Pay Flex CEO Shines Light on Opportunity for Payers, Providers to Collaborate on Revenue Cycle

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When it comes to health care costs, many consumers feel left in the dark. In fact, the No. 1 reason people do not pay their health care bills is due to confusion over the often antiquated and clunky payment process.

At the HIMSS Annual Conference & Exhibition in Las Vegas this week, PayFlex CEO and President Erin Hatzikostas hosted a session, “Equipping Consumers To Be The Chief Financial Officer Of Their Own Health Care,” to discuss how providers and health plans can work together to engage consumers to better understand and manage their health care expenses. PayFlex is a part of the Aetna family.

With the rise of consumer directed health plans turning patients into larger financial stakeholders in their care, “Consumers are left woefully behind in getting the information they need,” said Hatzikostas.

Consumers cannot make informed choices about their elective health care if they do not know what it costs. Furthermore, even after patients receive care, they are often left in a thicket of mail from providers and their insurer, including Explanations of Benefits (EOBs) which may look like bills, bills from providers that look like EOBs, etc.

While this is confusing for the patient, it also negatively affects doctors who performed services with the promise of getting compensated quickly. Collections typically take 3-5 months to process and only 17 percent of bills are collected. This delay is not linked to an unwillingness or inability by the patient to pay – three-fourths of people are willing and/or able to pay for their health care costs – but a lack of understanding of the payment system and process. “The No. 1 reason is that people were confused,” said Hatzikostas.

As a complex issue, the health care payment crisis requires a complex solution. Convenience and consumerism are hard to balance and simple solutions will not work.

In 2014, PayFlex launched Money Square for Health to help equip consumers to be better financial stewards of their health care. After just three years, the service earned over 200,000 users, with many repeat users. Beta testing confirmed the huge opportunity in the ecosystem to engage consumers and, with the learnings from Money Square for Health, Aetna launched AetnaPay to further empower consumers to become the CFO of their health care finances.

There is still much work to be done in supporting consumers to own their health care finances, but progress is being made. As we continue to shine a light on the payment black box, it will be imperative for providers to collaborate with health plans on solutions and work together to share quality data and advance work flows.

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The School Employee Guidance Program: Meeting teachers where they are

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As one suburban school teacher put it: “The stress never ends.”

She was responding to a 2017 Aetna survey that proved she wasn’t alone. The findings showed school employees with a higher prevalence of depression, anxiety and turnover compared to other professions due to a variety of factors such as classroom behavioral issues, increased class sizes and the focus on standardized testing scores.

With more than 1 million public school employees as members, Aetna is addressing the unique needs of this group by launching The School Employee Guidance program, the latest in the company’s ongoing commitment to improve its members’ emotional, physical and mental health.

“A teacher’s workday doesn’t end when the last bell rings. With the School Employee Guidance Program, teachers can connect to support when and how they need us, so that when the first bell rings the next day, they have all the tools in their back pocket to do the job they were inspired to do,” said Brooke Wilson, head of Worklife Services, Aetna Resources for Living.

Many existing school programs have been created in response to a tragic event or crisis, but The School Employee Guidance Program is different because it uses a combination of proactive individual and onsite group training and counseling for student behavior-based conflicts. The program also includes workshops on relevant topics including:

  • Preventing burnout
  • Coping with anxiety
  • Managing challenging interactions
  • Handling stress
  • Addressing autism spectrum disorder (ASD) and ADHD

Additionally, school employees enrolled in the program have access to a 24/7 help line for clinician support, confidential self-assessments, online webinars and videos on stress management and ADHD, and more.

The program is the result of a 2017 research study  that Aetna conducted. The survey included teachers, professional staff and administrators nationwide from a cross-section of large and small districts in high and low communities to determine the top challenges in their industry. The research findings concluded that:

  • 80 percent of survey participants said managing class behavior for ADD and ADHD caused significant stress

  • 24 percent of survey participants expressed the need for an on-staff counselor, social worker or therapist

  • The average class size has almost doubled from 15.1 to 27.1 students over time

To learn more about the program, visit the Aetna Public Sector website or contact your Aetna representative.

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Personalized and protected: Health and wellness for the globally mobile

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The cover artwork of the "Personalized and Protected: Health and wellness for the globally mobile" report.

From vital signs to MRI results, and from wearable fitness trackers, genome sequencing to family history and more, health care consumers and their records are awash with data.

Accessing, analyzing and using that data can be difficult when the information is spread across disparate databases. What’s more, consumers who have been faced with countless data breaches in recent years are wary of who should have access to that data.

“More data has been created in the past two years than in all previous years combined,” says Aetna International Chief Information Officer Alan Payne. “Humans can’t comprehend this level of data, and this has driven innovations like cognitive computing and artificial intelligence.”

What are the potential solutions to ensure that consumers’ health and wellness benefit from all this health data?

In a new study, Aetna International examines the impact big data could have on the delivery of quality health care and explores some of the large and small ways that impact is already being felt.

Read more information here.

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Helping Increase Access to Health and Wellness Benefit Solutions

Helping Increase Access to Health and Wellness Benefit Solutions
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Health care continues to evolve at a rapid pace and with that has come new technological advancements and care models. This includes tools and programs to help patients manage a wide range of conditions, from insomnia to weight loss to solutions that provide disease management and medication adherence support.

To help increase access to these tools and solutions, CVS Health has introduced Vendor Benefit Management, a first-of-its-kind service that allows CVS Caremark pharmacy benefit management (PBM) clients to more easily and efficiently onboard and manage third-party vendors and make their solutions available to members.

Our Streamlined Service

Increasingly, employers are supplementing their standard benefit offerings with novel digital and non-digital health and wellness solutions. In 2018, the average employer offered 14 supplementary health care solutions from different sources, including health plans and third-party vendors.https://www.castlighthealth.com/press-releases/castlight-releases-first-of-its-kind-report-on-digital-health-in-the-workplace/

However, the process to onboard and manage disparate vendors can be complex, resource intensive and time-consuming. Vendor Benefit Management aims to make this process easier for our PBM clients.

Specifically, the new service enables:

  • A more streamlined process to onboard and manage multiple vendors
  • An easy way to access negotiated pricing and standardized verification of member eligibility in real time
  • Simplified and streamlined billing and payment processing
  • Standardized measurement and reporting across all vendors

Big Health’s Sleep Solution

Poor-quality sleep and insomnia affect nearly 30 percent of adults and can underlie or impact a wide variety of mental health conditions. Big Health, a digital therapeutics company, is the first participating Vendor Benefit Management vendor and Sleepio, its personalized digital sleep improvement program, is now available to PBM clients via the service. The program is based on Cognitive Behavioral Therapy (CBT), which helps individuals make the changes necessary to improve their sleep problems.

Moving forward, CVS Health will be actively working to identify and onboard additional vendors to participate in the new service. This may include solutions such as smoking cessation and substance abuse support, care management solutions, medication optimization and adherence, and tools that help members navigate their benefits.

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

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Health is the Real Win: Attain by Aetna, A New Step in Helping Consumers Transform Their Health, Now Available

Health is the Real Win: Attain by Aetna, A New Step in Helping Consumers Transform Their Health, Now Available
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This article was written by Alan Lotvin, M.D., Executive Vice President, Chief Transformation Officer for CVS Health.

Aetna medical members now have a new personalized way to encourage healthy actions every day and achieve better health. The Attain by AetnaSM app, the first-of-its-kind health experience designed in collaboration with Apple, is now available for download in the Apple App store.  

Attain  is unique because it’s built for people like you and me – not elite athletes, but people who could use a nudge every now and then to take simple actions each day to lead a healthier life. Health isn’t one size fits all, and Attain provides recommendations personalized for you.

The Attain program offers daily and weekly activity goals, and then rewards you when those goals are achieved. More than just steps taken, the app tracks other activities that improve overall health and are measured by the Apple Watch, such as getting more sleep, improving nutrition and being more mindful. In a little more than three months, almost 300 Attain users in our pilot burned more than 4.3 million calories! Additionally, the app uses your health history to create tailored notifications based on clinical guidelines that help you stay on top of key health moments such as refilling prescriptions, getting preventative vaccinations like the flu shot, scheduling annual primary care visits or finding lower-cost options for lab tests when needed.

Attain was built from the ground up to protect user privacy and data. Users consent to the use of their data in Attain with a very straightforward, plain-language consent process. Information collected and used in Attain will never be used for underwriting, premium or coverage decisions. Users who change their mind can stop participating and opt-out at any time.

Achieving your best health is important. CVS Health wants to make getting personal support in health care simpler, more affordable and convenient. With tailored app notifications combined with the technology of the Apple Watch, you can receive the support you need to more easily incorporate healthy actions into your everyday life. We are truly excited to be able to share Attain more broadly.  

Aetna medical members who would like to learn more can visit AttainbyAetna.com and download the app via the Apple App Store to confirm eligibility and rewards* that are available to you. 

Aetna is part of the CVS Health family of companies. 

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

*Not all members are eligible to earn an Apple Watch®. Download Attain and sign in to see which rewards are available to you.

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Clinical Secure Messaging Helps Improve Medication Adherence

Clinical Secure Messaging Helps Improve Medication Adherence
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Graph showing Medication adherence improved in both groups of patients who used secure messaging.
Medication adherence improved in both groups of patients who used secure messaging.
Graph showing more optimal medication adherence with secure messaging.
Optimal medication adherence improved for both groups of patients using secure messaging.
Graph showing a decrease in the first-fill drop-off rate for patients using secure messaging.
First-fill drop-off rate also decreased among patients using secure messaging.

Historically, people with complex conditions may receive telephonic or in-person support from a specially trained nurse or pharmacist with the goal of helping the patient better manage their condition(s), take their medication(s) as prescribed and improve their overall health outcomes. In this increasingly digital age, however, people are turning to technology for help with a range of things, including health care.

Recognizing this shift toward digital engagement, CVS Specialty is bringing patients innovative digital and online tools to help them better manage their conditions and access additional support online. This includes secure, two-way messaging that puts a nurse or pharmacist at the patients’ fingertips.

Powering this capability is a proprietary, company-built tool loaded with therapy- and indication-specific clinical information. Patients opt-in to receive personalized message alerts via their mobile phone asking if they are experiencing certain common medication side effects. The messages are based on clinical trial data, the drug’s label and feedback from other patients, and are timed to reach the patient when they are more likely to experience a specific side effect. The message also includes a link to enable the patient to ask the pharmacist a medication-related question.

Following the launch of this tool for patients with chronic myeloid leukemia (CML), initial results were promising, with high engagement rates and improved medication adherence, compared to more traditional support methods, including telephonic outreach.

Scaling to Other Specialty Conditions

With positive results in patients with CML, CVS Specialty quickly expanded use of this tool across all specialty conditions and recently conducted a retrospective analysis of specialty pharmacy claims and use of secure messaging in patients with rheumatoid arthritis (RA) and multiple sclerosis (MS).

These findings were recently presented at the Academy of Managed Care Pharmacy annual meeting and showed that patients with these complex conditions can also benefit from this type of digital support when compared to more traditional support methods. Specifically, patients who received the customized, secure clinical messages on topics including adherence, condition management or side effect management, every 30 days, were more likely to re-fill their prescription(s) and achieved significantly higher medication adherence than the control group. In fact, optimal adherence for patients in the study with either MS or RA receiving this digital clinical support improved by 3.82% and 2.12% points, respectively.

At CVS Specialty, the goal is to help patients on their path to better health by offering support where and when patients need it most. This data shows the promise of clinical support delivered digitally and, as part of a health care innovation company, CVS Specialty is committed to continuing to help more patients manage their diseases in a way that meets their individual needs.

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Pharmacies & Retail Health Clinics Lower Costs and Improve Outcomes

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What should communities have on their to-do list for 2018? According to a recent CVS Health survey, nearly 40 percent of Americans see access to care as the top health care priority to address locally. Already one of the most accessible points of care in many communities across the country, pharmacies offer a variety of convenient, affordable services close to home.

Quality, Affordable Care is Closer Than You May Realize

Eight out of 10 Americans live within 10 miles of a CVS pharmacy, and 62 percent of people report going to their local pharmacy at least once a month. With millions of Americans visiting these sites every day, pharmacies are well-positioned – and equipped – to support the health care needs of local patients.  

At CVS Health, our 30,000 pharmacists across the nation are trained to administer vaccinations, provide medication counseling, and deliver disease management support. What’s more, CVS Health has more than 1,100 MinuteClinic locations where patients can walk in without an appointment and receive care for acute and chronic health issues from nurse practitioners and physician assistants who specialize in family health care. MinuteClinic’s recently expanded health services provide easier access to immunizations, treatment for minor illnesses and injuries, travel health, skin conditions, women’s services, preventive health screenings and monitoring, and general wellness care.

Improving Health Outcomes and Reducing Systemic Costs

The preventive care services and chronic condition monitoring offered at retail pharmacies and health clinics help identify potential health concerns sooner and can prevent chronic conditions from worsening. One study found that increased use of preventive clinical services could avert the loss of more than two million life-years annually in the United States and save nearly $4 billion in personal health care spending.https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0701

Additionally, access to care at retail pharmacies not only benefits individuals and their families, but also the health system as a whole. By providing a lower-cost alternative to more expensive health care settings, such as emergency rooms (ERs), where visits have been on the rise at a significant cost to the health system,http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act pharmacy use can help communities cut costs while improving outcomes. In fact, it has been estimated that as many as 27 percent of ER visits could be treated at a lower-cost site like a retail health clinic, saving the health care system up to $4 billion annually.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412873/

From administering immunizations to providing medication counseling to delivering disease management support, pharmacies and retail health clinics play an important role in helping community members on their path to better health. 

For more information about CVS Health’s efforts to improve pharmacy care, visit our Health Care Delivery & Innovation information center and the CVS Health Impact Dashboard. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.

CVS Health MinuteClinic provider examining patient
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Managing Chronic Health Conditions Between Doctor Visits

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Chronic health conditions such as diabetes, heart conditions, and cancer affect half of all American adults.https://www.cdc.gov/chronicdisease/overview/index.htm What’s more, one in four Americans find themselves dealing with two or more of these diseases at a time. In between doctors’ visits, patients often face managing not only these health conditions but also the associated costs of treating them. Through our vast community touchpoints, CVS Health is uniquely positioned to help patients manage their chronic conditions, improving health outcomes and reducing costs.  

Challenges Managing Chronic Disease

Americans are often prescribed medications, such as beta-blockers or insulin therapy, to manage their chronic conditions, but it can be difficult to manage prescriptions to ensure they are taken as prescribed. According to a recent CVS Health poll, people reported that sticking to a dosing schedule, managing prescription refills, and understanding drug interactions are among the most difficult tasks associated with managing their medications. And these challenges become even more unwieldy when patients have to manage multiple prescriptions at a time.

In addition to medication, regular screenings and monitoring help Americans stay on top of what they need to do to avert or manage their chronic conditions. Routine screening and other preventive services have been effective in detecting and treating various risk factors for chronic diseases. However, only 25 percent of adults aged 50 to 64 years are up to date on preventive screenings and services, and that number increases to 50 percent among adults aged 65 or older.https://www.cdc.gov/aging/services/index.htm

Pharmacists and Retail Health Clinics Can Help Connect People to Needed Chronic Disease Management Support

Availability of preventive and disease management services through locally accessible care sites, like CVS Pharmacy and MinuteClinic, can help connect people to potentially life-saving care. CVS Health's pharmacists are trained to provide medication counseling and medication therapy management to help patients stay on track with their prescriptions.

In addition, MinuteClinic nurse practitioners and physician assistants are on call to provide key screenings and monitoring for conditions such as diabetes and rheumatoid arthritis as part of CVS Health’s Transform Care programs, which provide condition-specific and personalized care to those who need it. This type of specialized care extends into individuals’ homes with services like Coram, through which home infusion nurses and pharmacists provide tailored care either at patients’ homes or at outpatient infusion sites to patients dealing with a variety of acute and chronic conditions.

And regardless of location, CVS Health offers a suite of digital pharmacy tools, and other innovative programs for CVS Health customers and CVS Caremark clients to help individuals better manage their chronic conditions by addressing barriers to medication adherence. The recently launched ScriptPath Prescription Schedule tool – just one example – helps patients keep track of and manage their multiple prescriptions with easy to understand icons and the creation of a simplified personalized prescription schedule.

For more information about CVS Health’s efforts to improve the quality, outcomes and affordability of chronic disease care, visit our Chronic Disease information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

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Improving Integration across Care Settings through Technology

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Health leaders rank care coordination as one of the biggest challenges to address in order to improve population health,https://www.qualityforum.org/Setting_Priorities/Improving_Healthcare_Quality.aspx underscoring the importance of arming providers with the right tools and technologies to deliver highly-personalized care solutions to patients.

By coupling the expertise of a pharmacy innovation company and a health plan, we are well-equipped to help providers address unmet needs in patients care. CVS Health and Aetna are expanding the use of technology and data to help complement providers’ holistic view of their patients’ health. Through our combined assets, we have the ability to improve connectivity among patients’ primary care providers to ensure high-quality care and continuity across care settings. This will, in turn, allow us to improve population health across the U.S.

Complementing Primary Care

One in three Americans views access to quality care as the most important health priority in their community. That’s why we are looking to narrow the distance between patients and their caregiving facility by leveraging digital data and making health care accessible in community locations. As a first step, we will be focused on staying in touch with the primary care doctor and integrating the care of the patient in a complementary way.

A combined company with our end-to-end capabilities enables better communication technology between the primary care provider, pharmacy and patient.

“We want to make health care easier to use by better connecting people,” says Dr. Alan Lotvin, Executive Vice President of Transformation at CVS Health.  “We are empowering the consumer to take a more active role in their health care by providing them with convenient tools and services that are seamlessly integrated within the overall health care ecosystem.”

For example, a connected glucometer could help monitor a patient's blood sugar and send an alert to a CVS Health provider for intervention if a patient's levels are too high. Between regular doctor visits, a patient with a chronic condition such as diabetes or hypertension could see a MinuteClinic provider for a series of tests to help understand how their medications are working, make adjustments to their therapeutic regimen, and receive tailored counseling on adherence and lifestyle management. In addition, telemedicine can also help fill the gaps between in-person visits to a local CVS Pharmacy or primary care provider. All information gathered during these visits could be captured and shared with their primary care provider and care team to help ensure connected care. This high-touch, integrated model could also be used to help patients transition from a hospital stay back to their home in order to help prevent unnecessary, costly emergency room visits or hospital readmissions.

Improving Population Health

Today, just five percent of the U.S. population is driving approximately 50 percent of total health care spending at more than $50,000 per patient annually. Many of these patients have common chronic diseases which, when unmanaged, can result in costly and sometimes debilitating medical complications.

Dr. Troyen Brennan, Executive Vice President and Chief Medical Officer at CVS Health, believes that reaching the dual goal of helping Americans achieve better health and reducing costs requires a combination of digital health tools and face-to-face interactions. According to Brennan, combining CVS Health’s community presence with Aetna’s data will help ensure that patients are receiving the right care and managing their conditions efficiently.

“We can take the local ability to interact with patients, and combine it with the ability to understand population management based on the data that comes with an insurance company,” says Brennan. “We want to take the programs that Aetna has been running and utilize them to improve interactions between patients and providers in our stores – allowing our pharmacists, nurse practitioners and people who are informed about benefits to counsel patients and make sure they’re doing the right thing for their health.”

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Improving Health Care Delivery and Fostering Innovation

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Our country faces significant rises in health spending and increasing rates of chronic disease, but our health care system is rising to the challenge and developing some of the most innovative solutions in the world. At CVS Health, we’re leveraging multiple touchpoints with patients, payors and providers to help build a more efficient and effective way of delivering health care.

Challenges and Opportunities in the Current Health Care System

With chronic disease on the rise, health care costs continue to grow. Nearly half of American adults suffer from one or more chronic diseases such as diabetes, hypertension, and cardiovascular disease. By 2030, it is estimated that the cumulative cost of chronic disease care will reach $42 trillion.

In addition to being common and costly, chronic diseases are also often preventable. Nearly half of American adults have at least one of three risk factors for heart disease or stroke and as of 2015, 15 percent of American adults were current smokers.

But there are opportunities to prevent and better manage chronic disease. Pharmacy-led solutions to improve medication adherence and advance care coordination can save money and improve outcomes. In fact, nearly $300 billion and tens of thousands of lives can be saved each year by helping Americans take their medications as prescribed. An additional $25-$45 billion could be saved each year through care coordination and management of care transitions.

Infographic: CVS Health is Improving Health Care Delivery and Fostering Innovation

Expanding Quality and Access

Our deep bench of clinical expertise includes nearly 36,000 pharmacists, nurses, nurse practitioners and physician assistants who provide direct-to-patient services through a wide array of CVS Health offerings. This allows us to expand access to quality, affordable care for families across the country, and creates strong relationships between patients, payors and providers.

We do this in a number of ways:

Forging Strong Connections

Our unique care model enables us to actively engage in partnerships with other major stakeholders to improve care coordination and reduce costs. For instance, we have established clinical collaborations with 70 major health systems to support joint clinical programs and electronic health record integration. And as part of the “medical neighborhood,” CVS Health is proud to help connect patients to medical homes and support a more coordinated and efficient health care system.

For more information about CVS Health’s efforts to improve pharmacy care, visit our Health Care Innovation & Delivery information center. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.

CVS Health is working to improve health care delivery and foster innovation.
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