How interoperability achieves cost savings in specialty pharmacy 

A group of healthcare providers use a tablet and a computer to look up patient data.

Lucille Accetta, Executive Vice President of Specialty Pharmacy and Product Innovation

The pandemic has shown firsthand the important role digital connectivity can play in managing complicated health challenges. It required complex navigation of our often fragmented health care system, managing differing state and local eligibility guidelines, multiple vaccine types, and patient vaccination status. Using tools like electronic health records (EHRs) we supported the largest vaccine rollout in history, administering nearly 50 million COVID-19 vaccines. Interconnectivity continues to play an important role in tracking second doses and boosters.

Improving efficiency in specialty care

The same connected capabilities can help CVS Specialty members on their medications faster, and stay more adherent. Today, we can see EHRs for almost 70 percent of our specialty patients and approximately 30 percent of specialty prior authorization requests are submitted with the diagnosis and treatment information in them, without needing additional provider outreach. https://payorsolutions.cvshealth.com/insights/enduring-cost-savings-clinically-sound-therapy-decisions This means patients can get the most appropriate medication quickly, avoiding unnecessary costs. It also helps shorten the specialty pharmacy onboarding process to as little as three days.

The impact of interoperability can also be seen in the infusion services provided by Coram. In the past, when a doctor ordered an infusion, it was printed and faxed — requiring the infusion provider to call the doctor’s office or hospital to get the health history necessary to provide treatment. As a result, the infusion care that the patient received remained siloed from the patient’s other providers. With Coram, when a doctor orders an infusion treatment all the relevant information can be obtained from the patient’s EHR along with the order, from medical history to comorbidities. By connecting this information in real-time, we can improve efficiency, reduce errors and lower costs. And the treatment information is added to the EHR so their entire care team can access it.

Proactive engagement in care management

Patients who are not adherent to their treatment regimens have a higher risk of acute clinical events such as hospital admissions and ER visits. In fact, such episodes are comment among those with rare or complex conditions, with one in three visiting the ER annually. And a single ER visit can cost an average of $1,900. Specially trained CareTeam nurses can use EHR information to identify, prevent and address gaps in care. This helps patients manage side effects, navigate the health system and benefits, address overall emotional and physical health, and identify additional support needs such as financial resources, support groups or ride programs. If a member is hospitalized, the care team can also support their transition and ongoing care once they are discharged. 

The impact of interoperability has been significant for providers, payors and patients alike and we continue to make investments in its future applications. We’re working to create a clinical data repository that is a central resource to make evidence-based information and medical histories accessible to care providers across our entire enterprise. This can break down both internal and external silos across the health care system by integrating with other providers. Our goal is to create more efficiency, ensuring our members receive high-quality care while managing costs for the long term.

12.14.21