Chronic

Proactive, Targeted Engagement Helps Reduce Spend and Prevent Overall Cost Escalation.

We have an innovative approach to addressing chronic conditions and patient concerns to help reduce health care spending.

Nearly half of all patients with chronic conditions leave a doctor’s office without understanding the next steps in their care.Atreja, Ashish et al. “Strategies to enhance patient adherence: making it simple.” MedGenMed: Medscape general medicine vol. 7,1 4. 16 Mar. 2005 Our flexible programs, like Transform Diabetes Care, help address these concerns.

The prevalence of diabetes and the cost burden it places on the nation’s health care system are well known. In addition, a patient with diabetes is required to make hundreds of annual decisions – especially for those using insulin.

Many people may not receive the support and guidance needed, particularly between quarterly or annual medical appointments. Treatment for diabetes must incorporate many facets, including clinical support, ongoing behavior change, emotional support, and use of technology.

Chronic Condition Management Programs
2:1 Savings Guaranteed*
Chronic Condition Managment Programs
2:1 Savings Guaranteed*

Effective results with combined diabetes and comorbidity care

Diabetes is prevalent and costly to manage with an estimated 34 million Americans diagnosed with diabetes.https://www.cdc.gov/diabetes/data/statistics/statistics-report.html Comorbidities like hypertension and chronic kidney disease (CKD) are common and make diabetes management even more complicated for plan members.

Connecting one-on-one with members helps make our Transform Diabetes Care (TDC) program so effective. Our analytics engine analyzes member data to help determine an appropriate level of support for the member, and outreach is determined based on a member’s clinical opportunity and disease acuity.

Members that need high-touch support will receive personalized, live engagement through local channels such as CVS Pharmacy and CVS HealthHUB or telephone outreach from specialized clinicians.

For members at-risk for having diabetes and comorbidities, the program offers an opportunity to identify and curb the progress of chronic conditions through proactive condition screenings that are followed up with focused messaging.

Transform Diabetes Care helps improve health outcomes

TDC uses early identification, individualized engagement and unique touchpoints to help members with diabetes achieve reduction in A1C. Members that also have hypertension and CKD receive additional support to help reduce blood pressure and improve outcomes and reduce costs related to CKD. And best of all, TDC supports lower medical costs for payors.

Transform Diabetes Care is more than a baseline diabetes offering

The program supports members across five clinical impact areas—more than the industry standard. TDC provides an unmatched ecosystem to deliver care how, where and when members need it. 

We are everywhere your members need us, and that makes a difference. About 77 percent of the U.S. population lives within 10 miles of a CVS Pharmacy. Our CVS HealthHUB and MinuteClinic locations keep growing, so we can provide even more care options in more locations across the country. 
 

65,000
participating pharmacies
9,900
CVS Pharmacy locations
1,100
MinuteClinic locations
~600
CVS HealthHub locations opened in 2020
65,000
participating pharmacies
9,900
CVS Pharmacy locations
1,100
MinuteClinic locations
~600
CVS HealthHub locations opened in 2020

Lowering medical costs while boosting adherence

Ongoing prescription therapy is key to managing chronic conditions, but 50 percent of maintenance medications are not taken as prescribed.https://www.ncbi.nlm.nih.gov/pubmed/22964778 Helping people stay adherent can make a difference—improving outcomes and lowering overall costs.

3.9% more members stay adherent with Pharmacy Advisor4Pharmacy Advisor delivers proven adherence gains with 3.9% more members staying on treatment. CVS Health Analytics, 2020. Adherence results are based on CVS Caremark data for clients enrolled in the Pharmacy Advisor All Channels program. Prevalence rates derived from the CVS Caremark Data Warehouse Adherence Outcomes Layer and medical cost savings estimates associated with improved adherence from the Pharmacy Care Economic Model (PCEM) 2020. 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.

3.9% more members stay adherent with Pharmacy Advisor4

Gaining control with proactive support helps drive adherence so that all members stay healthier, and their medical costs can be lower over time. The Pharmacy Advisor program identifies members in need of support and provides individualized outreach with one-to-one connections that lead to better adherence, improving health outcomes and delivering medical cost savings.

Our interconnected technology provides the largest real-time pool of behavioral data and analytics available. We apply understanding derived from predictive analytics to intervene at the right time, and in the right way. When the intervention is at the pharmacy, pharmacists are alerted to proactively engage with members during their visit. Face-to-face interventions are only available at CVS Pharmacy locations. Clients can also select a version of Pharmacy Advisor which provides interventions to a web-based platform that can be accessed at our network of ~56,000 non-CVS retail pharmacies. This allows Pharmacy Advisor interventions to take place with a member’s local pharmacist, even if they choose not to use CVS

Interventions include meaningful conversations between pharmacists and members about their treatment and individual challenges.

  • Uncovering adherence obstacles
  • Following up on medication drop-offs
  • Supporting ongoing interventions

Members also receive outreach according to their preferences for effective connections that improve adherence.

  • Text and email
  • Call Center outreach
  • Live and interactive voice response calls 

Motivating healthy behaviors through proactive connections

Managing a chronic condition can be complicated, even overwhelming for members, especially if they’re treating comorbidities. Health Advisor is designed to make it easier and to help members make better care decisions that will improve outcomes and lower costs. 

The program provides highly individualized support, based on ongoing review and analysis of medical claims, lab and pharmacy data, demographic data, plan benefits and other data sources. This real-time view of the member powers the analytic engine to identify and prioritize individualized communications known as next best actions (NBAs). By thoughtfully crafting each message and intervention using behavioral science techniques, Health Advisor is designed to significantly improve the effectiveness of each connection for a positive impact on health outcomes. In addition to proactive pharmacist outreach during pharmacy visits, we reach out to your members based on their preferences, using text, email and calls.

Health Advisor helps influence healthy behaviors

2:1

Savings guaranteedPlans must have 10K members.

Improves behavior change

15%15% source: CVS Health Analytics, 2019 based on a comparison group with 48 experiments, n= 4.1M. Actual results may vary depending on benefit plan design, member demographics, programs implemented by the plan and other factors. All contract and usage complies with applicable privacy laws. Client-specific modeling is available upon request.

Reduces preventable emergency room (ER) visits
12%CVS Health Analytics, 2019, based on a randomized controlled trial.

Reduces use of non-preferred or out-of-network sites of care
8%CVS Health Analytics, 2019, based on a randomized controlled trial. 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.

2:1
Savings guaranteed[5]
Improves behavior change
15%[6]
Reduces preventable emergency room (ER) visits
12%[7]
Reduces use of non-preferred or out-of-network sites of care
8%[8]

Want to learn more about how to support your members managing chronic conditions? Ask Us

*Guarantee based on return on investment (ROI) that is subject to terms and conditions.

The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted.

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.

Savings will vary based upon a variety of factors including things such as plan design, demographics and programs implemented by the plan.

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

CVS Health has extensive policies and procedures in place to ensure the appropriate handling of data. Employees with access to data are trained regarding the appropriate way to handle that data, which may include member PHI.

©2021 CVS Health. All rights reserved.

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