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Help to improve health outcomes and reduce overall cost of care with condition-specific management programs.
Chronic conditions drive most health care spending in the United States, accounting for the majority of physician visits, prescriptions for medication, and hospitalizations. Effective management can reduce complications and adverse events but can be challenging for patients. Depending upon the condition, an individual may be asked to make lifestyle changes, monitor symptoms and have regular tests or screenings as well as adhere to their prescribed therapy. Once patients leave the doctor’s office, they can feel confused and overwhelmed by the changes they have been asked to make.
Condition-Specific and Patient-Centric
Transform Care programs are designed to help members manage chronic conditions effectively, thereby improving clinical outcomes and reducing hospitalizations, emergency care and overall costs. Because each condition presents a unique set of challenges, and each patient responds individually, Transform Care programs are condition-specific and focus on highly personalized interventions. Pharmacy data provides insights about members and their behaviors relative to prescribed therapies. Advanced analytics help us assess the complexity of a member’s condition and define specific needs, helping to precisely target needed interventions.
Transform Care programs draw upon the full range of CVS Health assets, leveraging our local presence and the expertise of our clinicians to engage, counsel and support members. To help manage pharmacy costs, Transform Care employs CVS Health’s in-depth market understanding and innovative solutions to address condition-specific challenges. The programs also incorporate a range of technology—tools to help members monitor and manage their condition as well as connect with providers for better coordination of care.
Our Differentiated Approach
With more than 9,700 CVS Pharmacy locations and 1,100 MinuteClinic walk-in clinics, CVS Health is uniquely able to engage members face-to-face, in their own communities, when they’re thinking about their health. We have built the infrastructure and the clinical staff to provide highly personalized counseling and education to members with chronic conditions at various touchpoints as well as by phone, text and email. The Health Engagement Engine is a powerful clinical rules engine that connects our touchpoints and enables targeted interventions. Pharmacy programs such as ScriptPath and real-time benefits as well as a suite of digital tools are already in place to assist members in managing their prescription therapy.
Members enrolled in Transform Care programs have the option to access needed services within the integrated CVS Health system. Many screenings and lab tests can be performed in MinuteClinic, where members can also access health and wellness coaching. Our Specialty Care Teams and rare disease nurses are engaged with Transform Care programs targeting complex conditions, and we are also able to offer those members on infused therapies lower-cost sites of care when appropriate.
In our quickly evolving pharmacy marketplace, each therapeutic category presents its own cost management challenges. Transform Care programs target high cost and/or high prevalence conditions and tailor cost management strategies to the specific targeted condition. Transform Care programs engage our arsenal of pharmacy benefit management tools with the goal of delivering lowest net cost for the payor. As always, formulary, network and utilization management strategies are core to cost management. For select categories, value-based designs such as indication-based formularies or outcome-based contracting are offered to drive incremental value for payors. Transform Care programs include a drug trend guarantee for condition-specific medications.
Our integrated systems and strategic initiative with Epic enable collaboration between our programs and providers as well as existing disease management programs. For example, Epic enables MinuteClinic to share member visit data with physicians and case managers that use a compatible electronic health record systems, which collectively can help providers monitor the member’s condition. Connected devices enable the sharing of daily metrics for improved condition monitoring.
Increasingly, technology is helping patients monitor their chronic conditions and even helping to ensure that relevant data is shared with their clinical care team. Because accurate information about a member’s conditions is critical in helping counselors and coaches address any management issues, Transform Care programs incorporate such tools wherever appropriate.
A Comprehensive Approach
Transform Care provides high-touch, personalized support to help members successfully manage their chronic conditions. By utilizing CVS Health community-based touchpoints, members have easy access to clinical counseling, health and wellness education and recommended testing while connectivity with other members of their care teams helps to ensure greater coordination, resulting in lower cost of care overall.
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