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Optimizing prescription therapy is key to improving outcomes for chronic conditions that drive a majority of health care spend.
More than half of Americans have at least one chronic condition. Treating people with chronic conditions accounts for 86 percent of U.S.health care spend. Prescription therapy is the most effective and cost efficient treatment for a majority of chronic conditions, but whether people get the full benefit of prescribed therapy depends on many factors, not least of which is whether they actually take the drugs they’ve been prescribed.
As a company with a mission of helping people on their path to better health, CVS Health has invested significantly in resources and capabilities to enable us to optimize prescription therapy to help improve member health and help lower overall costs for payors.
Our multiple touch points including retail, mail and specialty pharmacy, MinuteClinic, long-term care, and infusion services, put us in direct contact with health care consumers every day providing an exceptional opportunity to influence health behaviors. Personal, face-to-face interactions have been proven to be two to three times more effective at increasing adherence and improving health outcomes. We have developed a connected delivery platform and robust health improvement programs that leverage the opportunity offered by our broad array of channel assets to support members and promote healthy behaviors.
Our adherence interventions are based on extensive research to help make them as effective as possible.
Programs Tailored to Patient Needs
Our Pharmacy Advisor program provides clinical counseling to members with chronic conditions. Transform Care programs offer additional condition-specific care management, such as a diabetes coach and lifestyle counseling at MinuteClinic.
Specially trained, therapy-specific CareTeams also offer skilled support to patients with chronic and complex conditions. Depending on the therapy and a member’s needs, CareTeam support can be augmented by infusion and rare disease nurses. The extra support provided by Transform Care programs and Specialty CareTeams can be especially important for members with comorbidities and multiple prescriptions, who may face significant adherence and condition management challenges, which could lead to costly complications and adverse events.
Nearly 50 percent of people prescribed maintenance medication for a chronic condition stop taking it in the first year, with the biggest drop-off occurring in the first month.1,2 When patients are non-adherent or fall off therapy it may lead to worse health outcomes and higher costs from avoidable downstream complications. CVS Health has a range of programs to help improve member adherence, utilizing our multipletouch points and ability to counsel members in person and over the phone.
Our Health Engagement Engine is a powerful clinical rules engine that integrates our enterprise assets, providing real-time, actionable health care information. It allows us to aggregate data from both internal and payor sources, and combine it with our clinical research to identify opportunities to improve adherence and close gaps in care. The engine helps us deliver proactive, targeted outreach to members at the right time through the right channel.
Our Differentiated Approach
The populations we serve give us access to a diverse and broad data set — from how people fill and refill prescriptions, to the impact of plan design and utilization management strategies. We can also integrate pharmacy and medical data to form a complete picture of the member and their unique needs and challenges. We combine this with insights gleaned from our extensive research and analytics to deliver personalized targeted interventions.
One of the greatest benefits of our integrated model is that we are able to connect and coordinate care across touch points, including with health care providers. We can deliver information about non-adherence and gaps in care directly into electronic health records so providers can address therapy issues with the member at the point of care.
We make it more convenient for members to access care in the most effective ways across the health care continuum. Digital tools and multiple, connected touch points make it easy for members to manage their prescription therapy, order refills, and get their questions answered. Programs like Maintenance Choice and Specialty Connect, which provide greater choice to members, have proven to increase adherence, demonstrating that greater accessibility can help drive appropriate utilization and better outcomes.
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2. Cassil, Alwyn. Rising rates of chronic health conditions: What can be done? Center for studying health system change 2008; no. 125.
Unless otherwise noted, all data is from 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.
Programs mentioned here may not be available for all plans.
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