Transcript Slide 1

NYBGH Actionable Pharmacy Benefit
Strategy for 2011 and Beyond
Best Practices in Medication
Adherence
Jack E. Bruner, FSA
Executive Vice President
Strategic Development
CVS Caremark
July 22, 2010
©2009 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.
Kellogg 6-2010
Agenda
•
•
•
•
•
The Emerging Health Care Environment
Why Adherence Matters
Why Non Adherence Happens
What Strategies are Employers Considering
Delivering Best-in-Class Adherence Results
– Best-in-Class PBM Engagement
– Best-in-Class Retail Engagement
– Proactive Pharmacy Care – Consumer Engagement
• Creating Breakthrough Adherence Results
– 30 day vs 90 day adherence
– The Impact of PBM Mail Clinical Programs
– Extending PBM Clinical Programs to Maintenance Choice
– The Impact of Evidence Based Plan Design
• Summary
2
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
The Emerging Health Care Environment
Health Reform
MEMBER EXPERIENCE
CVS CAREMARK
• Expanded Coverage
• Medicare
RETAIL
• Comparative Effectiveness
• Medical Home
MANDATORY
MAIL
• Accountable Care Organizations
• Bio Equivalents
COST SAVINGS
Health Reform Expands Access, But Cost and Quality
Breakthroughs Require Leadership
3
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Why Adherence Matters:
The Challenge and The Opportunity
Not adherent
18%
Adherent 17%
Overall Chronic Disease:
$1.3 Trillion1
Cancer $319 billion
Adherent
with Gaps
in Therapy
20%
Diabetes $132 billion
Hypertension $312 billion
Heart Disease $169 billion
Diagnosed but not
medicated 15%
Unaware of
condition/
undiagnosed 30%
Mental disorders $217 billion
Chronic conditions drive 78% of overall health care costs.
Adherence improves health and reduces costs.2
4
Chart. CVS Caremark BOB data for diabetes 1. Source 2. Centers for Disease Control and Prevention, 2003 Data.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
The Value of Investing in Adherence:
Heart Failure Study
• 49.9% of heart failure patients
studied were not optimally
adherent
• Re-hospitalization rates of
non-adherent heart failure
patients is nearly twice that
of adherent patients
• Optimal adherence saves
almost $40,000 per year
% Readmitted
Within 12-Mos.
Annual
Medical Costs
Annual Expense
$120,000
$100,000
$99,125
$77,708
$80,000
$60,946
$60,000
$40,000
$20,000
$0
Low
Moderate
High
Adherence Level
88% of heart failure patients in the Adherence to Drug Therapy
program maintain optimal adherence.
5
Sources: CVS Caremark Analytic Consulting, 2009. CVS Caremark data combined with third-party references including the United States Census, Centers for Medicare and
Medicaid Services (CMS) and the World Health Organization (WHO).
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Thomson Reuters Value of Medication Adherence
(VOMA) project
• In January 2010 Thomson Reuters initiated the VOMA project, which was
commissioned by CVS Caremark.
• The project focuses on the impact of medication adherence on these metrics:
– Net total annual healthcare costs (pharmaceutical, medical, and total healthcare costs)
– Annual healthcare utilization (hospital, emergency department, and physician visits)
– Annual worker productivity (absenteeism and short-term disability)
• These outcomes will be examined among patients with at least one of the
following conditions:
–
–
–
–
–
6
Asthma/COPD
Congestive heart failure
Diabetes
Dyslipidemia
Hypertension.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
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How Non-Adherence Happens
Persistence: Staying on medication
for the entire prescribed time period
Compliance: Taking medication doses
and refilling prescriptions on time
Scripts not refilled on time
% of fills
10
5
0
-4
-2
0
2
4
6
8
10
12
14
# of days past due date
Fewer than 40% of maintenance
scripts are refilled on time.
7
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
100
% of scripts filled
15
80
Scripts never refilled
60
40
20
0
1 2 3 4 5 6 7 8 9 10 11 12
Fill number
31% of original maintenance
scripts are never refilled.
Consumer Research: Consumers are Confused
by The Health Care System
• The health care system doesn’t make
it easy for consumers to do the right
thing.
• They don’t know who can tell them
how to save money
• Providers involved with their health
care are disconnected from one
another.
• Time demands to stay adherent
create big challenges for many
Source: 2009 CVS Signature Services Study by Synovate
8
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
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Video clip here
Why Non-Adherence Happens
Non-Persistent After First Fill Survey
5%
Non-Persistent After 2+ Fills Survey
Dr told to stop
9%
Inconvenient
22%
6%
Dr told to stop
6%
Cost
9%
Side effects
6%
Side effects
30%
7%
7%
Cost
Personal choice
Didn't need
21%
13%
15%
Personal choice
Forgot to refill
Forgot to refill
13%
Others
14%
17%
*Other includes: Didn’t need 5%; in hospital/nursing home 5%; changed drug stores 5%; changed medications 5%; went on vacation 4%; worried about side effects 3%; had samples 1%
45% of plan participants cite forgetfulness
as a root cause of non-adherence.1
CVS Caremark Analytics & Outcomes, 2008. 1. BCB analysis, primary consumer research using call center 8/23/07 – 9/13/07
9
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
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Inconvenient
Didn't need
Other*
Improving Medication Adherence
What is the status of these strategies to improve member adherence?
Currently using
44
ADOPTING A 90-DAY BENEFIT WHICH IMPROVES
MEDICATION ADHERENCE
THERAPY DROP-OFF OUTREACH TO MEMBERS
AND PHYSICIANS
CDHP DESIGNS WITH PREVENTATIVE
DRUG LIST COVERAGE
10
Source:
2010 Caremark.
Employer Benefit
Planning
Survey.
©2009
All rights
reserved.
CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
11
62
21
0%
20%
CURRENTLY USING
12
62
24
18
12
56
27
ADHERENCE COUNSELING ON THE FIRST FILL
OF MEDICATION
No interest
43
32
OUTREACH TO PRESCRIBERS TO RESOLVE
GAPS IN CARE
REDUCED COPAYS FOR CERTAIN DRUG
CLASSES, HEALTH MANAGEMENT PROGRAMS
AND/OR TARGETED HIGH-RISK MEMBERS
Considering for future
14
65
14
40
42
40%
60%
Percent Respondents
NO INTEREST
CONSIDERING FOR FUTURE
80%
100%
What Do Employers Want from
Preferred Pharmacies?
2008 CVS Caremark Benefit Planning Survey
Provide best discounts/lowest price
74
Highest generic or preferred brand use
17
54
Pharmacy available within 5 miles
31
46
Counseling on savings opportunities & pharmacy benefits
Participant's complete drug history visible to pharmacist
42
34
Pharmacy staff knows participants’ pharmacy benefits
34
35
13
9
15
16
10
33
39
15
12
Counseling to improve adherence
32
42
14
12
23
32
Added savings through OTC/supplies discounts
20
36
20%
40%
31
Medium Priority
Low Priority
Source: CVS Caremark Benefit Planning Survey, 2008.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Not sure
15
29
60%
Percent Respondents
Kellogg 6-2010
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Demonstrated adherence improvement
0%
11
8
15
18
38
Access to retail clinic services
High Priority
8
32
37
2 6
14
80%
100%
Evaluating Benefit Structure and Delivery Alternatives to
Support Improved Adherence, Pricing, Clinical Support
and Customer Satisfaction
30 Day
Refill
90 Day
Retail
Benefit
90 Day
Retail
Network
Initial
Adherence
Ongoing
Adherence
Mail
Pricing
Clinical
Support
Customer
Satisfaction
12
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
50%
Incentivized/
Mandatory Maintenance
Mail
Choice
Best in Class Strategies to Maximize
Adherence
• Promote 90 day supplies over 30 day supplies to drive higher adherence rates
– 90 day fills vs. 30 day fills reduce non-adherence by 40%
– A 90 day supply option with face to face interaction can be even more effective
in improving adherence
• Leverage Clinical Programs through Preferred Pharmacies
– First fill counseling, refill reminders and outreach programs are critical
– Addressing both mail and retail consumers is critical
• Implement evidence-based plan design to incent members to stay adherent
– EBPD improves adherence most among those with poorest adherence rates
– Compliance based and reduced cost sharing vs free may drive ROI
Best-in-Class clients maximize adherence through a
multi-faceted and comprehensive approach.
13
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Pfizer 30 vs. 90 Day Case Study
Member Profile with Adherence Gaps
Days Supply on Hand - Antihyperlipidemics
Days on Hand
100
75
Adherence:
73.9%
50
25
0
Dec 08
Jan 09
Feb 09
Mar 09
Apr 09
May 09
Jun 09
Jul 09
Aug 09
Sep 09
Oct 09
Nov 09
• Key findings
–
–
–
The above identifies a Pfizer member taking Lipitor 10 mg
This member started 30-day therapy on December 2008
In August 2009, they changed to 90-day therapy
• The chart shows the decrease in medication days on hand as the member approaches his or her next refill date
–
14
When a member is on 30-day therapy, there is more potential for gaps in care between fills
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Member Profile with Minimal Adherence
Gaps
Days Supply on Hand - Antihyperlipidemics
Days on Hand
100
Adherence:
95.6%
75
50
25
0
Dec 08
Optimally
Adherent
Feb 09
Apr 09
Adherence Band
Percent 90 Day
Usage
Under 80%
80% - 84%
85% - 89%
90% +
37.3%
47.2%
48.3%
61.6%
Jun 09
This is a Pfizer member profile taking Lipitor 10 mg; they started 90-day therapy in mid January 2009
• The gaps in therapy is minimal with their 90-day therapy
–
–
15
Your data shows that as the percent of 90-day usage increases, adherence increases
Further, mail service and Retail-90 pricing options provide more aggressive financial arrangements
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Oct 09
Note: Member profile based on Pfizer member. Adherence bands are Pfizer specific, but exclude
Pharmacia and Wyeth populations.
• Key findings
–
Aug 09
Careful Review of the Medical Literature:
What Works in Pharmacy Health Care
Pharmacist Intervention Is Superior to Other Adherence Efforts
COHEN’S D STATISTIC REVEALS RELATIVE STRENGTH OF INTERVENTIONS
IN META-ANALYSIS OF OVER 300 PUBLISHED STUDIES
0.64
0.307
0.27
0.217
0.127
0
Lay Person Pharmacist
or Nurse
Call
Call
16
Lay Person
at Home
0.16
Nurse or
Pharmacist Nurse/Doctor
Nurse/
Doctor
at Pharmacy /Pharmacist Pharmacist
at work-site
at Clinic
at Hospital
Source: Cutrona et al, Modes of delivery for interventions to improve cardiovascular medication adherence. Submitted for publication. CVS Caremark Harvard Adherence Partnership, 2009.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Our Consumer Engagement Engine in
Action: Personalized Opportunities for Helen
Identifies
Opportunities
Prioritizes
Opportunities
1
2
3
Generic
Preferred
OTCs
New Rx
Generic
Lapsed Rx
Mail Pharmacy
New Rx
Lapsed Rx
Therapy Gap
Safety
Automatic Refill
Health Plan
Messages
Consumer
Engagement
Engine
•
•
•
•
Evidence-Based Medicine
Plan Design
Personal Drug History
Behavioral Analytics
and Outcomes
IDs Most Effective
Communication Mode
Mail
E-mail
Pharmacy
Text
Inbound IVR
Customer Care
Outbound IVR
MD Communication
“Let’s make
that change.”
DATA ON ACTUAL BEHAVIOR
SAVINGS AND HEALTH OPPORTUNITIES FOR HELEN, NEWLY DIAGNOSED WITH DIABETES
17
Patient story is represented for illustrative purposes only. Any resemblance to an actual individual is coincidental. All data sharing complies with applicable firewall and privacy laws.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Days’ Supply Dramatically
Affects Adherence
Comparison of annual adherence: 30-day vs. 90-day supplies
100%
Annual MPR
80% MPR
75%
14%
14%
74%
72%
ACEs
ARBs
12%
13%
16%
14%
69%
71%
Metformin
Statin
50%
76%
73%
25%
0%
CCBs
Sulfonylureas
Notes:
1) MPRs were calculated using 2007 data for patients whose initial 2007 RX was in the first quarter of 2007 using claims from the remainder of 2007.
2) A random sample of 5% of members were selected from the BOB.
Source: Analytic Core Services, 2009.
18
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
MPR Comparison 90-Day Retail vs. Mail
MPR1 for Initiators2 from a 5% BOB Sample3 by Drug Class
100%
78%
75%
72%
72%
77%
78%
71%
69%
74%
69%
74%
76%
69%
50%
25%
0%
ACEs
90-day Retail
ARBs
CCBs
Sulfonylureas
Metformin
Statin
90-day Mail
Adherence at mail is systematically higher
than among 90-day retail programs
19
1) MPRs were calculated using 2007 data for patients whose initial 2007 RX was in the first quarter of 2007 using claims from the remainder of 2007.
2) Initiators did not have a claim for a drug within the indicated class in the last six months of 2006
3) A random sample of 5% of members were selected from the BOB.
Source: CVS Caremark Analytics and Outcomes, 2009.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Retail/Mail Choice Increases Adherence,
While Also Driving Low Cost Solutions
Maintenance Choice Improves Adherence Compared to Mandatory Mail
1000 People Starting Statin Therapy
1000
1000 1000
MAINTENANCE CHOICE
MANDATORY/INCENTIVIZED MAIL
30% MORE USERS
1 IN 3 DROP OFF
BEFORE 1ST REFILL
750
730 720
NEARLY HALF
NEVER MAKE IT TO
MANDATORY MAIL
580
500
520
DAY 1
40 DAYS
90 DAYS
No Surprise: Choice Improves Adherence!
20
Source: CVS Caremark Enterprise Analytics study of adherence in Maintenance Choice, 2009.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
470
360
250
0
STILL ON THERAPY WHEN THEY
HAVE A CHOICE OF ACCESS
180 DAYS
Maintenance Choice vs. Mail:
A More Personalized Consumer Experience
MPR1 rates for 90-Day Starts2 by Maintenance Class3 and Delivery Channel
100%
89%
80%
78%
82% 81%
85%
81%
85%
83%
85%
75%
75%
78%
82%
81%
82%
74%
50%
25%
0%
Overall
Top 6
ACEs
CVS
21
Anticonvulsants
Hypertensives
PPI
SSRI
Statin
MAIL
Notes:
1) MPR was calculated from the date of the a patient’s first RX within a maintenance class for the following 180-day period, truncating MPR at 1 for those where the sum of days exceeded 180.
2) 90-day Starts included initiators and those patients who had not received a 90-day RX in the 180 day period preceding their first RX within a maintenance class
3) Maintenance classes were any GPI4 class where 75% or more of the claims were listed as maintenance medications, these classes accounted for 99.1% of all claims designated as maintenance class
4) Results represent the experience from a pilot client’s patients, individual maintenance classes had sample sizes ranging from around ten to 50, with most around 30.
Source: CVS Caremark Analytics and Outcomes, 2009.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
90-Day Mail Pricing Case Study
Client Need
Solution
Results
• 67K-life client wants to maintain mandatory mail savings and increase
member satisfaction
• Client chose 90-day mail pricing mandatory plan design, Maintenance
Choice®
• Members gained access to 90-day mail pricing at CVS/pharmacy
• Members received letters to make transition
• Twelve months post implementation, 84% of eligible maintenance utilization
filled at 90-day mail pricing while improving member satisfaction*
• Adherence increased up to 5%; members that are optimally adherent
increased up to 7%
“Through Maintenance Choice, our members can enjoy the flexibility
of picking up their medications at a local CVS/pharmacy.1”
22
*Based on days supply. Data represents non-specialty maintenance drugs.
The Maintenance Choice program is available to self-funded employer clients that are subject to ERISA. Non-ERISA plans such as insured health plans, plans for city, state or
government employees, and church plans need CVS Caremark Legal's approval prior to offering the Maintenance Choice program.
Source:
CVS Caremark.
Caremark Analytic
data, February
2010.
CVS Caremark
employer
testimonial, December 2009.
©2009
All rightsConsulting
reserved. Services
CVS Caremark
proprietary
and1.confidential
information.
Notclient
for distribution.
19998Kellogg 6-2010
Behavior Change Moving from Mandatory
Mail to Maintenance Choice®
Delivery Channel of Maintenance Medications (% of Days’ Supply)
81.0%
51.5%
42.9%
39.7%
37.3%
46.0%
34.1%
49.6%
MAIL 90-DAY SUPPLY
CVS 90-DAY SUPPLY
31.8%
19.0%
16.6%
17.4%
16.7%
16.3%
Q4 2008
Q1 2009
Q2 2009
Q3 2009
Q4 2009
RETAIL 30-DAY SUPPLY
*Data represents non-specialty claims
“I travel frequently and would much rather pick-up my medications
at a pharmacy. I also like the automatic refill option. 1”
23
Source:
CVS Caremark.
Caremark Analytic
Services
data, February
2010.
CVS Caremark
Member
Survey,
Spring 2009.
©2009
All rightsConsulting
reserved. CVS
Caremark
proprietary
and1.confidential
information.
Not
for distribution.
19998Kellogg 6-2010
Choice of Access Drives Optimal
Adherence
Drug
Category
Average
MPR 2008
Average
MPR
2009
%
Increase
in MPR
% Optimally
Adherent
2008
% Optimally
Adherent
2009
% Increase
Optimally
Adherent
Diabetes
76.6%
79.2%
3.4%
57.2%
61.7%
7.8%
Cholesterol
80.2%
80.3%
0.1%
64.6%
65.2%
1.1%
Asthma
67.6%
71.3%
5.5%
46.9%
50.0%
6.6%
Hypertension
81.6%
84.3%
3.3%
68.6%
73.3%
6.9%
“Another convenient way for members to purchase prescriptions
at an affordable price and maintains compliance with therapy.2”
*Optimal adherence is defined as MPR ≥ 80 percent.
Source: CVS Caremark Analytic Consulting Services data, February 2010. 2. CVS Caremark employer client testimonial, December 2009.
24
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
19998Kellogg 6-2010
Engagement Changes Behavior:
Targeted Adherence Outreach
• Challenge
– Close to 70% of plan participants prescribed a chronic maintenance
medication will discontinue taking it within the first year1
• Solution
– Clinical interventions throughout the treatment cycle of participants on
maintenance medications with the right tactics to engage each plan participant
• Welcome letter
• Adherence survey
• IVR and Web: automated refill reminders, renewals, pick-up prompts
• Face-to-face non-adherence counseling at CVS Retail
• Local CVS pharmacist outreach calls to participants identified as
potentially non-adherent
• Personalized therapy drop-off letters to plan participant and provider
Result: 35 percent of plan participants chose to
restart therapy as a result of Adherence Outreach2
25
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Achieving Adherence Results with
Proactive Pharmacy Care™
Adherence of Participant Group vs. Control Group1
15.5%
100%
0%
7.8%
2.8%
25.0%
4.1%
60%
20%
16.9%
14.4% 3.0%
80%
40%
24.8%
5.8%
2.3%
*
*
+
Diabetes
10.4%
*
*
*
3.4%
3.8%
*
*
*
*
+
*
Hypertension
5.2%
High Cholesterol
Heart Failure
*
*
*
Respiratory
*Statistically significant after adjusting for age, gender, health status, and mail use. + Measurable, but not statistically significant.
Non-Adherence to Adherence
Maintaining Adherence
MPR
Program Impact
Proactive quality care prevents lapses in therapy,
achieving 25% higher adherence.
26
1. CVS Caremark A&O Evaluation of ATC Impact, 2008.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Comprehensive Adherence Support
Across Care Continuum
Challenge
Up to 60% of new
prescriptions are never
filled1
Results
• Pick-up reminders
• Electronic prescribing
Pick-up rate increased
up to 30%6
1 in 3 stop therapy
before first refill2
• First-fill counseling
• Refill reminders
• Welcome letter
Up to 70% stop therapy
within first year3; 50% are
inconsistent with therapy4
• Therapy drop-off and • Face-to-face counseling
noncompliance letters • Personalized
• Copay incentives
pharmacist calls
• Physician messages • Specialty CareTeam
• Automatic refill and
calls
renewals
44% have gaps in care5
27
Capabilities
•
•
•
•
• 90-day supply
assistance
• Self injection training
at MinuteClinic
Face-to-face physician consultation
Screenings at MinuteClinic
Physician messaging
Participant health reports
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Reduced
drop-off by 5% to 10%
50% restarted therapy8
Improves adherence
by 14-25%9
Beginning statin therapy
after a heart attack saves
$120 per participant10
Case Study: Best Practices in Evidence Based
Plan Design
Client Need
Solution
• 12,800 life employer wanted to increase employee adherence to drug
therapy in several disease states
• Balance ROI – pharmacy cost increase vs. overall medical savings
• Client implemented Evidence-Based/Value-Based plan 7/1/07
• Reduced member cost share to first tier copay within
Asthma/COPD, Oral Diabetes, Insulin and ARB drug classes
• Members received phone calls and letters to transition, remain adherent
•
•
•
•
Results
28
17.4% reduction in Emergency Room visits for pilot group
Reduced hospitalizations – down 1%
Direct costs declined 28.4%
Impact on overall health care trend
– Pilot group (members with asthma, diabetes, COPD, etc.) trend was 2.2%
lower than the overall group (all members)
Source:
Client-reported
October
2009. CVS Caremark proprietary and confidential information. Not for distribution.
©2009
Caremark.data
All rights
reserved.
Kellogg 6-2010
Pharmacy Adherence Results
PERCENT OF POPULATION
Case Study: Average MPR by Class
67%
75% 73%
61%
75%
76%
58%
53%
47%
50%
44%
40%
35%
INSULIN
ASTHMA/COPD
Jan-Jun 07
Jul-Dec 07
Jan-Jun 08
44%
50%
40%
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
40%
Oral Diabetes
Jul-Dec 08
Jan-Jun 09
Sustained improved adherence in key chronic conditions.
29
78%
ARBs
75%
75%
EBPD Effectively Increases Adherence
Relative Improvement in MPR by Baseline Adherence Category
80%
60%
40%
Compliance-based EBPD
Therapy- based EBPD
BoB Benchmark
73.4%
42.8%
32.4%
20%
8.4%
0%
-1.2% -3.5%
-20%
Poor: MPR<60%
Moderate: MPR 60%-80%
-4.5% -6.3%
-12.1%
Optimal: MRP > 80%
• An average client’s adherence strategy improves adherence
32% among those with poorest adherence rates
• EBPD improves adherence 73% among the same group
Greater adherence improvements
in populations with low baseline adherence.
30
Source: CVS Caremark A&O Evaluation of EBPD Impact, 2009.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Pharmacy Advisor™: How It Works
1. Identify members who can benefit
2. Outreach to engage and motivate (Mail, Phone, Face-toFace)
3. Member Counseling (Mail, Phone, Face-to-Face)
– Prescriber engagement if needed
4. Monitor and Follow-up
5. Report
31
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
Pharmacy Advisor: Managing Diabetes – Multiple
Channel Communication
32
Diabetic Member Experience
Diabetic Services Needed
What Do I Need to Know?
Member Resources
• How to Get Started
• My Diabetes Medications
• Importance of Blood Glucose Monitoring
• Recommended ADA Exams and Labs
• Diabetes Care Kit
• First-Fill Adherence Counseling
Gaps in Care and Adherence Counseling
- Phone, Letters and Web
- Face-to-Face
Patient Education and Support
- Phone, Letters and Web
- Face-to-Face
• Diabetes Advocate
• MinuteClinic®
How Can I Afford All of This?
Multi-Channel Savings Counseling
• Prescription Savings Opportunities
• Blood Glucose Monitor Programs
• Diabetes Supplies and OTCs
• Exams and Lab Tests
Copay Wavier, Generic and Mail Savings
- Phone, Letter and Web
- Face-to-Face
• Referral to Free Meter Programs
• 20% ExtraCare® Health Savings
• Affordable, Convenient MinuteClinic Visits
Who Can Help Me Stay on
Track?
Fully Informed Interactions
• Full View of Patient History Care Needs
• Pharmacist/Physician Coordination
• Integrated Health Messaging/Data Exchange
• MinuteClinic Exam and Lab Data Sharing
• Pharmacist
• Diabetes Advocates
• Physicians
• DM Program/Health Advocate Support
Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
• ©2009
Nurse
Practitioners
Kellogg 6-2010
CVS
CAREMARK
OTHER PBMs
Pharmacy Advisor™:
Higher Member Engagement
% Targeted Members Engaged1
74%
47%
Phone
Advisors
33
Disease
Management
Average
We reached and engaged
more targeted members
with diabetes
Face-to-Face
Advisors
Source: Cutrona et al, Modes of delivery for interventions to improve cardiovascular medication adherence. Submitted for publication. CVS Caremark Harvard Adherence Partnership, 2009.
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
After 3 Months: More Gaps Closed
Face-to-Face Advisors
Phone Advisors
25
20
PILOT
+98%
+59%
GAPS
CLOSED
GAPS
CLOSED
CONTROL
0
PILOT WEEKS
14
0
PILOT WEEKS
Gap closure will continue to improve over time.
34
Note: Condition Management pilot results for pilot participants in defined pilot region
Source: A&O gap closure data
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
14
Evaluating Benefit Structure and Delivery Alternatives to
Support Improved Adherence, Pricing, Clinical Support
and Customer Satisfaction
30 Day
Refill
90 Day
Retail
Benefit
90 Day
Retail
Network
Initial
Adherence
Ongoing
Adherence
Mail Pricing
Clinical
Support
Customer
Satisfaction
35
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010
50%
Incentivized/
Mandatory Maintenance
Mail
Choice
In Summary
• Poor adherence to medication results in tragic economic and human
consequences that drive healthcare cost.
• CVS Caremark has created the first six sigma approach to analyze root causes
and implement counter measures across channels.
• The key to success is an integrated process of improvements in pharmacist
counseling, convenience, access, communication and plan design.
• We are anxious to work with you to reduce overall healthcare costs by improving
adherence health outcomes.
The most significant opportunity to improve health outcomes and
deliver health and productivity savings is improved adherence.
36
©2009 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution.
Kellogg 6-2010