The Year of the Nurse — and COVID-19

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When the World Health Organization selected 2020 as Year of the Nurse, they didn’t know nurses would be on the frontlines of a global pandemic.

But like health care professionals around the world, CVS Health and Aetna nurses are working through the challenges of COVID-19, redefining the way health care is delivered and putting people on a path to better health.

“It's really a true opportunity to show our commitment, our effort and our skill in order to help other people.” — Todd Clair, RN, MSN
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“This is when we, as nurses, are needed the most,” says Todd Clair, a nurse and Care Manager for Aetna One® Advocate. “And it's really a true opportunity to show our commitment, our effort and our skill in order to help other people.”

Watch the video to see how our nurse practitioners, registered nurses, licensed vocational nurses and licensed practical nurses are showing that commitment every day.

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Supporting our frontline workers during COVID-19

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During the COVID-19 pandemic our colleagues are on the front lines. They’re working in our CVS Pharmacy locations, call centers, warehouses and mail facilities. They’re caring for patients one-on-one in their homes and long-term care facilities.

To support them, tens of thousands of CVS Health employees are working behind the scenes to help them focus on serving our patients, members and colleagues. 

“Our purpose of helping people on their path to better health has never been more obvious than during this pandemic,” said Colleen McIntosh, senior vice president, Corporate Secretary and Chief Governance Officer.

Colleen’s team provides licensing support for CVS Health. They’re working through the pandemic to make sure “we can turn the lights on” in our stores.

“We are going to come out of this as a stronger, more collaborative, empathetic organization.” — Katie Long, Senior Director of Plan Sponsor Services at CVS Health
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Eileen Cook, a senior director in Learning and Development, works with nearly 500 colleagues spread out across the country. They’re remaining focused on orientation, onboarding and training — especially important as CVS Health is hiring 50,000 people in response to COVID-19.

In Plan Sponsor Services, Senior Director Katie Long oversees 300 colleagues. Some now are teleworking. Others are in the office working through social-distancing guidelines.

Despite the challenges, she remains positive.

“We are going to come out of this as a stronger, more collaborative, empathetic organization,” Katie says.

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Home care dietitians improve tube feeding patient outcomes

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Coram’s research highlights the critical role home care dietitians play in decreasing tube feeding intolerance and improving nutrition outcomes

Home-based health care continues to gain traction as an option for people living with a variety of chronic conditions. In fact, home infusion care can be a safe and cost-effective treatment alternative when compared to the same care provided in an in-patient or hospital setting. Coram CVS Specialty Infusion Services (Coram) is leading the way in home infusion care and parenteral (intravenous) and enteral (tube feeding) nutrition with a team of skilled home care Registered Dietitians, who can address nutrition intolerance, assess adequacy of hydration in feeding regimens, and address associated patient questions.

To advance the knowledge of health care practitioners and improve care for patients, Coram is actively involved in home nutrition care research. This research includes evaluating the impact of transitioning nutrition care from the hospital to the home and the benefits of home-based parenteral and enteral nutrition in certain populations.

Coram dietitians Nicki Bray, MS, RD, LDN; Sarah Allen MS, RD, LDN; and Caitlin Wendecker, RD, CNSC, recently conducted research to evaluate the efficacy of home care dietitian recommendations in addressing reported enteral nutrition intolerances, and the critical role home care dietitians play in creating interventions to improve nutrition outcomes. They shared their findings in their abstract, Home Care Dietitian Intervention Effectiveness to Reported Intolerance.

When patients are sent home from the hospital with little additional support and potentially poor tolerance to tube feedings, their outlook and compliance with their home tube feeding regimen may be impacted. Identifying and effectively addressing intolerance will increase a patient’s compliance and improve nutrition outcomes.

Coram conducted a retrospective review of adult patient records that reported intolerance within 48 hours of start of care. This retrospective review supported the important role of home care dietitians in evaluating and managing tube feeding intolerance, with dietitian interventions effective for 72% of patients by day 30 and 91% of patients by day 60. Without appropriate intervention by a dietitian, patients may be at risk for poor nutrition outcomes such as gastrointestinal distress, malnutrition, weight loss or underfeeding.

Home enteral nutrition patients are also at increased risk for dehydration due to inadequate fluid administration, and Coram dietitians explored this in an additional abstract, Adequacy of Flushing Orders in Home Enteral Nutrition Patients, by Katrina Sesler, MS, RD, CNSC; Rebecca Caldwell, MS, RD, LDN; and Laura Kashtan, RD, which reviewed patients’ water flushing orders at discharge from facility to home care. From a retrospective chart review of adult patients, Coram dietitians noted that discharge flush orders are missing or are inadequate for a considerable number of home enteral nutrition patients. Individualized recommendations and early patient contact by a dietitian may be important to prevent dehydration in these patients.

Early intervention by home care dietitians can help patients address tube feeding intolerance, assess hydration levels, improve therapy compliance and address patient questions and concerns. This support can help improve patient outcomes, potentially preventing hospital readmission at a time when hospital resources are stretched due to the increasing rate of COVID-19 admissions. Measures to help patients remain home and avoid hospital readmission are always valuable, but today they are critical.

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Quarantined seniors face unseen dangers

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With an increased risk of severe illness from COVID-19, the Centers for Disease Control and Prevention (CDC) advises that adults 60 and older "stay at home as much as possible." But, studies show that isolation and loneliness can cause seniors physical and mental harm. In fact, it can be more harmful to a person’s well-being than obesity or smoking 15 cigarettes a day.

Why loneliness is lethal

The first step in finding solutions is to understand that loneliness and social isolation are related, but different problems, says Dr. Christopher Lim, M.D., Senior Clinical Advisor, Aetna Medicare. Isolation is objective and can be measured by factors like the size of a person’s social network. In contrast: Loneliness is a subjective and personal feeling. Both are common among older adults.

A 2020 study found that nearly a quarter of Americans aged 65 and older are socially isolated, and some 43% of adults aged 60 or older report feeling lonely. Add on the isolation felt with the pandemic, and these people face increased risk for heart attack, stroke, or even reduced antiviral protections that are so important right now.

“Loneliness is not a normal state of being for a human,” says Lim. “Biologically, we depend on others to survive in the world.”

Making connections

Fortunately, there are ways we can all help older adults stay connected while respecting social distancing:

  • Resources For Living consultants call at-risk seniors identified by the Social Isolation Index to offer customized local solutions, such as food delivery.

  • SilverSneakers, now offers members age-appropriate online video workouts from home.

  • Papa, Inc. program connects college students and seniors through “Assistance from a Distance” to encourage positive thinking, help with ordering groceries and medicines and explaining telehealth tools.

  • Through an Aetna Foundation grant, the Meals on Wheels program is developing a training curriculum to teach seniors how to use technology to make online connections.

Dr. Robert Mirsky, Chief Medical Officer, Aetna, talking with an older woman outdoors.
Dr. Robert Mirsky, Chief Medical Officer of Aetna.

“We are continuing to look holistically at our social connectedness offerings to build out a variety of approaches to identify and support our members who are lonely or isolated,” says Dr. Robert Mirsky, Chief Medical Officer for Aetna Medicare.

You can help, too. Consider adding your neighbor’s shopping list to your own. Call your elderly relatives to remind them they aren’t alone. Schedule a virtual visit between your children and parents. The connections you make during this time could be lifesaving.

Help older adults stay connected

  • Make a plan how to social distance and sanitize their home. Update phone numbers for pharmacy and other home deliveries.

  • Schedule regular phone calls and video chats.

  • Organize a virtual game night using online board games or set up identical game boards and use a speaker phone. 

  • Create a virtual book club or have grandparents read bedtime stories.

  • Host a long-distance dinner party with meal delivery and phone or video conversation.

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Focusing on solutions for CVS Pharmacy patients

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Saurabh Mistry’s personal motto is “Don’t focus on the obstacles, always focus and devote your energies on the solution.” It’s a mindset that was instilled in Mistry at an early age by his father while growing up in India and one that he tries to pass along to his team every day as a pharmacy manager at a CVS Pharmacy in Texas.

Mistry’s solutions-driven approach to his work is part of what earned him 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.

Giving back also drives much of Mistry’s work. Whether it’s returning to his home country to help his childhood community, going the extra mile to ensure his pharmacy patients are being prescribed the proper medications or proactively working to save his patients money, Mistry always strives to help others.

Watch above to learn more about the fulfillment Mistry gets from his work and why he’s always aiming to be the best and have the best team in place for his patients.

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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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Keeping community at the center of care at MinuteClinic

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With approximately 1,100 locations nationwide, MinuteClinic nurse practitioners and physician assistants work every day to provide patients with convenient, personalized care that’s close to home.

One MinuteClinic provider who takes that work to heart is Aimee Kleppin, a family nurse practitioner who works out of a CVS Pharmacy in Queen Creek, Arizona.

Highly motivated and community-minded in her work, Kleppin was awarded a 2019 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 its 29th year, the Paragon Awards honor colleagues who embody the core values of CVS Health.

Born in Puerto Rico to parents who are both pharmacists, Kleppin knew from the time that she was in high school that she wanted to be a nurse practitioner. In her years of working for MinuteClinic, Kleppin has developed a following of patients who trust her clinical knowledge and appreciate her caring approach.

Watch above to learn about Kleppin’s dedication to her local community, including a program on hygiene that she developed the local schools, and why she’s continuously inspired to help others through her work.

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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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The importance of bringing diabetes care into the community

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This article was written by Dr. Dan Knecht, Vice President of Health Strategy & Innovation at CVS Health.

1.5 million: That’s the number of Americans who are diagnosed with diabetes each year. 327 billion: That was the total cost of diagnosed diabetes in the United States in 2017, according to the American Diabetes Association.

These are big numbers, but they don’t tell the whole story. In addition to my day job as Vice President of Health Strategy and Innovation at CVS Health, I practice as a physician at Mount Sinai West Hospital in New York City. During my weekend rotations, I see firsthand the very real and negative impacts of uncontrolled diabetes on my patients. Diabetes can cause vision loss, kidney failure and neuropathic pain, in addition to accelerating and worsening cardiovascular disease.

Thankfully, the news is not all bad. As the number of people diagnosed with diabetes rises, so are the resources and treatment options available to them.

CVS Health recently partnered with Morning Consult to better understand the needs of people living with diabetes and the providers who deliver diabetes care. What we heard from patients and doctors is a desire to:

  • Expand access to local care
  • Better manage and predict out-of-pocket costs
  • Provide additional lifestyle support in the form of nutrition, exercise and social services

In honor of Diabetes Awareness Month, I sat down with fellow diabetes experts Dr. Steve Edelman, M.D., founder and director of Taking Control of Your Diabetes, and Joy Pape, R.N., a nationally known family nurse practitioner and certified diabetes educator, to discuss how we can address some of these needs through real action.

Watch our full CVS Health Live discussion above.

Read Dr. Knecht’s full article on LinkedIn.

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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