FLAACOs 2014 Conference - CVS Health: Collaborating with Providers

©2013 Caremark. All rights reserved. This presentation contains confidential and proprietary information of CVS Caremark and cannot be reproduced, distributed or printed without written permission from CVS Caremark.

Collaborating with Providers

Fall Conference

September 2014

2

© 2014 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution without written permission from CVS Caremark.

Medical Home is it enough?

MEDICAL HOME PRIMARY CARE BY THE NUMBERS (EST.)

Projecting the Supply and Demand for Primary Care Practitioners Through 2020 Health Resources and Services Administrationpublished November 2013

Number of PCP’s 2010 • Total 205,000

• Demand 212,500

7,500• Patients in need Over 18 Million

Number of PCP’s 2020• Total 220,800

• Demand 241,200

20,400• Patients in need about 51 Million

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Medical Home Evolving to Neighborhood

SNF’s

Urgent Care

Retail Health

LTAC

Retail Pharmacy

Home Health

Home Infusion

Specialty

4


Early Alignments – Strait Forward

SNF’s

Urgent Care

Retail Health

LTAC

Retail Pharmacy

Home Health

Home Infusion

Specialty

5

© 2014 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution without written permission from CVS Caremark.00000

Health System Affiliate Relations

Pharmacy Benefits Management programs

CVS retail pharmacy care programs

Retail clinics primary care support and connectivity

Specialty medications and pharmacy programs

6


Global Capitation

Changing Health Care Environment: Providers are Adapting Rapidly

Our goal is to improve pharmacy care and complement primary care to help providers reach their patient care goals

Fee for Service (FFS)

FFS with Pay for

Performance

Bundled Payments

Shared Savings Shared Risk

Evolving Contracting Arrangements

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Only Half of Patients Adhere to Evidence-Based Drugs Prescribed by Physicians

• Largest drop in adherence occurs within the first six months of treatment

• Consistently observed for multiple diseases and drugs in multiple clinical settings

• Adherence rate two years after MI:– Statins: 33%

– Beta-blockers: 53%

– ACEI/ARB: 50%

• 50% of patients have an evidence based gap in care

Sources: Benner et al. JAMA 2002; 288: 455; Jackevicius et al. JAMA 2002; 288: 462; Akincigil et al. JGIM 2008; 23: 115.

% F

ully

adh

eren

t0 6 18 30 42 60

100%

43%

34% 32% 30%27%

Months since statin initiation

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All Retail Pharmacies are Not Alike

Source: CVS Caremark Quarterly Adherence Report.

Comparing Adherence of Retail Chains(medication possession ratio (%))

80 8183

7072

74

CVS Top 3 Competitors

Anti-Hypertensives

Anti-Diabetics

Dyslipidemics

230+ million interventions have helped drive best-in-class adherence results

Comprehensive Pharmacy Interventions to Support Adherence

New Script Pickup

First Fill Counseling

Refill Reminder

Adherence Outreach

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Challenging Health Trends Call for More Advanced and Integrated Clinical Strategies

1. Milliman Specialty Medication Benchmark Study, 2013 analysis of 2011 data. 2. Cassil, Alwyn, “Rising rates of chronic health conditions: What can be done?” Center for studying health system change 2008; no.125. 3. DeVol, R., Bedroussian, A. An Unhealthy America: The Economic Burden of Chronic Disease. Milken Institute. October 2007. 4. Milliman analysis, 2013. 5. Per Member Per Month (PMPM) . Source: CVS/caremark Enterprise Analytics, 2013. 6.Targeting Cardiovascular Medication Adherence Interventions, Journal of the American Pharmacists Association, May/June 2012.

CLINICAL MANAGEMENT CHALLENGES

X

X

Timely, actionable clinical messages

delivered to patients and providers, ACOs/PCMHs

improves outcomes; Targeted interventions are

1.75X more effective6

1 in 2 Americans have a chronic condition;

Health care costs for patients with at least one

chronic condition is 5X greater1

Growing emphasis on quality measurement

across all lines of business; Clinical

metrics account for 38% of Medicare Part D Stars

½ of patients

do not adhere to their medication therapies, resulting in $290B in health care costs 2,3

31786

Specialty patients drive 25% of your total health

care costs4; Spend expected to double to $70 PMPM in 5 years5

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Reduce Costs by Improving Pharmacy Care

*Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary status, demographic characteristics and other factors. Client-specific modeling available upon request. This is a forward-looking statement and actual results may be different.

Source: CVS Caremark Enterprise Analytics, 2013.

Calculates the savings associated with providing good pharmacy care

27% Reduction

$3,028 Annual Savings

per Patient

$11,100Global capitation payment

($30)Moving to generics

($2,340)Improving adherence

Closing gaps-in-care ($658)

Payment after savings $8,072

Medicare Example: 100K Lives, PMPY

Pharmacy Care Economic Model*

Effective pharmacy management significantly improves ability to reduce cost of care

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How? Supporting Providers From Prescribing Through Practice Transformation

Bedside delivery of medications

Home infusion services

CVS onsite pharmacy

340B program

HOSPITAL TRANSITIONS

Convenient medication dispensing

Effective care management for rare conditions

SPECIALTY MANAGEMENT

Chronic disease management

Wellness Support

Acute minor episodes

Vaccinations

Two-way clinical messaging

Performance Guarantees

FOCUS ON YOUR PATIENTS

Actionable reporting

Data analytics

Shared savings

Shared risk

POPULATION HEALTH

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MinuteClinic® Provides Access to High Quality Care at a Lower Cost

900+ full time clinics in 29 states

with over 21M visits to date

Largest employer of board-certified

Nurse Practitioners

Over 2,300 NPs

Walk-in care, 7 days per

week including evenings

Up to 80% savings over higher

costs of care

92% overall patient

satisfaction1

50% of patients indicate no PCP

THE FIRST AND LARGEST RETAIL HEALTH CARE PROVIDER TO BE

ACCREDITED BY THE JOINT COMMISSION

1. Press Ganey Satisfaction Survey Results, 2012.

85% of patients use third party

coverage

50% of visits occur after 5pm or on

weekends

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• EMR integration and exchange of clinical data

• Participate in ACO and care system development

• MinuteClinic providers collaborate with health system medical directors

• Joint clinical programs for chronic care and wellness

• Affiliations now incorporate full pharmacy collaboration

Current Health System Affiliations

Our goal is to have affiliations in all major markets by 2017

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MinuteClinic is Adding New Services to Support Population Health Management

Non-acute services are now 18% of total volume and growing

Serv

ices

Exp

ansi

on

• Weight Loss• Smoking

Cessation• Hyperlipidemia• HIV Screening

• Health Risk Assessment/Visit

• Hypertension• Advanced Point-

of-Care Testing, including A1c

• Medicare Wellness Visit

• Additional Chronic Care Support in Collaboration with Health Systems

2013 20152014

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Case Study: minute clinic® Helps Lower Total Health Care Costs

• Large employer compared total health care spending (medical and pharmacy claims) for members using minute clinic® vs. members seeking care in other settings over a 1-year period*

• Subjects matched for age, gender and health status

• minute clinic® patients had lower physician visits, ED visits, and hospital days

minute clinic® users had 8.3% lower total health care costs when compared to non-users.1

8.3%Reduction

minute clinic®Users

Non-minute clinic®Users

Total Health Care Costs (PMPY)

~$3350

~$3100

*Using de-identified data. medical and pharmacy claims for employees and their dependents who received care at a retail clinic between June 1, 2009, and May 31, 2010, were matched to those of subjects who received care elsewhere.1. Sussman, Andrew MD., et al. Retail Clinic Utilization Associated with Lower Total Cost of Care. The American Journal of Managed Care. April, 2013. 19:4.

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Clinical Affiliation – What does it look like?

• Located in Southern NJ

• 4 Acute Care Hospitals

• 5 Ambulatory Locations

• 3 Imaging Centers

• 3 Urgent Care locations

• 2 SNF’s

• Oncology, Lab services, Occupational Heath, Sleep Centers, Health and Wellness

• About 1B in annual revenue

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Evolving Relationship CVS Health & Virtua

Collaborate on Clinical Risk Relationships

Improve HospitalTransitions

Improve PharmacyCare

Complement PrimaryCare

Streamlining HospitalTransitions to

Outpatient Setting

• CVS DeliveRx™ (Bedside Delivery)

• Exploring Coram Home Infusion

• Exploring Medication Reconciliation programming

Ensuring patients areadherent to their

Medications at retail

• Collaboration on improving adherence, closing gaps in care

• Transparent Pharmacy Care

• Actionable Reporting

Affiliation with CVS/Pharmacy and

MinuteClinic

• Access • Chronic disease

management support• Wellness support• Seamless connectivity

to physician EMR

SliverScript

• Helping manage pharmacy for MSSP

• Cost savings and • Quality improvement• Shared savings

Caremark PBM• Helping manage

employee pharmacy needs

Increasing Provider Risk

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Messaging the Integrated Approach – The Where & Why

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Retail clinics are they here to stay?

What retail clinic growth can teach physicians about patient demand – Lisa Zamosky Published in Medical Economics Jan 2014

MinuteClinic® Today 900+ = over 50%

MinuteClinic® Planned

~1600-2000 = 50%-67%

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Where is the Value?

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Re-thinking the Clinical Neighborhood

Retail Pharmacy

Specialty Urgent Care

Home Infusion

Retail Health

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Additional CVS Health Programs Add Value for Providers and their Patients

Bedside Delivery*

Coram Home Infusion

340B Program*

CVS Onsite Pharmacy*

In-home Pharmacist Consultation*

PATIENTFOCUS

Accordant Specialty Care Management

Specialty 340B*

Specialty Connect

NovoLogix Cost Management

HOSPITAL TRANSITIONS

Pharmacy Advisor @ CVS*

HealthTagin-store messaging

POPULATION HEALTH

Patient and Provider Insight Tool for SilverScript members

PBM Services for Health System Employees

Medicare ACO Support through SilverScript

SPECIALTY MANAGEMENT

*Available in some areas

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Pharmacy Advisor® Counseling: Focused on Improving Medication Management

*Conditions addressed vary by line of business. **Specific interventions may vary by line of business.

Collaborating with case managers for better care coordination and optimal results

• One-on-one pharmacist counseling for patients with most prevalent and costly conditions* at more than 7,600 CVS/pharmacy locations

• Proactive, patient-specific interventions at key events in therapy**: new to therapy, non-adherence and gaps in therapy

Offering the focus, access and expertise to complement your health management strategies and support your quality improvement goals:

31790

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Early identification of Home Infusion Sensitive Conditions (HISCs) and patient flow management

Clinical Liaisons to provide assessment, risk stratification, education and discharge planning assistance

IV expertise, therapy specific protocols, and expert compounding standards help ensure patient safety

Real-time outcomes dashboard demonstrates program success

Coram Provides Market-Leading Home Infusion

• Services include:

– Anti-Infectives

– TPN and Tube Feeding

– Cardiac and Transplant

– Immune Therapies

– Alpha-1 Therapies

• Home infusion arrangements guaranteed prior to discharge

WORKING TOGETHER TO IMPROVE HOSPITAL

TRANSITIONS

All-cause readmission rate for Coram patients is <5%1Compare to 18% for post acute care2 and 24% for skilled nursing facilities3

*Source: 1Coram National Infusion Results, Q1–Q4 2013 2MMRR: 2013: Volume 3 (2) 3The Revolving Door Of Re-hospitalization From Skilled Nursing Facilities, Health Affairs, 29, no.1 (2010):57-64

Improved Care Coordination and Patient Transition

Improved Readmissions and Patient Satisfaction

Improved Hospital Financial Performance

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Medicare Part D Expertise

• Second largest national Prescription Drug Plan Sponsor - 3.6M members

• Medicare Part D coverage in 50 states, and D.C. • Full and timely visibility of all adjudicated drug claims across our national

network of pharmacies (includes Wal-Mart, independent pharmacies, Walgreens, etc.)

• Competitively priced plan options - Ex., $0 annual deductible and $0 copay for all Tier 1 generic drugs at any preferred pharmacy (CVS, WalMart and independent pharmacies)

• Mail order prescription delivery option at no extra cost for 90 day supplies

SilverScript Insurance Company - Wholly-Owned Subsidiary of CVS Caremark

Well positioned to help ACOs and providers manage their Medicare population

22643

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Interactive Pharmacy Analytics Tool Supports Your Population Health Management Strategy

Identifying high-value patient outreach for targeted impact

• Identify patients for cost savings, adherence outreach and therapy changes

• Practice and patient level views

• Drill-down reporting for physicians, nurses, and case managers

Sample report: Report specifics subject to change

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Helping to Achieve ACO Quality Measures

• Pharmacy Data Sharing to Manage Chronic Conditions

• Improve Quality Measure Results

• Improve Patient Health

Diabetes Hypertension

Coronary Artery

Disease

Ischemic Vascular Disease

ACO Clinical Quality Measures Related to Key Disease States Impacted by Improved Medication Adherence

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Pharmacy Care Provides Support for Key Segments of Your Patient Population

High Risk/High CostReduce costs and improve outcomes through specialty management and condition-specific counseling

Moderate and Rising Risk Support through chronic disease management, ongoing therapy monitoring, and care transitions programs

Low RiskEngaging low risk patients to help keep them healthy, providing easy access to adherence and primary care support when needed

5%

20%

40%

35%

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Thank you for your time today…

James Dold [email protected]

Mark Bowen [email protected]

mailto:[email protected]

mailto:[email protected]

Healthcare

FLAACOs 2014 Conference - CVS Health: Collaborating with Providers