Disrupting Healthcare from a Consumer Retail Space · between Q1 2014 and Q1 2015 4 • More than...

The Governance Institute’s Forum on Consumerism & Transparency – The Ritz-Carlton, Amelia Island

Amelia Island, FloridaNovember 13–15, 2016

©2016 CVS Health and/or one of its affiliates: Confidential & Proprietary

Willis ChandlerVice PresidentHealth System AlliancesCVS Health

October 14, 2016

Disrupting Healthcare from a Consumer Retail Space: CVS' Experience to Date

Agenda

1. Consumer driven healthcare trends

2. Challenges these trends presented to CVS

3. Our response

4. Questions and takeaways



Emergence of Consumer-driven Health Care

Emergence of consumer-driven health care

ENROLLMENT IN EXCHANGES1

Previously uninsured gaining coverage

• Uninsured rate fell from 20.4% in Q4 2013 to 11.5% in Q1 20162

• More than half of adults with new exchange or Medicaid coverage uninsured previously3

Market is shifting to individual shopper • Individual market enrollment grew 37%

between Q1 2014 and Q1 20154

• More than 6M people now receive health coverage through private exchanges, with a 35% increase projected for 20165

EVOLVING MARKETPLACE

10

14

18

22

25

6

8

13

15

17

2015 2016P 2017P 2018P 2019P

Public Exchanges

Private Exchanges

1. Accenture forecast, CBO update 2016, Avalere projections, CVS Health analysis. 2. “Health Insurance Coverage and the ACA, 2010-2016,” ASPE Brief, March 2016. 3. “Affordable Care Act Tracking Survey,” The Commonwealth Fund, May 2015. 4. “Health Enrollment trends and Market Outlook,” Mark Farrah Associates, June 2015. 5. Accenture projections, CVS Health analysis.



“Retailization” of health care continues with growth in consumer-directed health plans

Sources: AIS’s Inside Consumer Directed Care; Kaiser; AHIP surveys.; Advisory Group infographic

33319b

What do consumers want from healthcare?

• Transparent search

• Convenient access

• Durable relationship

• Positive encounter

As Patient Cost Share Rises…

Promoting Healthy Behavior Is Critical in Avoiding Unintended Consequences with CDHPs

CVS Health is positioning itself to help meet consumer needs

CVS Health Advantages

More than 9,500 convenient locations

CVS/minuteclinic

Innovative plan design options

Adherence programs: Pharmacy Advisor

Trusted brand

Note:1. Retail pharmacy locations include more than 1,660 Target locations.

Cost

Adherence

…sustaining adherence becomes more challenging

…patients may choose to cut corners on their health and

wellness needs to avoid costs



Consumer-driven Challenges for CVS

Inconsistency

8

≠

© 2015 CVS Health Confidential & Proprietary



CVS Eliminates Tobacco


How often do consumers want to come to the pharmacy?



The Relationship Between Therapeutic Complexity and Medication Adherence is Strong

Source: Choudhry NK, Shrank W. Archives of Internal Medicine, 2011.

As their therapy increases in complexity, statin users become less adherent1

3638

47

5765

71737375

Sta

tin

s to

Ad

her

ence

(%

)The average statin user:

• Takes 11 medications, 9 of which are maintenance medications

• Makes 5 visits to the pharmacy per month

• Has at least 2 different prescribers

Least Complex Therapy Most Complex Therapy

37949

ScriptSync® : reducing medication complexity for patients taking multiple medications a

Coordinates refill and renewal schedules for patients taking multiple maintenance medications

ONCE COORDINATION IS COMPLETE, PATIENTS CAN:

Pick up all maintenance medication refills in a singleCVS Pharmacy visit

37481



Labeled dosing packages

Date and day of week clearly labeled

Pre-packaged medication

Sorted by time of day

Medication name and dosage

Consumers expect to…

Transparent SearchConsumers expect to:• Know the price in advance

• Find a provider who is a good personal match

• Learn about other patients’ experiences

• View available times and schedule an appointment online

Convenient AccessConsumers expect to:• Make an appointment outside of traditional

business hours

• Have a location open for immediate care

• Schedule same-day appointments

• Have the option to see another provider if theirs is unavailable

• Talk to a provider without having to travel

Durable RelationshipsConsumers expect to:• Have access to all of their clinical information

• Trust that the health system knows them and their unique needs

• Have the health system anticipate and support their clinical and non-clinical needs

Positive EncounterConsumers expect to:• Find the right office or location without getting lost

• Have their appointment start on time

• See a clinician who treats them with respect

• Understand their bills and be able to pay easily

• Voice concerns and have someone respond quickly

Source: The Advisory Group Infographic



>3,100Providers (NPs/PAs) nationwide

MinuteClinic: High-Quality, Lower-Cost Care

32 million+ visits

Walk-in care, seven days per

week

Up to 80% savings over higher

costs of care

94% overall patient

satisfaction

70+major health system

affiliations

1100+ Full-time Clinics in 33 States and D.C.

THE FIRST RETAIL HEALTH CARE PROVIDER TO BE FULLY

ACCREDITED BY THE JOINT COMMISSION

50% of MinuteClinic patients do not have a PCP50% seen on Evenings and Weekends

Rapidly Growing to Meet Access Needs: Comprehensive national network of clinics (includes Target Clinics)

More than 50% of the U.S. population is within 10 miles of a MinuteClinic

More than 1135 locations in 33 States and D.C. as of January 2016




Expanding access with telehealth services

Source: JM Polinski, T Barker, N Gagliano, A Sussman, TA Brennan, WH Shrank. Patients’ Satisfaction with and Preference for Telehealth Visits. J Gen Intern Med, August 2015. 1. All patients who responded to the survey. N=2383

Exploring expanded access opportunities via strategic partnerships to expand the future of telehealth

MINUTECLINIC TELEHEALTH MODEL— 15,000 VISITS

95% of patients rate their telehealth visit as good or better than a traditional visit

37895

Looking Ahead: Creating Digital Solutions For Patients

ONLINE WAIT TIMES REMOTE QUEING SCHEDULING

View wait times online and with mobile

Sign in to queue online and with mobile

Schedule future appointment

• 2015: 3-million texts alerts sent from kiosk

Sign intoKiosk

Agree to text alert

Receive text for return

Return for visit

• 2016: Deploy online wait times, remote queuing, and scheduling

Patient decides where to wait




CHOOSEDELIVERY

Empowering Patients with Our Digital Tools

Innovation helps make prescription management easier for patients

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.

REAL-TIME ALERTS

FAST, SECURE ACCESS

SCAN TO REFILL

ADHERENCE REMINDERS

90% of patients agree that the option to pick up at CVS Pharmacy makes their lives easier.

Patients Want Choice: With Specialty Connect, More Than Half Choose Retail Pickup

*Based on the availability of CVS Pharmacy locations and subject to applicable laws and regulations. Services are also available at Long’s Drugs locations. Products are dispensed by CVS Specialty Pharmacy and certain services are only accessed by calling CVS Specialty Pharmacy directly. Certain specialty medication may not qualify. In compliance with state laws in-store pick up is currently not available in Arkansas, Oklahoma and West Virginia. Some states require first fill prescriptions to be transmitted directly to the dispensing specialty pharmacy. Other restrictions may apply. Products available through the specialty program are dispensed by CVS Specialty in compliance with all applicable state laws.

HIGHER SATISFACTION, BETTER OUTCOMES• 11.4% more of these patients are optimally adherent

CHOICE• Specialty prescriptions accepted at every CVS Pharmacy location

• Choice of retail pick up or delivery

ACCESS AND SUPPORT• Access to 99% of specialty drug spend including medications

with limited distribution

• Centralized clinical support



Connectivity and Healthcare Silos

• Adherence opportunities delivered to EHR

• Review patient-specific alerts at point of care or at the convenience of care managers

• Evaluate and take action on adherence opportunities

We’re connecting with providers to help provide effective care for your patients

Ability to connect with most major electronic health record systems

*Not commercially available. CVS Health uses and shares data as allowed by applicable law, our agreements and our information firewall.

Connected at CVS Pharmacy*

• MinuteClinic EHR can connect to our affiliates to access patient information, such as current medications and allergies

• MinuteClinic sends visit summary to provider EHR, promoting transparency and continuity of care

Connected at MinuteClinic

38031



• Pharmacy reaches out to patient

• Patient does not pickup script

• Clinical eMessaging program* uses smart targeting on specific medications to help ensure clinical relevance

• After a certain amount of time has passed without script pick up

• Message is sent to EHR

• Message includes patient information, script details and reason for the communication

• Sent through DIRECT message

• Message is imported into patient health record

We’re letting providers know when their patient is not picking up scripts

Data is only shared in accordance with the law and our agreements with our clients. *Not commercially available.

Patient Does Not Pick Up Script

Message is Generated and Sent

Message Arrives in EHR

ELECTRONIC CLINICAL MESSAGE FLOW

38031

Asking Ourselves Hard Questions



Infusion Therapy for Specialty Conditions: A Hospital Case Example

…are estimated to account for $35 billion of the specialty market1

…make up as much as 33% of specialty drugs in the pipeline2

1. EvaluatePharma. 2. EMD Serono Specialty Digest. 3. CVS Caremark Internal Data, 2014.This slide contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.

INFUSED DRUGS…

$4,215

$7,457

$171 $933

Home Hospital Outpatient

Drug Cost by Site of Service Average Cost of Admin

INFLIXIMAB (REMICADE), STANDARD DOSING OF 100 KG PATIENT3

Up to

33%of pipeline

37949

Key Themes and Takeaways



Key takeaways for health systems

Patients know more and expect more

Culture of consumerism is accelerating with employer and payor cost sharing strategies

Consumerism is here to stay

Consumers vote with their feet (50% of Minute Clinic visits are after hours)

How aligned is your business with consumerism?

Strategic alignment

Consumers do not want healthcare silos

No health services organization is expert at everything thus partnerships are an inevitability

Is partnering a core competency of your organization?

Strategic partnerships as a core competency

©2016 CVS Health and/or one of its affiliates: Confidential & Proprietary

Thank You



Our Model Meets Evolving Healthcare Needs…

Patients PayorsProviders

Medical Claims Editing

…helping deliver excellent outcomes while lowering costs

Long-Term Care

PBM/ Mail

SpecialtyInfusion

Digital

Retail Clinics

Clinical Programs

Retail

38031

Disrupting Healthcare from a Consumer Retail Space · between Q1 2014 and Q1 2015 4 • More than...

Documents

Transcript of Disrupting Healthcare from a Consumer Retail Space · between Q1 2014 and Q1 2015 4 • More than...