Transform Rheumatoid Arthritis Care

Helping payors and members address the unique cost and care challenges of a complex condition.

Transform Rheumatoid Arthritis Care is a comprehensive solution, powered by the CVS Health integrated pharmacy care model, that helps payors better manage costs and patient care for a costly, complex condition.

Integrated Cost Management

Rheumatoid arthritis (RA) accounted for nearly half of all specialty trend in the first half of 2017 and cost payors $9.39 per-member-per-month.* Transform RA Care expands indication-based formulary and outcomes-based contracts to autoimmune conditions to help control costs and deliver incremental value to clients. Combined with holistic patient care and existing, proven cost-control programs, our multi-pronged approach enable us to offer payors who implement all the components of the program a trend guarantee** for RA drugs.

Transform RA Care delivers savings through:

  • Value-Based Contracting
  • Indication-Based Formulary
  • Utilization Management
  • Managed Network

Value-based management strategies help deliver incremental value to clients through a more precise indication-based formulary for RA, and several outcomes-based contracts for autoimmune agents. Outcomes-based contracts focus on expected outcomes as an indicator of success. If the outcome is not achieved – for instance, a member discontinues therapy – the manufacturer will be required to provide additional value.

High-Touch, Personalized Support

RA is a complex, often progressive condition that can be hard to manage. Patients face many challenges including symptom management and side-effects. They may struggle to stay on therapy – potentially leading to non-adherence and disease progression. By providing personalized, whole-person care, Transform RA Care helps ensure a better patient experience and improved outcomes.

Patient-Focused Clinical Management

Members enrolled in Transform RA Care receive personalized care,  specific to their point in the health care journey, from AccordantCare Specialty. Pharmacists and specially-trained Accordant nurses in the RA Center of Excellence can help a member better manage their symptoms and comorbidities, connect them to social support, and offer coaching and education. When needed, proactive patient outreach helps improve engagement rates, and reduce gap days and condition-related complications, such as hospital and emergency room visits.

3.9% point increase in MPR for members supported by Accordant CareTeam nurses³

In addition to prescription information AccordantCare nurses, through the integration with Epic and its Care Everywhere, also have access to patient diagnosis, biometric and health data from any providers using a compatible electronic health record system, to support clinical decision-making.

A Better Patient Experience

Specialty Connect can help deliver up to an eight percent improvement in adherence by giving patients the option to obtain their medications through one of more than 9,700 CVS Pharmacy locations or have it delivered to their home or office, while still benefitting from our high-touch clinical support.4

With more than 70 percent of CVS Specialty patients signed up to receive electronic messages, we can also connect with members digitally.*** By utilizing technology innovations, including secure messaging, we can engage members wherever and whenever it is convenient for them. The partnership with MyHealthTeams, which offers myRAteam, a social network that connects RA patients, enables members to share their experience and learn more about managing their condition.

Considerations for your business
  • What is your RA trend?
  • Have you adopted a comprehensive, integrated approach to managing RA in your member population?
  • Could your plan save money by implementing a comprehensive RA management strategy?
Have a question about the Transform RA Care program?

Unless otherwise noted, all data is from CVS Health Enterprise Analytics. 

CVS Health is an investor in MyHealthTeams, and helps spread the word about MyHealthTeams to individuals who could benefit from joining the community. Individuals should review the MyHealthTeams’ Privacy Policy carefully to understand their rights when using the MyHealthTeams site.

Sources:
1. http://www.niams.nih.gov/health_info/osteoarthritis/osteoarthritis_ff.asp
2. https://www.rheumatoidarthritis.org/treatment/costs
3. CVS Health Enterprise Evaluation and Population Health Analytics, January, 2015 — February, 2016. MPR = Medication Possession Ratio
4. Internal Analysis of PBM patient adherence. Adherence metrics took into account patient eligibility and data was collected between 7/1/2016 to 6/30/2017.

* Trend measured as post-rebate per-member-per-month spending 
** Trend guarantee may not apply to all payors. Savings, trend changes and clinical results will vary by client depending on member demographics and other factors. Client-specific modeling available upon request.
*** CVS Specialty Digital data, 2017

†Where allowed by law. In-store pick up is currently not available in Oklahoma. Some states require first-fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Products are dispensed by CVS Specialty and certain services are only accessed by calling CVS Specialty directly. Certain specialty medication may not qualify. Services are also available at Long’s Drugs locations.