Next-generation transform diabetes care

Thirty-four million Americans have been diagnosed with diabetes.¹ On average, managing diabetes costs more than $9,600 a year per patient.² Despite that investment, 70 percent of patients are unable to control their A1C levels over the course of a year.

While effectively managing the condition is critical to help avoid costly adverse events and complications, it can be challenging. In addition to prescription therapy, recommendations typically include glucose monitoring and lifestyle and diet changes. Comorbidities are common. Diabetes nearly doubles the risk of heart attack and is the leading cause of kidney failure.³

Transform Diabetes Care, launched three years ago, is an insights-driven solution designed to help reduce the complexity of self-management, improve health outcomes for plan members, and prevent the onset of diabetes for those at risk of diagnosis. Since its launch, it has demonstrated positive clinical outcomes and results.

CVS Health is evolving Transform Diabetes Care for more individualized care across a broader spectrum of management areas, with a guarantee of improved outcomes and lower costs.

With our expanded enterprise capabilities, we have even more tools, assets, and expertise to help members better manage their condition. We have also further expanded our investment in advanced analytics, and significantly enhanced our community-based care capabilities. Integrating all these factors, CVS Health is evolving Transform Diabetes Care for more individualized care across a broader spectrum of management areas, with a guarantee of improved outcomes and lower costs.

Drawing on a Deeper Data Set

Most condition management programs take a one-size-fits-all approach based on principles of population health. Our next-generation Transform Diabetes Care program is highly personalized, using a wealth of member-specific data including medical and pharmacy claims, labwork, and other biometric and demographic information. This gives us a comprehensive view of the member’s data, which informs a predictive model to help identify and stratify members based on their risk profile.

Each intervention is intended to make it easy for the member to know exactly what they need to do next.

The model 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. When a member takes action and closes the gap, their profile is updated, and the entire cycle starts over again. Each intervention is intended to make it easy and clear for the member to know exactly what they need to do at any given point to best manage their condition.

Comprehensive Clinical Benefit

Typically diabetes management programs focus on two areas: glucose monitoring and lifestyle changes. Next-generation Transform Diabetes Care significantly expands this scope, also addressing guideline-driven screenings, medication optimization, and adherence. This is designed to deliver higher value for payors and better outcomes for members. In all, the program addresses 120 possible gaps. A member’s next best action could address the need for a recommended screening, counseling on the use of the appropriate site of care — such as an in-network lab or urgent care rather than the emergency room — and discussing changes in the medication regimen including resolving gaps in care and dosage adjustments. For medication changes, we encourage the member to review any recommended changes with their primary care provider.

Our comprehensive view of member data also enables an individualized approach to glucose monitoring. We use advanced analytics to look at 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 don’t need a meter. By only offering meters to those who need them, we help lower cost 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 higher-risk members.

People with Diabetes Need More Comprehensive Support and Guidance

Among members with diabetes:

• 29% would benefit most from glucose monitoring⁴
• >60% follow a poor diet and/or lack an exercise regimen⁵
• ~50% do not get recommended screenings⁶
• ~47% aren’t optimally adherent to prescribed medications⁷
• ~28% aren’t on the best-fit medication regimen⁸

Local Engagement and Care Delivery

Members with diabetes benefit from ongoing support, yet physician office visits are infrequent and often rushed, leaving members unsure about next steps and best practices. In the current health care environment, they may be avoiding office visits altogether. 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.⁹

In contrast to traditional condition management programs that largely rely on telephonic outreach, the program utilizes multiple engagement channels, including face-to-face counseling at our pharmacies, MinuteClinic stores and our expanding network of CVS HealthHUB locations, as well as text, email, and telephonic outreach. Certified Diabetes Educators provide health coaching, while registered dietitians can be accessed for nutrition counseling. In addition, enrolled members receive vouchers for two MinuteClinic visits annually 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 is picking up a prescription, or the pharmacist reaches out telephonically. Best-in-class documentation systems ensure consistency of messaging, and electronic health record (EHR) connectivity ensures coordination of support across all channels and the member’s care team.

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

Pharmacists who work with Panel patients receive in-person and online training that addresses both clinical and behavioral issues. Their interventions, which typically take about 15 minutes, are designed to uncover and resolve issues that keep the member from complying with recommended condition management. When appropriate, the pharmacist may direct the member to a MinuteClinic or HealthHUB, where they can complete a recommended screening, often on the same day. HealthHUB locations can provide immediate diabetes lab tests and guideline-driven screenings as well as face-to-face care plan support and development. HealthHUB locations are also stocked with diabetes supplies, and the Care Concierge can educate members on the use of a glucometer or other resources.

Transparent Reporting, Guaranteed ROI

At CVS Health, we believe that a new transformative approach is needed to help people with chronic conditions. With the comprehensive support and effective outreach of next-generation Transform Diabetes Care, enrolled 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.

Transform Diabetes Care is one of a suite of Transform Chronic Care programs, which also include Health Advisor and next-generation Pharmacy Advisor. Each program was developed to help reduce health care costs. 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.

With individualized care plans, proactive outreach, and convenient care options, we’ve evolved Transform Diabetes Care to reduce your diabetes-related costs while improving outcomes and the care experience for your members.

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.

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Image source: Licensed from Getty Images, 2020.