Chronic care

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For those with chronic and complex conditions, we’re with you every step of the way, so that you can better manage your day-to-day symptoms and, ultimately, lead a healthier life.

Latest on chronic care

Healthy Conversations, Episode 4: Diabetes

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Welcome to Healthy Conversations, an open discussion among healthcare professionals about the latest innovations, what we’re learning on the front lines of the healthcare industry, and how it’s changing in real-time. So much of our attention has been focused on the pandemic, but chronic illness continues to compound the effects of COVID-19.

In this episode, we’ll focus on one of America’s most widespread chronic diseases: diabetes. November is American Diabetes Month, and we spoke with the CEO of the American Diabetes Association, Tracey Brown, about her own experience and how her organization is working to transform diabetes care. You can hear Tracey’s extended interview in the podcast episode below.

We also connected with Dr. Kenneth Snow about innovative technologies like CGM (continuous glucose monitors), early detection, and the fine line between giving patients more autonomy and the risk of overwhelming them. Lastly, we’ll hear from Rebecca Rice, pharmacist and educator, about the evolving role she plays in the life of chronic care patients via the unique HealthHub model.

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Tune in to Healthy Conversations wherever you listen to all your favorite podcasts.

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Healthy Conversations
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Understanding health disparities in diabetes to improve health

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There are more than 34 million Americans living with diabetes, a disease that costs the U.S. more than $327 billion per year. However, the disease does not affect all segments of the population equally.

“We have long known that health disparities exist among different populations based on social determinants of health (SDoH), such as demographics, race, ethnicity and other factors,” explained Sree Chaguturu, Chief Medical Officer, CVS Caremark. “In recent years, it has become clearer that significant disparities also exist in access to health care and outcomes for diabetes.”

Diabetes disease burden varies by community

Diabetes prevalence varies and research has shown that it affects minority communities disproportionately. American Indian or Alaska Native adults have the highest rate of diagnosed diabetes. The risk of being diagnosed with diabetes is 77 percent higher among African Americans and 66 percent higher among Latinos/Hispanics, according to the Centers for Disease Control and Prevention. Non-White Hispanics tend to be diagnosed with diabetes at younger ages and exhibit higher fasting glucose levels, decreased insulin sensitivity, increased insulin response, and more severe forms of diabetes complications.

Social factors such as education, employment insecurity, poverty, and access to nutritious food also all have a profound impact. Poverty has been shown to be a leading cause of type 2 diabetes. In fact, living in poverty can double or even triple the risk of developing diabetes and many minority groups are disproportionately affected by poverty. Among African Americans, the poverty rate is 21.2 percent and 17.2 percent among Hispanics, compared to 9 percent among non-Hispanic Whites.

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24%

Is the percentage of people living in poverty during the two years prior to diagnosis that resulted in an increased risk of type 2 diabetes

26%

Is the percentage of people living in poverty at any time prior to diagnosis that resulted in an increased risk of type 2 diabetes

Drivers of disparities in diabetes care

For people with diabetes, improving outcomes requires effective management. Here too, racial and ethnic disparities can be barriers to effective disease management.

  • Affordability:  ability for members to pay for their medications

  • Awareness: knowledge of treatment options, healthcare system, and value of adherence

  • Accessibility: proximity to and convenience of care and treatment through available channels.

  • Trust: level of comfort and confidence patients have in healthcare channels available to them

Approaches to addressing disparities in diabetes care

It is difficult to overemphasize the importance of addressing the social determinants of diabetes given their profound impact on morbidity and mortality. What’s more concerning is that many of these disparities appear to only get worse year after year. Clearly, addressing these disparities will help control rising health care costs.

“Addressing the disparities resulting from social determinants will take a large-scale effort by many stakeholders,” stated Sree. “Health care companies like CVS Health can play a crucial role by using their capabilities and nationwide presence for community-based health literacy programs, building a diverse and inclusive workforce that can serve the needs of all patients, and developing patient-centered quality improvement initiatives in areas of clinical vulnerability and disparities, such as diabetes and other chronic medical conditions.”

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Project Health makes minding health affordable

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For Janai Derrick, staying healthy during the pandemic is essential to her dual role as a mother and a caregiver. Because her daughter has multiple health issues and developmental disabilities, Derrick needs to be vigilant in protecting her own health.

“One of my children is special needs and I'd like to be around as long as possible for her,” she says.

Derrick also has a family history of chronic conditions like diabetes and high blood pressure, which may increase the risk of severe illness from COVID-19.

“I just want to stay ahead of that and not turn out like the rest of my family,” she says. “I have regular doctor visits, but I fully believe in checking on my health, even between appointments.”

So, when Derrick stepped off her bus and saw signs advertising free health screenings outside her CVS Pharmacy in Johnston, Rhode Island, she decided to check out the event.

Project Health events provide free health screenings in multicultural communities nationwide with large populations of uninsured residents. They include blood pressure, body mass index (BMI), glucose and cholesterol screenings to detect early risks of chronic conditions.

“At the heart of our purpose of helping people on their path to better health is our commitment to breaking down the barriers for people to access quality and affordable health care,” says Eileen Howard Boone, Senior VP Corporate Social Responsibility & Philanthropy.

This year’s events are funded through a $600 million investment over five years to address health disparities in disenfranchised communities. Access to screenings significantly impacts health outcomes – including COVID-19 infections and deaths – says Boone.

“COVID-19 is one of many examples of health issues that disproportionately impact communities of color more frequently than other racial and ethnic groups,” she adds.

Kristiana Giannini, a pharmacist in Johnston, says the events provide an important alternative source of care.

“As a pharmacist, we tend to be one of the most accessible health care providers,” she says.

CVS Pharmacist Kristiana Giannini seated at a table with Janai discussing her test results.
CVS Pharmacist Kristiana Giannini advises Janai on her test results

At the event, Derrick learned that her blood pressure was high, even though she is currently on medication. She plans to check in with her doctor.

“The pandemic has opened up a whole new world of what life looks like for us and what we have to be careful of,” she says. “It only made me more diligent about wanting to check my health.”

Learn more about Project Health including locations for free screenings, at cvs.com/projecthealth.

Since 2006, Project Health has delivered more than $133 million in free health services to over 1 million Americans in underserved communities.

In 2019 alone, participants received:

  • 215,000 biometric screenings

  • 2,113 counseling sessions for smoking cessation

  • 2,672 referrals for flu shots

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Heart At Work: Helen Volf

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During the early months of COVID-19, Karen, a Type 1 diabetic patient called her CVS Pharmacy in tears, afraid she couldn’t get her life-saving insulin. Pharmacist Helen Volf diligently went to work to resolve the issue. Months later when Helen and Karen finally met there were tears again, but this time, tears of gratitude. Watch the video. 

Thank you, Helen. Your concern and follow-through for your patient provided relief when it was desperately needed. #CVSHeartAtWork  

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Reimagining diabetes treatment

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Managing diabetes can be complex. Achieving and maintaining one’s best health for this chronic condition, which causes higher than normal blood sugar levels, depends on a person’s ability to monitor symptoms, manage complicated medication regimens, control blood glucose and practice healthy behaviors.

“There are 50 different things — or maybe more — that a person with diabetes could be doing at any time to best manage their condition,” says Stella Wong, Senior Director for Product Development at CVS Health. “It's overwhelming.”
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In the U.S., more than 34 million people live with diabetes and deal with these challenges, according to the Diabetes Research Institute Foundation. And only about 23 percent of people with Diabetes have it under control, says Peter Simmons, RPh, Vice President of Chronic Care Optimization. “Given the array of solutions available, that's a shame. We feel like we can do better.”

To do that, CVS Health created a proactive, integrated and holistic plan that reimagines diabetes treatment for its members. The goal is to reduce the complexity of self-management and improve health outcomes for plan members with diabetes — while preventing its onset.

Available with Caremark and Aetna benefit plans, the Transform Diabetes Care program uses CVS Health data insights and analytics to create personalized care plans for individuals across five clinical areas. The plan can be communicated through local CVS pharmacists and HealthHUB® professionals, digitally and virtually. Members are provided myriad tools to support their personalized care plan.

Peter Simmons, Vice President of Chronic Care Optimization for CVS Health.
“We always seek to be consumer-centric, consider how to deliver care locally and make care as simple as possible for customers and patients,” says Peter Simon, CVS Health’s VP Chronic Care Optimization.

The data also allows CVS Health to identify gaps in care and respond to patient needs before they arise. This proactive approach sets it apart from most other treatment plans, says Kyle Smith, head of CVS Health Transformation Marketing. “I think that's the most compelling thing about the work that we're doing.”

The program also utilizes a Pharmacist Panel to help patients stick to their plans, says Pharmacy Services Market Support Coach Rebecca Rice. “Pharmacists continue the conversation with their patients about their health while building trust and rapport,” she says.

“We think about our purpose every day: how we can help people on their path to better health,” Simmons says. “We always seek to be consumer-centric, consider how to deliver care locally and make care as simple as possible for customers and patients, especially those managing chronic conditions such as diabetes.”

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Addressing out-of-pocket costs for diabetes patients

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Rising costs are a burden for too many people living with diabetes today. Patients with a high-deductible health plan shoulder all of their medication costs while in the deductible phase of their insurance, which means they may be forced to make difficult decisions about whether they can afford their medications and fill their prescription.

Recent data reveal there is uncertainty on how to manage and predict the out-of-pocket costs associated with diabetes management. For example, nearly one-third of patients (32 percent) do not feel they have the resources needed to manage their own out-of-pocket costs. To address this challenge, CVS Health is working to eliminate member cost as a barrier to medication adherence.

Improving medication affordability and adherence

Improving diabetes outcomes while reducing costs is a priority for CVS Health. We recently launched RxZERO to enable employers and health plan sponsors to leverage formulary and plan design approaches to offer all categories of diabetes medications at zero dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members. The new plan design enables plan sponsors to eliminate member out of-pocket costs for the entire diabetes therapeutic area — including oral medications for Type 2 diabetes — and fully adhere to American Diabetes Association standards.

“Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the five percent of people with diabetes who are living with type 1 diabetes. However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications — improving affordability for the 95 percent of people with diabetes who are living with type 2 diabetes.”

— Troyen A. Brennan, M.D., M.P.H., is Executive Vice President and Chief Medical Officer of CVS Health

CVS Caremark analysis shows that members taking branded diabetes medications spend on average, $467.24 out-of-pocket per year, with nearly 12 percent spending over $1,000 annually.

A comprehensive approach to diabetes management

A person living with diabetes is required to take many tasks to manage their therapy annually. To make disease management affordable, accessible and local, CVS Health offers numerous programs to help people with diabetes effectively manage their condition and stay on track with their prescribed treatment plan.

We provide supportive care at our HealthHUB locations to complement the care that patients receive from their primary care physicians. Our HealthHUB model provides a first-of-its-kind community-based store that offers a broader range of health services, new product categories, digital and on-demand health tools and trusted advice. In these locations, people living with diabetes are able to receive the coordinated care and services they need all within our own four walls.

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NAFC grant spotlight: Broad Street Clinic

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CVS Health Foundation has partnered with the National Association of Free & Charitable Clinics (NAFC) on a multi-year program, awarding grants to increase access to care, improve health outcomes and lower overall health-care costs across the country.

Among the 2019 NAFC grant recipients is the Broad Street Clinic, a North Carolina-based clinic that was founded in 1993 by a group of local physicians and is dedicated to providing care to the uninsured and low-income members of its Morehead City community.

The Communities Served by the Broad Street Clinic

Broad Street Clinic (BSC) serves Carteret County and the surrounding areas. Currently, BSC serves 850 patients with about 3,000 visits annually for adult primary and specialty care. The majority of BSC patients are employed by the local commercial fishing, hospitality and tourism industries.

Community-Focused Chronic Disease Care

BSC provides free medical and pharmaceutical services to uninsured and underinsured, low income people with certain chronic illnesses, including diabetes, hypertension, thyroid disease, pulmonary and cardiovascular disease, and hepatitis C. BSC also provides gynecological and limited dental and vision services.

How the CVS Health Foundation Grant is Helping

BSC has been using the CVS Health Foundation grant to provide health coaching for diabetic patients. By learning to use the clinic’s electronic health records reporting, clinic providers have been able to target patients with diabetes and then further check A1C levels and last testing dates.

Since receiving the CVS Health Foundation grant, Broad Street Clinic has held two diabetes workshops. Participants have gotten to know one another and are sharing personal tips and tricks for managing their condition.
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These patients are encouraged to attend diabetic workshops held at the clinic to learn more about the disease and how to manage it. Clinic nurses and diabetic educators work with patients to teach them about healthy lifestyle changes and to develop their individual self-care plans.

A Group Effort to Better Manage Diabetes

Since receiving the CVS Health Foundation grant, BSC has held two diabetes workshops, with plans for more in the works. At each, participants got to know one another and share personal tips and tricks for managing their condition. They also filled out self-management goal worksheets, which they placed in self-addressed envelope to be mailed a month later so that they can check their own progress.

In addition, each participant received a pair of support stockings to help with leg and foot circulation and reduce swelling, a common symptom of diabetes. One woman, a cashier, called the clinic to report that the stockings helped her to feel more comfortable while on her feet all day.

To stay up-to-date on the latest CVS Health Social Responsibility news and content, sign up for email news alerts.

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Taking control of diabetes with HealthHUB

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HealthHUB, our first-of-its-kind concept store now open in select locations nationwide, connects patients with health care services, advice and personalized care right at their neighborhood CVS Pharmacy. 

This ease of accessibility was what prompted Luis to stop by his local HealthHUB to see someone about abdominal pain he was experiencing.

What he and the nurse practitioner discovered was that the issues he was having went beyond simple pain: He was diabetic, but wasn’t currently being treated for the condition. Within his 40-minute visit, the HealthHUB team set Luis up to meet with both an eye doctor and a dietician and he left with a treatment and management plan in place.

Watch the video to learn more about how Luis’s trip to his local HealthHUB got him back on track.

To learn more about our enterprise-wide approach to diabetes management and care, visit our Managing Diabetes with CVS Health page.

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For diabetes patients, a Care Coach is just a click away

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CVS Health pharmacist Matthew Scarnecchia could see the concern on the face of his patient. Richard, a 59-year-old man who suffered not only from Type 2 diabetes but also high blood pressure and high cholesterol, was alarmed by the results of his latest blood-sugar test. His A1c was 7.5 percent — above his goal range of below 7 percent.

With a few questions, Scarnecchia learned that Richard was worried about also getting low blood sugar from his diabetes medication. It turned out that Richard was taking his diabetes medication in the morning, but not eating until he was at his workplace after a long commute. “I recommended that he take his Glipizide with his breakfast at work to see if that would help,” Scarnecchia says. It did. Just a few months later, Richard’s A1c had dropped to 6.3 percent and he was no longer having low blood sugar readings.

Nearly as satisfying, this one-on-one consult took place without either man leaving his desk, even though they were 2,000 miles apart – one in Arizona, one in Florida. Through his insurance provider, the patient had signed on to CVS Health’s Medication Therapy Management program and met with Scarnecchia face-to-face via an online app that can be accessed through any computer or mobile device.

Personal Consultations from Anywhere

Once enrolled in the program, patients can slot in a video consultation from anywhere. In addition to their regular doctor’s appointments, they can talk with a specialized pharmacist who can advise on medication compliance, interactions and side effects, and, most importantly, suggest some everyday adjustments, such as diet and exercise, that can make an immense difference in controlling diabetes.

CVS Health’s Medication Therapy Management program provides patients with one-on-one care with a specialized pharmacist who can help them better manage their chronic condition from the comfort of home.
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A video meeting benefits patients and pharmacists alike. A patient can show his or her latest blood-sugar results or other medical reports without needing to mail them. If a patient is having issues injecting insulin, the pharmacist can point to possible alternative injection sites on a visual model. The one-on-one view also allows pharmacists to pick up on nonverbal cues. “I can see if a patient seems confused about their results and give explanations that might be helpful,” says Scarnecchia.

Patients can take advantage of this face-to-face coaching even before they might need medication. With diabetes tied to so many other health concerns — high blood pressure, nerve damage, heart disease — it’s especially vital to try to halt or slow down the condition’s progress.

Small Changes Can Make a Big Difference

When an A1c of 5.8 percent tipped him into the prediabetic range, 60-year-old Jeff welcomed the chance for video chats with pharmacist Brian O’Halloran, and has kept those appointments every three to four months. “During our visits, we’ve discussed healthy lifestyle changes,” says O’Halloran. “Jeff decided to stop drinking diet sodas, and reported, nine months later, that he’d stayed off them.” 

Small but attainable goals are easier to meet, explains O’Halloran.

“In March 2018, Jeff said he wanted to lose 5 pounds before his next time we talked. I told him ‘Don’t shop the aisles.’ That’s where grocery stores stock all the processed foods. Instead, I suggested he shop the perimeter — where he could pick up fresh vegetables and meats. When we spoke again in July, he’d lost 6 pounds.”

Both pharmacists find that patients look forward to the on-screen sessions, which often last for 30 minutes. Even a patient’s family member may stop by to wave hello, says Scarnecchia. Patients can also contact the pharmacist in between scheduled sessions. When a patient shares good news about improved bloodwork, O’Halloran warmly congratulates them on their success.

For diabetes patients, a video visit is part of the “big picture” of managing of their condition. Patients can ask questions that may not have occurred to them while in their doctor’s office. “It’s more like a conversation,” says O’Halloran, “and more comfortable for the patients.”

To learn more about our enterprise-wide approach to diabetes management and care, visit our Managing Diabetes with CVS Health page.

To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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