Transform RA Care

Holistic Care and Guaranteed Cost Control for a Complex Condition

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FEATURE
January 17, 2018
Executive Vice President and Chief Medical Officer, CVS Health

Rheumatoid arthritis (RA):

  • Affects 1.5M people in the U.S.*
  • Costs more than $19B annually to treat*
  • Had post-rebate trend of 19.6%**
  • Costs $9.39 per-member-per-month**

CVS Health today launched Transform Rheumatoid Arthritis Care, the latest addition to the company’s suite of Transform Care programs, to help the company’s pharmacy benefit management (PBM) clients better manage care and costs for RA. Transform RA Care adds value-based management strategies – including outcomes-based contracts and an indication-based formulary for autoimmune conditions – to the holistic patient care and existing cost-control programs powered by CVS Health’s integrated pharmacy care model for better management of this high-cost condition. Our multi-pronged approach enables us to offer a trend guarantee to clients who implement all the components of Transform RA Care by improving both clinical care and cost management for RA.***

Nearly 50% of overall specialty trend was from cost and utilization of drugs for rheumatoid arthritis**

Transform RA Care Offers a Trend Guarantee Through Improved Cost Control and Patient Care

Integrated Cost Management
Patient-Focused Clinical Management
A Better Patient Experience

Value-Based Contracting

Indication-Based Formulary

Utilization Management

Managed Network

Accordant Comprehensive Care Management

RA Center of Excellence
Support and Education

Connected Digital Tools

Specialty Connect
Choice of Retail Pick Up or Mail Delivery****

MyHealthTeams Partnership

Integrated Cost Management Patient-Focused Clinical Management A Better Patient Experience

Value-Based Contracting

Indication-Based Formulary

Utilization Management

Managed Network

Accordant Comprehensive Care Management

RA Center of Excellence

Support and Education

Connected Digital Tools

Specialty Connect

Choice of Retail Pick Up or Mail Delivery****

MyHealthTeams Partnership

Cost-Control Strategies

Given the high impact of RA drugs on overall pharmacy spending, effective cost-control strategies are critical. Transform RA Care utilizes our integrated pharmacy care model to further enhance our comprehensive suite of proven, in-market formulary and utilization management (UM) tools, with a managed network approach, and a new, targeted, value-based management enabled by capturing plan member outcomes data. These strategies, in conjunction with high-touch patient care, enable us to better manage both outcomes and spending, and offer a pharmacy trend guarantee to payors who choose to implement Transform RA Care.***

Existing cost-control strategies such as specialty guideline management (SGM) — including prior authorization and quantity limits — Advanced Control Specialty Formulary, and Exclusive Specialty, form the core components of the Transform RA Care program. Health plan clients aligned with the Preferred Specialty network can also utilize the program.

Transform RA Care Helps Achieve Savings with Comprehensive Cost Management

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Value-Based Management — Outcomes-based contracting

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Indication-Based Formulary — Advanced Control Specialty Formulary

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Utilization Management — Prior authorization, step therapy and quantity limits

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Managed Network — CVS Specialty exclusive network

Up to 5% client savings from implementing Transform RA Care**

In addition, we have negotiated several outcomes-based contracts for autoimmune agents, which help deliver incremental savings while enabling better patient outcomes. When a drug does not effectively treat a condition or is not well tolerated, most patients will discontinue therapy. For certain RA drugs, outcomes-based contracts ensure that if the member discontinues therapy the manufacturer will be required to provide additional value. This would also be the case if a patient is moved to a higher dose or frequency, indicating that the drug at its primary dosing level was not providing the desired clinical benefit — not unusual for autoimmune conditions.

Such contracts enable us to capture outcomes information and deliver cost control and better management for an expensive and complex condition for clients aligned with our Transform RA Care program.

We are also expanding our indication-based management offering to autoimmune conditions. Indication-based management determines formulary placement for specific drugs rather than the therapy class. By providing preferred placement for clinically appropriate, cost-effective drugs to treat specific indications we can negotiate better pricing and rebates with manufacturers on behalf of our clients.

High-Touch Patient Care

Given the disease burden, RA patients often struggle to stay on medication and need help managing their symptoms, side effects and condition. Transform RA Care offers proactive support from AccordantCare Specialty, as well as innovative digital tools that can help members start and stay on therapy and create a better plan member experience.

CVS Specialty patient Rick Postell shares his journey with RA

Members enrolled in Transform RA Care will benefit from proactive, personalized care and disease-specific expertise of the specially trained pharmacists and Accordant nurses in our RA Center of Excellence.

In addition, their RA CareTeam offers a comprehensive, personalized approach, including initial clinical assessment, benefits verification, care coordination, and medication dispensing and distribution. Embedded pharmacists and specially trained AccordantCare nurses provide a range of high-touch patient care services such as symptom and comorbidity management, social support, as well as coaching and education. Nurses can conduct proactive patient outreach to help improve engagement rates and reduce gap days and condition-related complications, such as hospital and emergency room visits.

The integration with Epic, the largest electronic health record (EHR) database in the country, and its Care Everywhere, enables Accordant nurses to obtain patient diagnosis, biometric and health data from any provider using a compatible EHR, in addition to prescription information to support clinical decision-making. Nurses and social worker teams have access to clinical information allowing them to efficiently and effectively collaborate with CVS Specialty pharmacists for seamless, highly coordinated care.

Specialty Connect provides members unmatched choice and access. Members can choose to pick up their medications at their local CVS Pharmacy or have it delivered to their home, office or location of choice. No matter what they choose they get high-touch clinical support from the pharmacists and nurses at our RA Center of Excellence.****

Transform RA Care — High-Touch Personalized Support for Better Outcomes

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Accordant CareTeam — 3.9% point increase in MPR for RA with nurse engagement1

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RA Center of Excellence — RA experts manage more than 300,000 patients2

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Specialty Connect — 18.5% of new autoimmune patients prefer pickup at CVS Pharmacy over home delivery3

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Digital Tools — 70% of patients opted in to email and text notifications4

Consumers today want to be digitally connected and health care is no different. More than 70 percent of CVS Specialty patients are signed up to receive electronic messages from us. We utilize the latest innovations in technology, including secure messaging through our app or website, to better engage members whenever they want to connect to us, to help improve health outcomes and create a better patient experience. Of the patients enrolled in our secure messaging program, 80 percent report they have completed their required lab tests and 30 percent more are optimally adherent.**

We also have a partnership with MyHealthTeams, which offers myRAteam, a social network that enables patients to connect with others and share their experience or learn more about managing their condition. By utilizing a range of proactive patient care strategies, Transform RA Care is designed to enable more members to be optimally adherent and effectively manage their condition.

Transform RA Care brings together a complete suite of cost and care management services to help provide holistic care and guaranteed cost control for this complex condition. We continue to evolve our suite of Transform Care programs that are designed to help members manage chronic conditions effectively, thereby improving clinical outcomes and reducing hospitalizations, emergency care and overall costs.

Transform RA Care brings together a complete suite of cost and care management services to help provide holistic care and guaranteed cost control for this complex condition. We continue to evolve our suite of Transform Care programs that are designed to help members manage chronic conditions effectively, thereby improving clinical outcomes and reducing hospitalizations, emergency care and overall costs.

Want an analysis of your plan's RA trend? Ask Us
FEATURE
January 17, 2018
Executive Vice President and Chief Medical Officer, CVS Health

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1. CVS Health Enterprise Evaluation and Population Health Analytics, January, 2015 — February, 2016. MPR = Medication Possession Ratio.
2. CVS Specialty, as of June 2017.
3. CVS Health BOB data analysis from Jan 10-Dec 31, 2016.
4. CVS Internal Analysis of Specialty Connect patients. Data was based on an observational study of Specialty and PBM patients with dispenses for seven key therapies.

https://www.rheumatoidarthritis.org/treatment/costs/ Last updated Oct. 2017.

** CVS Health Enterprise Analytics, 2018. Data for first half of 2017.

*** Trend guarantee available for payors meeting a minimum threshold of members with RA. Savings, trend changes, and clinical results will vary by client depending on member demographics and other factors. Client-specific modeling available upon request.

**** Where allowed by law. In-store pick up is currently not available in Oklahoma. Some states require first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations.

 Adherence results may vary based upon a variety of factors such as plan design, demographics and programs adopted by the plan. Client-specific modeling available upon request.

CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.

Image source: Licensed from Getty Images, 2018.