When the COVID-19 pandemic began in early 2020, CVS Specialty teams – from pharmacists and clinical experts to our specialized care and customer support units – confronted challenges they had never before seen. For example, Accordant, which provides nurse-led care management to members with complex, chronic diseases, and Coram, delivering specialty pharmacy and infusion therapy services in home-based and outpatient settings, realized they needed to make swift adjustments to ensure safety for all and continue providing quality care for patients.
Prem Shah, Executive Vice President, Specialty Pharmacy and Product Innovation for CVS Health, spoke recently with Andrew Krueger, M.D., Medical Director of Accordant Health Services, and Tricia Lacavich, Vice President and General Manager of Coram CVS Specialty Infusion Services, to reflect on how they responded to the crisis and how it may have a longstanding impact on how CVS Specialty supports patients.
Prem Shah: At the beginning of the pandemic, we knew that our Accordant members and Coram patients would need extra support to make sure all of their concerns were addressed. How did Accordant and Coram work to respond to their members’ and patients’ needs during this time?
Tricia Lacavich: Because Coram offers home-based care, our top priority was creating a safe environment in the home for our patients. We began making video calls to patients to ensure they were feeling secure and able to competently access their medication. We also immediately put a screening process in place to protect the health of our patients and staff.
As you know, personal protective equipment (PPE) was in short supply at the beginning of the pandemic, and our patient-facing nurses were in critical need of gowns, gloves and N100 masks to make sure they remained safe in the patient's home.
You may also recall hospital occupancy was a major concern. And as you’ve said previously, unprecedented challenges require innovative thinking and swift action. Recognizing the need for quick solutions, we put our Hospital Capacity Optimization program in place to help transition eligible IV-therapy patients to home-based nursing care, with the goal of ultimately increasing hospital bed capacity for those who need it most during the pandemic. And now, we’re partnering with HHS to administer COVID-19 treatment to eligible, high-risk patients in their homes or long-term care facilities as part of the U.S. government’s Operation Warp Speed.
Dr. Andrew Krueger: On the Accordant side, we were deeply concerned about the impact a COVID-19 diagnosis would have on our member population, many of whom are immunocompromised. We knew we had to act quickly to educate our staff on care management and prevention guidelines and create a space for them to share questions from our members. One of the ways we provided information to our staff was through a podcast series dedicated to COVID-19 education for our nurses. It covered a range of topics from prevention, to testing and treatments, which were critical to their day-to-day communication with their members.
We also established a set of questions our nurses were required to ask every member on a regular basis to make sure they were staying safe and healthy.
Prem Shah: There’s not a single person in this country who has been unaffected by COVID-19 or its ripple effects – even the healthiest among us. Many of our Specialty patients and members are particularly vulnerable. What have been your patients’ or member’s main concerns about COVID-19, and how have you responded?
Dr. Krueger: Everybody is different. Some Accordant members depend on their physicians for advice about the virus, while others rely on social media. But, across the board, we saw an increase in anxiety in our members – potentially due in part to misinformation. We organized our nurses to focus on keeping members safe and making sure they knew what to do if they got sick.
Depression has been another issue for many of our Accordant members. We’ve been screening members regularly for depression, and we helped with physician referrals and coordinating telehealth appointments when doctors weren’t seeing their patients in person.&
In the early days of the pandemic, some Accordant members told us they were nervous about getting their medications filled in-person at the pharmacy. We worked with them closely to address these concerns, and for many that included shifting to mail order to maintain continuity of care. It’s worth noting that every situation was unique, and the solution was not a one-size-fits-all, so this meant supporting members based on their needs.
Lacavich: Our Specialty patients were concerned about Coram staff coming to their home to administer the infusions, but they also didn’t feel comfortable going to an office or hospital to get them. We invested a lot in education to help patients understand our rigorous guidelines around COVID-19 symptom-checking and the use of PPE to quell their concerns. For example, think about how daunting the N100 mask looks at first. That could be scary for patients to see and it caused real concern, so we aimed to educate them on why our staff wore these masks: They may look scary at first, but they’re really a positive thing that’s meant to protect their health and ours.
In addition, our Specialty patients were also concerned about supply. Some of our tube-feeding patients expressed fear they would be unable to get their nutrition, or their child’s nutrition. Many patients called into our centers asking for 90- and 120-day refills. We worked continually to reassure patients that there was plenty of supply and they would not run out.
These efforts were no small feat and required round-the-clock work and creative thinking from the Coram team at the beginning of the pandemic. However, our patient’s safety comes first, and their appreciation kept our team going. In fact, we’ve received a tremendous amount of feedback from patients who were incredibly grateful to be able to receive their infusions at home, and shared that it not only helped them feel safe during the pandemic, but gave them that human connection so many of us were craving in those early days. In some instances, our Coram staff was there when no one else could be, including their own family.
Prem Shah: What is the greatest lesson you’ve taken away from the past several months?
Dr. Krueger: This is not a new lesson, but one that has been reinforced for me: Health care is deeply personal. It’s most effective when people have meaningful interactions with a real, live human being.
That’s where our nursing teams came in. Members were reassured they were not in this alone – that their care management team is there for them. In a world that was very uncertain and changing rapidly, they brought a bit of calmness and consistency to it.
Lacavich: I've learned we have to be ready to pivot from what we thought and knew as we confront new challenges with an open mind. These are stressful times but my team, as well CVS Specialty as a whole, proved they can move mountains. We faced some pretty challenging situations, but we worked together to ensure our No. 1 priority – patient safety and quality care. Despite the incredible challenges brought on by the pandemic, no one ever just threw their hands up and said, "This can't be done." To me that speaks volumes.