- Programs & Services
Transform Care programs provide condition-specific, patient-centric care and management, helping to reduce pharmacy and overall cost by enhancing outcomes.
Therapy for chronic conditions can be complex, and many patients have multiple comorbidities, further complicating their treatment regimens.
Transform Care programs are designed to effectively help members manage chronic conditions and help improve clinical outcomes while also helping to deliver lower net costs to the plan. Each Transform Care program is condition-specific, designed to address the needs of the individual member and utilizes a broad array of CVS Health resources and capabilities most appropriate for the condition. With our multiple access points at which we already interact with members, when they are thinking about their health, we can deliver customized interventions to promote better outcomes.
Transform Diabetes Care
Anti-diabetic drugs are one of the top pharmacy spend and trend drivers for payors, and people being treated for diabetes drive a disproportionate share of overall health care costs. Transform Diabetes Care helps to address both aspects of spend by integrating pharmacy benefit manager (PBM) drug cost management strategies, in-person pharmacist counseling, diabetes-specific coaching, and care by a nurse practitioner at MinuteClinic, all enabled by our Health Engagement Engine. Transform Diabetes Care complements standard disease management programs and supports the various needs of all members being treated for this complex disease. Integrated systems enable collaboration between our program and providers, plans and existing disease management programs to effectively extend the reach of the physician, support client goals and coordinate all points of care throughout member therapy.
Single-digit Trend Guarantee
Transform Diabetes Care includes use of our standard managed formulary to help ensure utilization of the most cost-effective, clinically appropriate treatment options. Members enrolled in the program use the CVS Health Diabetes Network to fill their antidiabetic drug prescriptions. The network is composed primarily of the CVS Pharmacy and CVS Caremark Mail Service Pharmacy network, and is Any Willing Provider compliant. These solutions enable us to guarantee payors single-digit year-over-year trend5 for anti-diabetic drugs, which have been trending above 15 percent for several years.
High-touch Personalized Counseling and Coaching
The program utilizes analytics to identify and reach members with diabetes, and target appropriate interventions, whether in-person at the pharmacy, or by phone, text or email. Eligible members can choose to enroll in the connected glucometer program. Members receive a cloud-connected meter, which transmits their blood glucose readings to a team of diabetes counselors. This enables diabetes coaches to reach out directly to the member with highly targeted and actionable messaging on how to improve their blood glucose control and better manage their condition. Better control of blood glucose has been proven to help reduce A1C levels, an important measure of effective condition management for diabetes. Pharmacists have expertise in medication management and can help counsel members and help improve adherence through in-person or on the phone interactions. Members have access to a suite of digital resources, available through the CVS app, to help them better manage their medication therapy.
Connected Model Enables Effective Support
Members in the program receive two vouchers for a diabetes monitoring visit at no additional cost to the member, including an A1C check, at MinuteClinic, where they can also have exams and tests to help track their condition and prevent complications. The clinicians at MinuteClinic can also counsel members on lifestyle changes, self-management, and other aspects of diabetes therapy.
We also utilize Epic, one of the largest electronic health records vendors in the industry, to help improve connectivity with health systems and providers.
Our Differentiated Approach
Transform Care programs utilize our integrated resources to provide condition-specific personalized care for enrolled members. Depending on the condition, the program may involve pharmacist counseling in person or by phone; check-ups, tests and lifestyle support at MinuteClinic; or the services of our Specialty CareTeams.
These interventions are delivered through one of our wide range of touchpoints at a time when a member is most likely to be engaged in their own care, and customized to each member’s preference and lifestyle.
Pharmacy Spend Management
Each therapeutic category presents its own cost management challenges. Transform Care programs are designed to deliver lowest-net cost through formulary and network management appropriate to the targeted condition.
Considerations for your business
- Does your benefit plan deliver targeted interventions customized to the needs of each member with diabetes?
- How well do your members with diabetes adhere to their prescription therapies?
- Have you adopted a comprehensive, integrated approach to managing diabetes in your member population?
Have a question about our Transform Care programs?
2. The Staggering Costs of Diabetes in America. http://www.diabetes.org/diabetes-basics/statistics/infographics/adv-staggering-cost-of-diabetes.html.
3. Diabetes: Comorbidities and Drug Therapy Problems in Patients with Diabetes. http://www.medsmanagement.com/pdf/Diabetes%20Manuscript.pdf.
4. Prevalence of comorbidities high in type 2 diabetes. http://www.healio.com/endocrinology/diabetes/news/in-the-journals/.
5. Guarantee subject to variation based on plan population demographics and client’s current spending in the category.
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.
Transform Diabetes Care may not be available for all plans.
CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.