- Programs & Services
- Cost Management
- Improving Health
- Transform Care
- Member Engagement
- Government Services
Transform Diabetes Care
Multi-faceted support helps members lower A1C levels and better manage their condition.
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 with personalized, high touch support including in-person pharmacist counseling, diabetes-specific coaching, and care by a nurse practitioner at MinuteClinic.
Transform Diabetes Care complements standard disease management programs and supports the various needs of members being treated for this complex disease. Integrated systems enable collaboration between our program and providers, plans and existing disease management programs, to support client goals and coordinate all points of care throughout member therapy.
Initial results for Transform Diabetes Care show significant improvement for enrolled members. Plan members who previously had uncontrolled diabetes lowered their A1C levels by one percentage point and maintained that improvement for six months. Among members with uncontrolled diabetes, such a reduction may reduce health care costs by $2,800 per member per year. These members were highly engaged; they used connected glucometers to monitor their blood sugar levels at least five times a month. Any abnormal readings prompted outreach from certified diabetes educators, who helped members get back on track.
Transform Care programs utilize our integrated resources to provide condition-specific personalized care for enrolled members through our wide range of touchpoints. For Transform Diabetes Care, we utilize advanced analytics to identify members with diabetes and to target appropriate interventions.
Pharmacists provide personalized counseling to enrolled members face-to-face at the pharmacy or over the phone. This counseling has proven highly effective. For example, in a pilot with one client, the pharmacists’ workflow at CVS Pharmacy was adjusted to prompt a discussion with an eligible member about enrolling in the glucometer program. When eligible members presented at the pharmacy to fill prescriptions for antidiabetic medications, the pharmacy technician referred them for pharmacist counseling. During this face-to-face counseling, the CVS pharmacist was prompted to discuss the connected glucometer program before completing the prescription transaction. Forty-five percent of eligible members who presented at the pharmacy were successfully enrolled with this face-to-face support, which was 14 to 18 percentage points more effective than traditional direct mail and email outreach.3 Based on these encouraging initial pilot results, we intend to add CVS pharmacist-led retail enrollment to the Transform Diabetes Care program.
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. Plans can choose from several network options including CVS Health Diabetes Network to fill a prescription for their antidiabetics. The CVS Health Diabetes Network is composed primarily of CVS Pharmacy locations and CVS Mail Service Pharmacies. The network is designed to provide a higher level of care; to join the network, pharmacies must meet the program’s standards. These solutions enable us to guarantee payors single-digit year-over-year trend for anti-diabetic drugs.4
Support Through Connectivity
Eligible members can choose to enroll in the connected glucometer program. Enrolled members receive a connected meter, which captures their blood glucose readings and shares them in near-real time with certified diabetes educators. 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. We also utilize Epic, one of the largest electronic health records vendors in the industry, to help improve connectivity with health systems and providers.
Considerations for your business
- Have you adopted a comprehensive, integrated approach to managing diabetes in your member population?
- 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 a question about our Transform Diabetes Care programs?
1 Based on initial data with a large, self-insured employer plan, measured at the population level. Individual client results may vary.
2 Based on a model 100,000 life commercial client population. We estimate a medical cost savings may be achieved based on an anticipated A1C improvement target of on average 1 percentage point among uncontrolled population, however, medical cost savings are not guaranteed. Enterprise Evaluation and Population Health Analytics; October 2016 updated November 2017, Gilmer et al. Predictors of health care costs in adults with diabetes. Diab Care 2005;28:59-64. Fitch et al. Medical claim cost impact of improved diabetes control for Medicare and commercially insured patients with type 2 diabetes. J Manag Care Pharm 2013;19(8):609-20. Savings will vary based upon a variety of factors including things such as plan design, member demographics and other programs implemented by the plan.
3 Based on initial pilot data with a second large, self-insured employer plan, measured at the population level. Individual client results may vary.
4 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.