays.
Meeting members where they are
Members with diabetes benefit from ongoing support, but physician’s office visits can be rushed. Our program uses multiple engagement channels, including face-to-face counseling at our pharmacies, MinuteClinic locations and our expanding network of CVS HealthHUBs, as well as text, email and telephonic outreach. Members do not have to use CVS pharmacies, and can continue to use their preferred pharmacy. Certified diabetes educators provide health coaching, while registered dietitians are available for nutrition counseling. In addition, enrolled members receive vouchers for two MinuteClinic visits annually to help facilitate recommended screenings and check-ups.
Members identified as most at risk are assigned to a Pharmacist Panel. 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 CVS pharmacy register when the member is picking up a prescription, or the pharmacist reaches out telephonically. They also proactively plan for these counseling sessions in addition to the prompt on the screen which tells them to call or schedule a time. Electronic health record (EHR) connectivity ensures coordination of support across all channels and the member’s care team.
Specifically, for our diabetes care management solution, Pharmacist Panel has reached 70 percent of the eligible population using CVS pharmacies and engaged with 50 percent.
These in-depth conversations help uncover opportunities to support better condition management. Even if a member does not use a CVS pharmacy, the resources and outreach provided via telephone, app and web offer support.
Our diabetes care management solution is differentiated from other disease management programs in several key ways. Working together, we can help improve outcomes for members, ultimately helping to reduce pharmacy benefit costs for health plans and employers.