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Supporting Our Patients with Chronic Disease

September 19, 2019 | Condition Management

A doctor comforting a female patient.


As we transform the health care experience for all patients, we pay special attention to the needs of patients with chronic diseases who seek care more frequently. We continue to invest in the development of smart and robust solutions to address the health impacts and escalating costs related to chronic disease in the U.S. Our efforts include expanding preventive care and treatment for chronic conditions, improving medication adherence, coordinating care across the healthcare system, engaging patients where they are, and offering healthier product options at our stores.

Personalizing Care Solutions

Our Transform Care programs continue to deliver frequent and highly personalized care to millions of CVS Caremark members who are managing a chronic condition. The programs combine patient-related health and pharmacy data with drug cost management strategies that make care more effective, affordable and easy to navigate.

Transform Diabetes Care, introduced in 2016, has since been adopted by more than 230 CVS Caremark clients, representing 3.4 million members. The program uses advanced analytics to identify members with diabetes and target appropriate interventions. A certified coach develops and helps execute personalized management plans for Type 2 diabetes patients based on their pharmacy data and electronic health record information. The patients use at-home, connected glucometers for glucose readings, which their coach can monitor to offer help as needed. The program also ensures patients receive prescription refill reminders, in-person counseling on diabetes management, and comprehensive diabetes visits at MinuteClinic locations at no out-of-pocket cost.

By 2021, we plan to offer an enhanced diabetes program that combines CVS Health’s local and pharmacy care with Aetna’s care management, targeting, analytics and other capabilities, resulting in a best-in-class diabetes and chronic offering. The enhanced program will derive from the current Transform Diabetes Care model, making for a seamless transition and member experience for clients who wish to adopt the enhanced product. Features of the enhanced product may include:

Aetna’s care managers can provide a single point of contact for members with chronic conditions regardless of which conditions members have. The member’s care manager will also have access to the member’s information from their engagement in the Transform Diabetes Care program and can coach based off of that information.

Creating Comprehensive Programs for Complex Conditions

Another way we are reducing costs and enhancing patient care is through the development of comprehensive programming designed specifically for complex chronic conditions like kidney disease and cancer.

In 2018, we introduced a program to support patients with End Stage Renal Disease (ESRD), a disease that affects nearly 700,000 Americans. Taking a staged approach, our program seeks to slow the progression of ESRD and reduce associated hospitalizations. Beginning with early disease identification and patient education, the program will follow with the development of a comprehensive home dialysis program, for both hemodialysis and peritoneal dialysis. Understanding that longer, more frequent hemodialysis treatments often lead to better outcomes, we will initiate a pivotal clinical trial of a new home hemodialysis device in support of a planned U.S. Food and Drug Administration (FDA) submission to obtain market clearance.

We will select new program participants by determining who is most at risk for kidney disease and progression to kidney failure, as identified through medical and pharmacy claims data and predictive analytics algorithms, in accordance with HIPAA. Our Accordant Care nurses will engage these individuals to educate them on their risk level, important tests they should consider taking, and the need to see a nephrologist. This team will work with individuals as they progress toward ESRD.

We also work with our health care partners and clients to help manage the cost of oncology care while ensuring access to vital therapies for patients. Our approach promotes evidence-based cancer care, lower-cost but clinically equivalent treatment options, and a holistic patient care model that helps patients adhere to therapy. An important component of our cancer care approach is helping providers stay up-to-date with the latest research and advancements, a challenge in the fast-paced field of oncology.

In 2018, we partnered with the leading oncology organization National Comprehensive Cancer Network (NCCN) to provide physicians with a tool to access the latest evidence-supported information. Treatment Guidelines from the NCCN are integrated into Novologix, CVS Health’s proprietary technology platform, and serve as the clinical foundation of multi-drug regimen prior authorization (PA) for physicians and patients. Novologix helps drive cost-effective regimen selection by determining treatment coverage that meets treatment plan needs.