Making a difference in the lives of CVS Pharmacy customers

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For CVS Pharmacy Training Store Manager Pablo Heredia, putting his store colleagues and customers first is a natural extension of the commitment he has for his family.

“I tell my team, ‘Most of our patients are people that you don’t know what they’re dealing with, you don’t know the pain they have,’” Heredia explains.

That empathetic perspective helped Heredia earn a 2019 Paragon Award, which recognizes the best-of-the-best among CVS Health colleagues who deliver direct care to patients and customers. Now in its 29th year, the Paragon Awards honor colleagues who embody the core values of CVS Health.

Whether it’s making sure every pharmacy patient knows about the Rx Savings Finder, or training to become a pharmacy technician, Heredia is dedicated to making sure that every customer gets the best care possible when they walk into his San Diego, California, store, and inspires his team to do the same.

Watch above to learn more about what motivates Heredia daily to make a difference in the lives of his store customers.

A photo of Pablo Heredia.
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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.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. 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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Using data to drive value to our members

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From opioid misuse, gene therapy and chronic care management to end-of-life issues and hospital acquired infections, our Clinical Insights and Analytics (CIA) team is using member data and medical knowledge to make an impact on the lives of the people we serve and set them on a path to better health.

CVS Health’s Clinical Insights and Analytics (CIA) team is using member data and medical knowledge to make an impact on the lives of the people we serve and set them on a path to better health.
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“We are a clinical think tank,” says CIA team member Rebecca Smith, a senior program manager. “We have the clinicians, the project management, the operational expertise and the data analysis all in one place, all working cohesively.

“We're all working towards the same goal, which is to drive better value of care for our members.”

Watch the video above to learn more.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. 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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Fighting Pneumonia With a Toothbrush: New Program Is Yielding Results

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A woman smiling with a toothbrush in front of her mouth.

A first-of-its-kind CVS Health initiative to combat hospital-acquired pneumonia through better oral health is improving outcomes and receiving rave reviews from patients. Launched earlier this year, the Rush to Brush program has supported more than 10,000 Aetna members undergoing surgery with kits containing high-quality oral care products, education and a personalized ‘get well soon’ card.

“The program has allowed us to offer members a simple health care solution right at their fingertips,” said Daniel Knecht, M.D., Vice President of Health Strategy and Innovation for CVS Health. “It also shows the power of bringing key industry stakeholders together to solve a problem unearthed by member data.” 

Leveraging the information contained within surgery pre-certifications, the kits arrive in-home to members approximately one week before their scheduled hospital admission. The effort is designed to help reduce the incidence of pneumonia, the number one hospital-acquired infection and one of the most life-threatening illnesses patients can contract. 

Oral care is critically important in the post-operative setting because the mouth is filled with bacteria. “We want to shift the paradigm around oral health in hospitals. It’s actually more important to take care of your teeth and mouth when you go in for surgery, not less,” said Mary Lee Conicella, DMD, Aetna’s Chief Dental Officer. One study found disease-causing bacteria—especially those linked to pneumonia—present in 90 percent of patients within 72 hours of being admitted to the hospital. Those bacteria don’t just stay in the mouth, however; they are often inadvertently inhaled into the lungs.https://www.aha.org/2018-03-29-what-your-hospital-doing-about-1-hospital-acquired-infectionhttps://msphere.asm.org/content/1/4/e00199-16https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4414413https://aricjournal.biomedcentral.com/track/pdf/10.1186/s13756-016-0150-3

Brushing one’s teeth greatly reduces the population of bacteria in the mouth, according to nurse-researcher Dian Baker, Ph.D., professor at California State University, Sacramento. “When patients brush their teeth, they’re basically taking their bacterial count from hundreds of millions down to just a few, and this greatly reduces their risk of pneumonia.”

Dr. Baker’s research inspired the Rush to Brush program, which is paying dividends in terms of clinical results, member satisfaction and reduced health care costs. Early results demonstrate decreases in the incidence of pneumonia among members who received the Rush to Brush kit when compared to those who did not.Data based on early observations of pneumonia claims within 90 days of procedure, not yet statistically significant. Additionally, estimates project that the program will yield substantial savings in avoidable medical costs across Aetna’s commercial and Medicare business.

A note from a patient who took part in the Rush to Brush program.
A note from a patient who took part in the Rush to Brush program.

And members love it. Seventy percent took the kit with them to the hospital, and 95 percent have expressed positive feelings toward the program and Aetna. Members who received the kit have been effusive, saying the initiative “shows that Aetna is caring and considerate” and that “the fact that Aetna took a vested interested in my recovery meant so much.” One member noted that the kit “took the guesswork out. All items were needed, all items were used – this was better than flowers!”

In addition to collaborating with Dr. Baker, Aetna worked with plan sponsor Johnson & Johnson as well as Colgate-Palmolive and IntelliDent to outfit the kits with Colgate Total toothpaste, a soft-bristled toothbrush, Listerine Zero mouthwash, disposable toothbrush shields and tips on good oral health.

The program illustrates CVS Health’s and Aetna’s unique ability to use clinical and member data insights to unlock members’ health care needs, allowing us to bring together the resources to meet our members on their road to recovery and better health.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. 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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New Aetna Enhanced Medical Bundles Provides Cash Benefits to Members Following Unexpected Health Events

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Most employers know that medical plans are a benefit that they are expected to offer to their employees. That’s the easy part. The difficult aspect is that medical plans come in many shapes and sizes, don’t always cover everything and those with high deductibles can leave employees with financial stress.

“Employers and their benefits advisers often face pressure to develop packages that deliver attractive, cost-effective options to a workforce with diverse needs,” said Randy Finn, Senior Director, Voluntary Business, Aetna. “Bundling a medical plan with a supplemental plan is a helpful solution that can deliver both administrative and cost efficiencies to employers, including savings on premiums and fees, while also enriching the benefits package they can offer their employees.”

In 2019, Aetna introduced the Aetna Enhanced Medical Bundle℠, which combines an Aetna medical plan with one or more of its supplemental plans. The Aetna supplemental plans pay cash benefits directly to members, which they can use to help cover medical plan expenses, like their deductible, or even everyday costs like childcare, rent and groceries. They also help ensure members can financially weather unexpected health events.

An Aetna Enhanced Medical Bundle can include one, two or all of three of the supplemental plans, which are:

  • Aetna Accident Plan: Cash payments for common services related to an accident, like a broken ankle.

  • Aetna Critical Illness Plan: Cash payments for expenses faced during a serious illness like cancer, stroke or heart attack.

  • Aetna Hospital Indemnity Plan: Cash payments for out-of-pocket costs associated with a planned or unplanned covered inpatient stay.

On top of cash benefits, bundled plans provide additional benefits to members. They can manage their medical and supplemental benefits through a single website, and Aetna leverages the medical claim so employees don’t have to submit additional paperwork to get their supplemental claim paid.

Through one or more supplemental plans, members gain a cost-effective means to minimize out-of-pocket medical expenses and protect themselves from a potentially financially devastating medical event.

“Whether its related to a high-deductible health plan or another medical plan, the supplemental plans under the Aetna Enhanced Medical Bundle can give members confidence that they have a safety net in the event of a health care need and the ease of an all-in-one process to manage their benefits,” said Pat McGinn, National Vice President of Sales, Aetna.

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How we make coverage decisions

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Whenever we tell members that a requested treatment is not covered, they want to know – how could we deny a procedure that their doctor believes could improve their quality of life? Our answer is based on scientific data – or lack thereof – and our responsibility to put member safety first.

It is never easy to tell an individual or family that a treatment or procedure is not approved – it’s the hardest thing we have to do. However, our guiding principles will continue to be proven effectiveness and member safety, as determined by rigorous scientific studies.

Only if effectiveness and safety are equivalent will we consider the relative cost-effectiveness of various treatments. In certain cases, we require a particular therapy to be tried before covering comparable, but more expensive options.

A member’s benefit plan defines the services that are covered and excluded. Our professional clinical staff develops clinical policy bulletins to inform members and providers which treatments are considered experimental and investigational, as well as the criteria that determine whether a technology or service is medically necessary. We use these bulletins to guide medical coverage decisions. Clinical policy bulletins do not guarantee coverage, but rather define when a service or treatment will be approved if it is not specifically excluded by the member’s plan.

Aetna’s clinical policy bulletins help guide evidence-based medicine that improves quality, reduces waste and provides members with access to affordable care. We constantly evaluate new published and peer-reviewed studies or additional evidence when developing our clinical policies, and will continue to do so.

For more information, please visit the clinical bulletins page or read the FAQ.

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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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Helping Seniors Save Money Through SilverScript

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SilverScript, our Medicare-approved Part D prescription drug plan provider serving more than 5 million members, focuses on providing seniors and people with disabilities with consistent, worry-free coverage.

For Alexis Spina, one of our Pittsburgh-based colleagues, that focus is integral to her work every day. A clinical pharmacist, Spina works the Medicare call queue, educating members daily on lower cost drug alternatives that have the same clinical benefits as their current medications, tailoring her responses to each member’s specific level of understanding.

Her conversations with members have been so impactful that some of them have been developed into talk tracks that other colleagues on her team now use for their own calls.

Spina says that with each phone interaction she tries to make the patient feel like they are speaking with someone who truly cares about their well-being.

For her hard work and leadership, Spina was awarded a 2018 CVS Health Paragon Award, which recognizes the best-of-the-best among CVS Health colleagues who deliver direct care to patients and customers. Now in their 28th year, the Paragon Awards honor colleagues who embody the core values of CVS Health.

Watch to learn more about Spina’s passion for helping patients save money and live a healthier life.

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Addressing Rising Drug Prices

Addressing Rising Drug Prices
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Rising drug prices hurt patients and lead to negative and costly outcomes throughout our health care system. For example, data show that 40 percent of patients do not pick up their prescriptions when out-of-pocket costs per prescription exceed $200.CVS Health Internal Analysis. Completed December 2015, Retail RxDw; Analysis Timeframe of 1/1/15 – 12/28/15 When patients don’t take their medications as prescribed, the cost to our health care system is approximately $290 billion.https://www.nehi.net/writable/publication_files/file/pa_issue_brief_final.pdf

At CVS Health, we recognize that one of the most important things we can do is to help people afford and take their medications. That’s why we’re working to improve transparency and pioneering solutions to help patients get the right medicine at the lowest possible cost.

Providing Information across Multiple Points of Care

Information about how much a drug costs is not always readily available. According to a poll sponsored by CVS Health, more than half (57 percent) of patients do not know how much a drug will cost them, and nearly as many (54 percent) believe it would be helpful to have information about the cost before they fill their prescriptions.

CVS Health is working to expand visibility into drug cost information across multiple points of care.

  • At the physician’s office: Our real-time benefits technology – used by 100,000 prescribers nationwide – enables visibility into what a patient will pay for a specific drug under their benefits plan and presents up to five lower-cost, clinically appropriate alternatives for consideration by the prescriber.
  • At the pharmacy counter: Our more than 30,000 retail pharmacists use the Rx Savings Finder tool to search for potential savings opportunities.
  • For CVS Caremark members: About 230,000 times per month, CVS Caremark members search the Check Drug Cost tool to find lower-cost, clinically appropriate alternatives to more expensive medications.

Helping Control Costs While Promoting Better Health

As a Pharmacy Benefit Manager (PBM), we use every tool at our disposal to bring down drug prices. For example, we encourage the use of lower-cost, clinically appropriate generic alternatives, which data show can lead to a 3-percent decrease in overall mortality.https://www.ncbi.nlm.nih.gov/pubmed/2522238. We offer evidence-based guidelines to help prescribers connect patients to the most cost-effective medicines, resulting in more than $2.9 billion in savings.CVS Health White Paper. Current and New Approaches to Making Drugs More Affordable. Published August 2018 We also provide point-of-sale rebates and zero-dollar copay drug list options to clients, helping to deliver savings directly to patients at the pharmacy counter.

Keeping Costs Down for Patients, Employers and Government Programs

Our PBM strategies rein in costs across the health care system and also increase access to affordable medications for patients. While brand manufacturers have increased prices on average 9.2 percent annually from 2008 to 2016,https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.05147 we have worked to stabilize drug costs for our clients and patients. In fact, CVS Health kept drug price growth to just 0.2 percent in 2017.

For more information on how CVS Health is working to expand access to more affordable and effective health care, check out our Cost of Care 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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