- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
Working Together to Transform Diabetes Care
In the United States, and around the world, diabetes is a top spend and trend driver. Managing the condition is a complex issue for payors and for anyone with the diagnosis. Treatment generally requires lifestyle changes as well as medication, and many people find it difficult to stay on track. With poor compliance, the condition is likely to progress and the patient may develop other conditions, further complicating the treatment regimen.
The additional challenge for payors is that many people with diabetes — or at high risk of developing the disease — are unaware of their status and are taking no preventive action.
Managing diabetes — whether as an individual or as a payor evaluating the needs of a population — requires multiple tactics and long-term support. What the patient does day after day, from eating and exercise to staying adherent to the medication regimen and monitoring blood sugar, can make a difference in whether the condition progresses.
1 in 3 Americans May Develop Diabetes
It’s critical that we develop more effective tools and strategies to help support people with diabetes. The Centers for Disease Control and Prevention estimates that one out of three people could develop diabetes in their lifetime unless they take preventive action. Close to 30 million Americans have diabetes now, but it’s estimated that nearly one-third of them — nine million people — have not been diagnosed and are not being treated.
Roughly 86 million Americans are thought to have prediabetes — a condition in which a person’s blood sugar is high, but not high enough to qualify as diabetes. Without intervention, these people are likely to develop diabetes within 10 years. Care for people with diabetes already accounts for one out of every five dollars spent on health care in the United States and one out of every three dollars Medicare spends. Given that, such increases in prevalence threaten health care budgets at every level.
Transform Diabetes Care
Given the cost and care challenges facing the health system, our clients and their members, CVS Health has developed a program focused specifically on members with diabetes. We have marshaled resources across CVS Health to provide high-touch, coordinated support for every member taking an antidiabetes prescription medication.
With robust clinical assets, strategic partnerships and a wide range of engagement channels, CVS Health is uniquely suited to provide a truly comprehensive offering that complements standard disease management programs and supports the various needs of members with this complex disease.
More than 9,700 CVS Pharmacy locations give us an opportunity to provide face-to-face consultations conveniently to members, integrated into their routine when they are already thinking about their therapy. At more than 1,100 — and growing — MinuteClinic locations, members can obtain necessary exams and tests to help them manage their diabetes between doctor visits. Enrolled members receive two vouchers per plan year for diabetes monitoring visits, including A1C checks, with no out-of-pocket cost.
Transform Diabetes Care emphasizes tailored support for individuals with diabetes and incorporates both clinical and cost management solutions. Support is enabled by our Health Engagement Engine (HEE), which connects our pharmacies, retail clinics, and health care professionals. Using member data, the HEE enables more effective outreach by identifying and prompting personalized, actionable opportunities for members with diabetes across all our touchpoints.
With insights gathered from pharmacy claims, connected glucometer readings and member-provided nutritional information, our clinicians are enabled to support each member’s specific needs as their care requirements evolve. Regardless of where members fall within the disease spectrum, our program can help to maximize the effectiveness of care and improve health outcomes for your members with diabetes.
Controlling Pharmacy Cost and Trend
Antidiabetic drugs are a top spend driver for our payors. In 2016, the category ranked number one in terms of gross cost for our clients, trending at more than 20 percent. Trend has been driven by price inflation in the mid-teens and utilization growth of more than 5 percent. Transform Diabetes Care employs several cost containment and clinical strategies to help maximize savings opportunities.
These projected savings enable us to guarantee single- digit year-over-year drug trend, subject to variations based on plan population demographics and current spending on antidiabetic drugs.
Trend management is achieved with two primary solutions. First, it includes use of our standard managed formulary to help ensure use of the most cost-effective, clinically appropriate treatment options. The majority of clients using this formulary have consistently demonstrated lower trend and per-member-per-month costs for the antidiabetic drug category.
Second, it includes use of the CVS Health Diabetes Network. The network is designed to help make prescription management easier for members and to enable a higher level of care for enrolled members, while providing information on adherence.
This network is primarily comprised of CVS Pharmacy and CVS Caremark Mail Service Pharmacy. The network is Any Willing Provider compliant; applying pharmacies must meet the high care standards of the Transform Diabetes Care program. In the case of Medicaid networks, we ensure the network complies with minimum state access requirements. The network helps to promote member engagement and face-to-face intervention opportunities, as well as helping to ensure cost-effective dispensing. Use of the network also helps to simplify fulfillment for members.
Better A1C Control with a Connected Glucometer
According to the American Diabetes Association, blood glucose (blood sugar) monitoring is the main tool patients have to check their diabetes control. Maintaining a log and comparing levels at consistent times over the course of days can help determine how activity and diet affect blood glucose. Care providers — personal physicians or other clinicians who assist in managing the condition — can also review the logs to evaluate whether the current treatment regimen is effective or should be modified.
Technology is rapidly transforming this aspect of diabetes care, making it easier for the member to keep track of glucose readings and for the clinician to review and provide counseling when appropriate.
Members enrolled in Transform Diabetes Care may be eligible to opt in to our connected blood glucometer offering. Using the device, members can continue to test as usual while their readings are conveniently captured, logged and shared with a team of diabetes counselors.
These insights enable the team to provide one-on-one coaching on topics such as blood glucose control, medication management and adherence. Coaches also provide preventive care and lifestyle management recommendations specific to members' needs to help improve their health outcomes. The team will provide ongoing individual support to members as needed.
How can you help members with diabetes better control their A1C levels? Ask Us
Patients Face Many Challenges
Following prescribed medication regimens can help people with diabetes control their blood sugar levels and avoid complications. More often than not, diabetes is not the only condition a patient is trying to manage. Rather, people with diabetes often have multiple comorbidities. Estimates of medication use among people living with diabetes range from eight distinct drugs per day to as many as 16.2 Medication regimens can be complicated and non-adherence is common. Transform Diabetes Care is designed to address the needs of the whole patient, including comorbidities.
Reasons for non-adherence vary and can include bothersome side effects, confusing medication regimens and out-of-pocket costs. As the disease progresses, blood sugar levels rise and the prescriber may add medication or change dosages. Such transitions further complicate the regimen and increase the risk of non-adherence.
In addition to complying with the prescribed drug regimen, patients with diabetes typically must make dietary and lifestyle changes, monitor their glucose levels, and obtain regular tests, screenings and check-ups. Many patients find it challenging to comply with all these recommendations on their own, even though compliance can have a huge impact on the progression of the disease and development of complications.
Controlling the condition and delaying its progression is important. Complications and comorbidities drive up both prescription and overall care costs. Medical costs are twice as high for people with diabetes as for those without it.
High-Touch, Personalized Counseling and Coaching
Transform Diabetes Care offers these patients direct, high-touch engagement and support. We utilize advanced analytics to stratify members with diabetes and target appropriate interventions based on prescription history and therapeutic complexity of the individual member. Enabled by our Health Engagement Engine, we are able to engage members when they are already thinking about their health during one of their most frequent health interactions — at the pharmacy. We also engage members by phone, text or email.
At their first fill of a prescription for an antidiabetic medication, pharmacists receive a prompt to counsel the member and explain the importance of adherence and answer any questions. Over the course of therapy, they also address non-adherence and gaps in care, helping members identify and overcome their unique challenges relative to medication therapy. In addition, one-on-one coaching will be provided telephonically by diabetes counselors, as needed, based on readings from the member's connected glucometer. The focus is always on actionable messaging and medication management solutions.
Digital tools help further reduce the complexity of the member’s day-to-day care needs — providing refill reminders and even daily medication prompts, if desired. We can also deliver messages to the member along with their prescription, reminding them of plan-sponsored services such as screenings.
Additional Support at MinuteClinic
Members enrolled in the program will receive vouchers for two diabetes monitoring visits at MinuteClinic, including A1C checks, at no additional cost. At MinuteClinic, members can obtain exams and tests to help monitor their disease and prevent complications, while also receiving education and suggestions on lifestyle improvement opportunities.
Licensed nurse practitioners and physician assistants counsel patients on lifestyle changes, including diet, to help reduce risk and prevent complications. They can also provide counseling and education on self-management, side effects and other aspects of antidiabetic therapy.
With the patient’s permission, visit summaries and test results can be shared with the patient's primary care physician if the physician is on the Epic health record sharing system.
Available at MinuteClinic
- A1C test
- Comprehensive foot exam
- Kidney function (Microalbumin test)
- Blood pressure check
- Cholesterol test
- Body mass index (BMI)
- Diet consultation
Personalized Clinical Support for Eligible Members with Diabetes
Making Living With Chronic Conditions A Little Easier
Diabetes is a pervasive and growing problem in the United States, affecting the lives of millions of people and their families. Transform Diabetes Care puts care and counseling within easy reach for members with diabetes. With an emphasis on personalized and face-to-face support, our innovative solutions can work collaboratively with other condition management programs to support a better member experience, help reduce payor and member costs, and help improve clinical outcomes and quality performance. Providing multiple means of support for members with diabetes and continuously innovating to enhance that support aligns with our purpose of helping people on their path to better health.
Delivering whole-person care with a personal touch for patients with complex, chronic conditions helps improve outcomes and keep payor costs low.
Health Engagement Engine
This proprietary technology platform powers our integrated model, transforming data into actionable interventions for better outcomes.
1. CVS Analysis, Gilmer (2005), CDC Prevalence Data.
2. Robert Wood Johnson Foundation, 2015. American Diabetes Association, 2012.
3. CVS Analysis, Gilmer (2005), CDC Prevalence Data. Projection for 100K population.
Unless otherwise noted, data source is CVS Health Enterprise Analytics.
Savings, trend changes and clinical results will vary by client depending on member demographics and other factors. Client-specific modeling available upon request.
Transform Diabetes Care may not be available for all plans. Transform Diabetes Care complies with Any Willing Provider laws in most states.
CVS Health uses and shares data as allowed by applicable law, and by our client contract agreements and our information firewall.