The MS Care Challenge

The MS Care Challenge
BRIEFING
August 22, 2017
Executive Vice President, Chief Medical Officer, CVS Health

The 400,000 Americans who have multiple sclerosis (MS) deal with a chronic yet unpredictable neurological condition that is usually progressive, and often accompanied by comorbidities. Managing this condition is challenging for patients, providers and payors alike, with complications of the disease and of treatment, adherence issues, side effects, medication interactions, and increasingly expensive therapies.

No two patients living with MS are alike, and the needs of any individual patient vary depending on how far the disease has progressed. MS requires a holistic, patient-centric approach to help manage complications of the disease. This approach also helps patients start and stay on the most clinically appropriate drug and dosage, at the lowest price, and the most cost-effective site of care, regardless of benefit.

Classifying and Treating MS

There are four different classifications of MS, with the vast majority of patients falling into three categories — relapsing remitting (RRMS), secondary progressive (SPMS), and primary progressive (PPMS). There are more than 10 oral, injectable and intravenous infusion treatment options for RRMS, and a new drug to treat PPMS, Ocrevus, was approved by the U.S. Food and Drug Administration (FDA) at the end of March.

The MS Care Challenge Accordian

Challenges for Patients
Each patient’s journey in managing and living with multiple sclerosis is unique because disease progression varies widely.

Each patient’s journey in managing and living with multiple sclerosis is unique because disease progression varies widely. But there are some common challenges most patients face, including:

MS patients also often have comorbidities not directly tied to their disease. Research shows that the five most prevalent comorbidities among MS patients were psychiatric issues including depression and anxiety, high blood pressure, high cholesterol, and diabetes.*

Treatment Side Effects and Risks
Side effects of MS medications include flu-like symptoms, injection site pain, rashes, nausea, and fatigue.

Side effects of MS medications include flu-like symptoms, injection site pain, rashes, nausea, and fatigue — with as many as 80 percent of MS patients experiencing fatigue at some point — and in some instances, a racing heartbeat. Some medications also come with safety warnings about potential medication interactions or risk factors. For instance, MS patients who are prescribed Tysabri or Tecfidera are at higher risk of having an active infection from a virus known as the John Cunningham (JC) virus, which can cause a rare brain infection called progressive multifocal leukoencephalopathy (PML). The virus is common in the U.S. and can be activated by immunosuppressive medications like MS drugs. Patients prescribed these medications should get tested for the presence of the virus prior to initiating therapy.

Risks and safety issues have prompted the FDA to impose Risk Evaluation and Mitigation Strategy (REMS) requirements on several MS treatments. CVS Specialty has certified sites, including CVS Specialty Coram infusion centers, which have expertise in administering these REMS requirements.

Effective Clinical Management

CVS Specialty patient Judith Rahmani shares the story of her journey with MS

Care for patients managing multiple sclerosis is complex and evolves with disease progression, and medication therapy is just part of the solution. The CVS Specialty holistic patient care approach not only includes medication delivery, drug counseling, adherence support, and financial coordination assistance but also helps to address members’ clinical and emotional needs.

The first step in effective clinical management is improving adherence, a particular concern for MS patients, given condition complexity, comorbidities and side effects. From 17 to 46 percent of MS patients, according to a study, fail to adhere to their medication regimen. Research suggests that MS patients who fail to adhere to prescribed medication often feel that their medication isn’t working, or experience treatment fatigue over the ongoing need to self-inject. In addition, patients with depression are 1.76 times more likely to be non-adherent.

Gaps in treatment and adherence failures can lead to more relapses, unnecessary complications, and a faster progression of disability, and those who stop treatment or stop important self-management activities are more likely to use costly emergency services. Care management support is critical to help patients stay adherent.

The MS CareTeam has specially-trained embedded nurses who assist members in managing these challenges. CVS Specialty has more than 300 specially-trained rare disease nurses, including more than 50 MS nurses.** Members who receive Accordant CareTeam nurse support, report 52 percent fewer flares, leading to fewer hospitalizations and up to an 11 percent reduction in total health care costs.*** We are also implementing Epic, one of the largest electronic health records systems in the industry, to help improve connectivity with health systems and providers. Increased connectivity with all key stakeholders is critical in providing coordinated, personalized care.

Integrated Specialty Pharmacy Model**

Nurses connect with members to conduct a full assessment of their current condition and comorbidities, and to evaluate their overall health risk. The nurses help create a care plan that supports members’ personalized needs and is modified based on disease progression or change in therapy. They also conduct proactive outreach, help identify and close gaps in care, and act as liaisons with physicians, pharmacists and other providers, as needed. Annually, CVS Specialty nurses make 149,000 outbound calls to patients, each one supported by educational material sent securely and tailored for each individual.

Another key aspect of MS treatment is optimizing the site of care, because some MS drugs are infused intravenously. Infusion treatments in a hospital setting may drive up costs, while ambulatory infusion sites (AIS) offer consistently lower costs and greater convenience for patients. CVS Specialty has 71 certified infusion suites across the nation and its home infusion services are accessible to 97 percent of the U.S. population. AIS sites are shown to have better outcomes with fewer complications. The personalized attention improves quality of life and reduces stress.

Clinical Innovations

We are also constantly developing and implementing patient-focused technology solutions and tools that can help improve care management. Members with MS can access:

Number 1

A digital app that helps members stay on track with refills and offers 24/7 access to medication and refill information as well as secure messaging to their CareTeam.

Checkmark

MyHealth Teams, a social network that helps patients with chronic conditions connect and support each other, reducing the isolation that some MS patients feel.

We are also piloting connected wearable devices that aid in monitoring stability during walking in order to help avoid falls. These devices can also share data with the physician and CareTeam to help inform and improve patient care plans while improving patient engagement.

Our comprehensive approach is focused on managing the whole patient and providing the right level of support.

How can you better control costs for MS treatment while improving patient care? Ask Us
BRIEFING
August 22, 2017
Executive Vice President, Chief Medical Officer, CVS Health

Explore Programs

Specialty

Our integrated PBM and specialty pharmacy model helps lower medical and pharmacy costs, improve outcomes and create a better member experience.

Patient Care

Care for specialty patients is complex. A holistic approach helps ensure that patients have proactive clinical support as well as access to medication, helping to improve outcomes and lower costs.

Adherence

Investing in adherence helps reduce overall health care costs and drive better health outcomes.

*CVS Health Internal Analysis.

**Nurse support is available to members whose plans include Accordant Care Management (CareTeam Choice or CareTeam Advanced).

***Example from Self-Reported Data, Accordant Comprehensive Data Warehouse, 2013. 2. Up to 11.1% Reduction in Overall Spend. Accordant Comprehensive Data Warehouse; SQL Server 2008. Greensboro, NC: Care Management Health Services, a CVS Health Company, 2013.