- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
How our Integrated Model Addresses Key Patient Challenges
Our goal in combining CVS Health and Aetna is to address the challenges of today’s health care system and transform the experience by putting consumers at the center of care, beginning with the creation of a new front door to health care. The current system is complex, fragmented and based on an episodic, fee-for-service model that is often wasteful. This leads to higher costs – the U.S. spends $3.5 trillion on health care and that is rising. But the money spent does not always lead to better outcomes. This is unsustainable and the entire system needs to be transformed. We can and must do better.
CVS Health intends to push the system toward less expensive, more convenient, high-quality care.
This starts with engaging the consumer in their individual health care journey. We will use our consumer-centric assets to introduce the appropriate programs and services to help them achieve their health goals, thus improving health outcomes and lowering costs.
Five Initial Areas of Focus
The five initial areas we will focus on will include improved care management for both common and complex chronic conditions, preventing avoidable hospital re-admissions, site-of-care management and optimizing primary care:
Common Chronic Disease Management
Site of Care Management
Optimize Primary Care
Complex Chronic Disease Initiatives
The opportunity is massive. As a nation, we spend more than $2 trillion annually – 86 percent of total medical spending – on treating patients with chronic conditions.
We aim to help improve the management of five common chronic conditions – diabetes, cardiovascular disease, hypertension, asthma and behavioral health. We will build on our near-term medical cost savings, by utilizing our rich clinical data and community assets, and through tighter integration of pharmacy and medical claims. As part of a new pilot program launched in the fourth quarter of last year, we will provide adherence outreach and counseling to Aetna plan members who are at high risk for adverse health events. This quarter, we will be launching another pilot to provide specialized, enhanced services to support Aetna members with congestive heart failure. Many of the pilots will include select other clients for a broader population base.
The next target is reducing avoidable hospital re-admissions by utilizing Aetna’s clinical programs to identify patients at the point of discharge and engaging them though our retail assets to better support them. In the first quarter of this year, we plan to launch a pilot in which we will schedule MinuteClinic follow-ups within 14 days post-discharge when the patient is unable to see a provider. We will also engage patients after discharge, provide them strategies for care management and help mitigate risks of non-adherence, side effects and gaps in care.
Better Care, Open Source Model
While some of the pilot programs are focused on Aetna members, we intend to expand the health and wellness services we offer to plan members of all our health care partners through an open source platform.
We will also aim to increase the use of lower-cost sites of care, including home infusion, when appropriate. Research has shown that at-home and other alternative sites of care can be safer for patients and lower costs for payors.
We intend to expand the health and wellness services we offer, to plan members of all our health care partners through an open source platform.
To help with early identification and ongoing management of chronic diseases, we will expand the scope of services available at MinuteClinic, thus optimizing and extending primary care.
We are also developing a series of comprehensive programs to better manage complex chronic diseases. Our aim is to target conditions such as kidney disease where the goal is reducing hospitalizations and delaying the progression of the disease, and oncology where the objective is to align provider incentives to focus on quality and outcomes, while enhancing patient support. These solutions will be accessible through a broad range of channels – from local community-based assets, to virtual and digital solutions – all coordinated across the member and the consumer journey.
Concept Stores to Simplify the Patient Journey
A key element of simplifying the patient journey is the opening of a series of health care concept stores which will serve as a testing ground for a new retail engagement model. The new stores will provide health care services in a more convenient, accessible, and customer-focused manner. We will pilot new programs and service offerings, identify the solutions that are the most effective and scalable, and roll them out more broadly.
The new store will feature new health and wellness categories in the front store as we optimize our merchandising to focus on “Best Of” category assortments. It will also offer an expanded suite of health care services including a Care Concierge, and other health and wellness support. In our MinuteClinic locations, we will introduce new clinical services such as enhanced screenings for chronic disease and in-clinic phlebotomy. And our pharmacy staff will use our data and analytics capabilities to provide personalized prescription support and actionable information at key points in care to help improve patient outcomes.
Health Engagement Engine
This proprietary technology platform powers our integrated model, transforming data into actionable interventions for better outcomes.
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