Answering your top 5 most asked questions of 2022

Jessica DaMassa:

Hi, and welcome to CVS Health Live, our ongoing series that delivers timely perspective and relevant insights into tough healthcare issues happening right now. I'm Jessica DaMassa. Well, you guys, we have had an action packed year on CVS Health Live. We've learned so much, we've witnessed so much health innovation, and we've met a lot of really great experts, and we've also had really tremendous audience participation from you guys. So to say thank you, wish you happy holidays and end the year with no question unanswered, we have pulled together what we're calling a mega panel of experts to answer some of your top questions that have been submitted throughout the year. So this episode is going to cover all range of topics. These are your top questions. So everything from issues about health equity to CVS Health homecare, everything will be answered. No question unanswered into the new year.

Let's kick this off and let's get started. All right, I want to set the scene for this first question. Back in March, you guys might remember, we discussed how CVS Health is bringing innovative care options to patients. And one question that came up regarding preventative health really stood out. So we're going to shout out Nikki R. Nikki, thank you so much for your question. Back then, Nikki asked, how can data from the CVS Health network help to predict disease risk and intervene for better outcomes? All right, so to answer this one, I'm excited to bring in Dr. David Fairchild. He's the Chief Medical Officer of Retail Health. David, can you share some insight here for us please?

Dr. David Fairchild:

What a great question. So thanks for that question, Nikki. And I guess I would start by saying data is a very powerful tool for healthcare systems and clinicians to help improve the health of patients, and I'm really happy to be able to talk about that. And I guess before I start, I would say that having the data is really only half the solution. So you need to have the data and manage it well, but you also need technology and data management systems to be able to fully execute on and make the most of the potential of having data to improve the health of patients and populations of patients. And I'm really excited to be able to talk about this. It's something that's very, very much a passion of mine as the use of electronic health records and others, and I'll talk some more about that.

So I mentioned electronic health records. Probably one of the most transformative events during my healthcare career was the development of an electronic health record or EHR for short, that we use and is very much commonplace now. When I started out, we did everything on paper. And so it's made such a huge difference. And the power and potential of managing data to help improve the health and welfare of patients is just really amazing. Groups like the Medical Group Management Association, MGMA, have pointed out that electronic health records have lots of values, like increasing the accuracy of the way we take care of patients, helping to reduce costs, and also providing the ability to manage populations of patients. And I'm going to talk about all of these things as we go forward.

So at CVS Health, we use an electronic record called Epic. And the reason we chose that record, that electronic health record, and there are lots of systems that one can choose from, is that it's probably the most powerful and far reaching. So at CVS Health, we use Epic. The electronic health record is basically the backbone across all of our clinical systems. So whether you're in MinuteClinic or Quorum or even in Pharmacy Now, we're using Epic to be able to coordinate care and make sure that we use data to help improve the care of patients no matter where you show up within the CVS health system.

And there's probably two areas that I'd like to highlight first. One is convenience. The first one is convenience. So how could a health record help the convenience factor of a patient? Well, one of the ways in which it does that is that it provides easy access to data. So let's say for example, you went to a MinuteClinic in Boston, Massachusetts, and you had a test done. That test result gets recorded in the electronic health record. And let's just say a month later, you are in San Francisco and you need to go to the MinuteClinic there or access the health system in some other way. That chest X-ray, that lab test result will be right there.

So that's a very convenient factor because no matter where you go in the CVS system, your data will be at the fingertips. Back in my early days, paper records stayed in one place, they didn't travel anywhere. And these days, you would think that electronic records all talk to each other and that you can access data from anywhere, from any system. And that's just not the case. And one of the reasons we chose Epic is because it has a very good interoperability. So convenience is dependent on having access to your data, and that's one of the reasons we've chosen Epic.

Another example which is related is the ability of electronic records to help reduce cost. So how does that work? Well, think about this. If you had that same lab test or X-ray done, and if it wasn't available when you're in California while you're out there, then the easiest thing for the health system to do is just say, well, let's just repeat that chest X-ray. We'll just do it here. We can't get access to it. And so that's an extra cost, that's a redundant, unnecessary expense.

And so because we have a system of data management that allows providers anywhere in our system to access the data, you don't have to repeat tests unnecessarily. And you would think this is an uncommon event, but I'm here to tell you that it's not. In fact, just a month or so ago, I had to help my mom have a doctor's visit. She lives in New Hampshire, and she had some tests done up there and come down to Boston close to where I live to see a specialist. And it took me, no kidding, hours of phone calls, multiple phone calls, to get that test transferred as opposed to just having the health system just repeat the tests that were already done. So this is a not insignificant benefit of our electronic health record. So convenience for patients and cost savings.

Another way in which we use electronic records, which I think is very, very important, is to drive health screenings. So how do we do this? And so for example, it might be the need to get pap smears or a colon cancer screening test or a mammogram test. The way in which we use data to help people do that is by looking at the health claims. So say Aetna data has claims on every health test that you've done that has a medical claim with it. And so we can look and see, oh, when was David Fairchild's last colon cancer test? Or when was his last blood pressure check? Those kinds of things.

And so there are guidelines or protocols for when people of different ages should have their tests done. And so we can use the data that we have in Aetna in many clinical, all the clinical data that resides in Epic and other places, analyze those data and then be able to send reminders to patients, hey, you're overdue for your colon cancer test, or, hey, you're overdue for your mammogram test. This would be a good time to do to get that test done. And because you need it to help screen for cancers or whatever.

And you would think again that the impact of these things might be small, but I can tell you for sure that there are many examples of patients who thought, I don't have colon cancer, I don't need to get that test. And then somebody from Aetna reaches out to them and encourages them to get the test. Or the MinuteClinic provider reminds them that they're overdue and they get that test. And sure enough, a small breast mass or a small colon cancer gets found and it's treatable because of that screening test. I've seen that story over and over again in my career. So using data to help screen patients and find diseases or cancers or other things when they're easily treatable is a very powerful way in which we use data to help improve people's health.

And we don't just keep data to ourselves either. One of the things that I'm very proud of is that we do a good job of communicating with other providers when patients come in to see us. And again, we ask permission for patients to allow us to transmit data, but after a MinuteClinic visit for example, we can communicate back to someone's primary care physician or other physicians of their choosing and make sure that they're aware of tests that were done in MinuteClinic. And overall, we can have access to about 75% of health records through Epic. And then we also are part of data sharing consortiums for quality improvement purposes to make sure that we can share electronic health data with other electronic health records, not just through Epic. So we do, I think, a good job of trying to be as interoperable with other health systems and other doctors as possible.

And then when we think about the power of data, we like to think about our datasets as being holistic. And what do I mean by that? So data that resides in one part of the CVS Health system can be used in another part of the health system. So a good example might be Aetna has a lot of claims data. And so for example, we know who patients are who have diabetes, and patients who have diabetes often are on medications and they make frequent visits to the pharmacy to collect those medicines. One of the ways in which we use data to help improve patient's health is we can send a message using the Aetna data to the pharmacy. So when the patient comes in to pick up their Metformin or other medication for their diabetes, the pharmacist will see a note, hey, David, who's standing in front of you is overdue for his diabetic retinopathy scan. Remind him of that.

And the pharmacist can also point out that the MinuteClinic, which is just across the store there is one of the options if they want to, to get that diabetic retinopathy scan done. So that's a way in which we use data across the CVS Health systems to help encourage patients to get the tests done that they need. So in summary, what a great question, and it's really exciting for me to talk about the use of data and how we use it holistically. We take people's, patients, your health data very seriously and guard it and protect it as we should, but we also use it to help encourage people to get the tests done that they need and try to use that across our system. So I feel very proud of where we are, and it's very exciting to be part of a company that's not only helping individual patients get the screening tests that they need, for example, but also managing populations of patients to help improve the health of a population of patients and reduce the healthcare costs here in the United States. So thank you for that question.

Jessica DaMassa:

All right, thanks David. Well, that crosses one question off of our list. We still have a few to go. This next question actually brings us to a popular topic right now, population health. So population health refers to health outcomes within a group of people rather than just considering the health of one person at a time. So focusing more on the community rather than the individual. Back in June, David G. asked us, does CVS Health have a population health strategy? I'm going to turn to a guest from CVS Health Live past to answer this one. Please join me in welcoming back to CVS Health Live, the Executive Vice President and Chief Medical Officer for CVS Health, Dr. Sree Chaguturu. Sree it's great to see you again. I can't believe we're already at the end of the year in approaching the holiday season. But before we get there, can you shed some light on what CVS Health is doing around population health?

Dr. Sree Chaguturu:

Thank you, Jessica. It's such a great question from David G. about what is population health? What is CVS Health's strategy? And I think population health is a really confusing term for a lot of people. So before I answer the question of what is CVS Health's strategy regarding population health, let me just take a brief moment to define it the way that I think about it and that we think about it as an organization. And you can think about population health, as you had talked about, as uplifting communities, improving community health. But more specifically, I think about it as two different things, clinical strategies to improve health, specifically around chronic disease management and preventative services of common conditions. Not only limited to that, but it really is about clinical interventions. The other piece is financial incentives and really thinking about how do we make sure that we move from a system that is fee-for service, paying for the things that you do to managing total cost of care and improving quality simultaneously.

So CVS Health's strategy is tackling both of those things. With respect to improving clinical quality, we are leveraging, utilizing, all of our resources across Aetna Retail Pharmacy and in Caremark to ensure that patients have access to the care that they need to understand what preventative service that they need and connect them to those preventative services. It could be through behavioral nudges and messaging through Aetna or Caremark to members to remind them about those clinical services, but it could also be directly providing those services. If you look at MinuteClinic, there are 1100+ MinuteClinics across the country and the types of services that they're providing, it's not just acute care services. It's expanded beyond acute care to chronic disease management, preventative out services. You can get your vaccines, you can get your hypertension managed, you can get your diabetes managed. These are critically important to managing population health. So again, we are clinically engaging with members and patients in their communities in the ways that they need.

The financial piece. So the second part of population health management is incentivizing providers by paying them for improving population health. And across our health benefits, we are working with providers across the country in value-based arrangements. So that's identifying measures of success that are both quality and financial and paying for improving quality of care for populations. So we are both doing it clinically as well as financially, to ensure that we're delivering the promise of population health across this country.

Jessica DaMassa:

All right. Thank you so much, Sree. It was a pleasure seeing you again, and we really appreciate you joining us here again today. All right, onto our next question. So over the summer, CVS Health provided an in-depth look at trust in healthcare in their health trends report. One of the things we learned was that even as trust in public institutions falls, consumers still continue to place high levels of trust in the healthcare system. But one of the questions that came up is, where do underserved communities fall in terms of trust? Darlene N. asked, is CVS Health working on building trust and winning over black and Hispanic communities? And I agree, Darlene, this is definitely a mission that should be at the forefront of how we're doing healthcare. I'd like to invite Dr. Joneigh Khaldun, Vice President and Chief Health Equity Officer to provide some insight into this question. So Joneigh, thank you so much for joining us here again today. Can you talk to us a little bit about how CVS health is building trust among black and Hispanic communities?

Dr. Joneigh Khaldun:

Well, thanks Jess. It's great to be back and thank you, Darlene for that really important question. And it's true that many underserved communities are understandably frustrated with the healthcare system and don't trust it. And this is because of historical and quite frankly, current failures of the healthcare system to provide care in a respectful and equitable way. And this does create mistrust. And this lack of trust unfortunately, contributes to disparities, which is really why it's so important that we focus on establishing and strengthening trust, especially among black and Hispanic communities. So we also know that when people don't see healthcare providers who look like them and have shared lived experiences, it contributes to worse health outcomes. And this is particularly concerning as we look at representation within the healthcare workforce. So for example, when we look at the mental healthcare workforce across the country, less than 5% of psychologists are black, but black people actually make up about 14% of the population.

And there's similar racial and ethnic under-representation for the Hispanic community as well as among physicians. So we're absolutely working to make sure that across all of our lines of business, our colleagues truly represent the people who we serve. And in fact, I'm proud to share that in support of our diverse representation goals At CVS Health, we've expanded recruitment efforts and we now work in collaboration with nearly 90 historically black colleges and universities in 90 Hispanic serving institutions. And we will continue to support diversity in the workforce because it's just so important to advancing trust. We're also looking for ways to connect with our Aetna members. So actually two years ago, I'm so proud of this program, we launched the Medicare Multicultural Initiative to really bring a cross-functional approach to health equity for black and Hispanic members.

The program has already helped members across Florida and Texas, also in Pennsylvania, helping them to better manage their diabetes and high blood pressure. And because of the success of this program, we're actually expanding it into additional markets. So I'm really, really excited about that. We're also building trust through our local retail strategy. So our CVS Pharmacy y mas locations look and feel unlike any other CVS pharmacy. They're actually staffed with bilingual associates and healthcare professionals and provide brands that really do speak to and are more personalized to Hispanic community. And then finally, during the pandemic, we also addressed inequities related to the COVID-19 pandemic and vaccine access and access to testing with a particular focus on black and Hispanic populations. So in 2021, we actually provided $1.8 million in funding to community health centers, free and charitable clinics and black churches to expand vaccine education and distribution. So I would say that while we still have a lot of work to do, we are absolutely committed to building trust and advancing health equity in historically marginalized communities. So thanks, Jess for this question. I'm excited about the work that we have ahead together.

Jessica DaMassa:

Thank you, Joneigh. Thank you so much for answering that question. It's really inspiring to hear the work that you're doing and that you're going to be bringing into next year. All right, up next, our next question, it's going to be focused on our Health Zones initiatives. So you might remember this episode, this is actually one of my favorites from the beginning of the year, the beginning of 2022. And CVS Health had then launched it's Health Zones initiative, which focused on reducing health disparities and advancing health equity in high-risk communities across the country. Love this. We address various populations in the episode, but today we want to provide more information around how CVS Health is supporting aging Americans because they're another high-risk population. So when discussing how CVS Health is engaging high-risk communities, we receive the following question from Daniel G. who asked, how is CVS Health engaging seniors throughout our communities, including those at risk if they miss medications or delay refills due to cost or need to be monitored for chronic conditions?

All right, thanks, Daniel. That's an excellent question. And to provide a response to this one, I'd like to welcome a brand new guest to CVS Health Live. So please join me in welcoming Dr. Alena Baquet-Simpson, Executive Medical Director at Aetna Medicare, a CVS Health Company. So welcome Dr. Alena Baquet-Simpson, it's great to meet you. It's wonderful to have you here. And thank you for jumping in to answer this question. So can you tell us a little bit about how CVS Health and Aetna are supporting seniors and their unique healthcare needs?

Dr. Alena Baquet-Simpson:

Well, thank you Jess for having me. I'm very happy to answer this question. At Aetna CVS Health, we want to ensure that all of our members have access to quality healthcare that's also convenient when and where they need it. And that's why we are enhancing the services available to seniors in our MinuteClinics and health hubs where they can access primary care, urgent care, and mental health services. And for members at risk or those who just prefer to receive care within their homes. There's telehealth, which gained a lot of acceptance during the pandemic. In 2022 all of our Medicare Advantage plans are offering access to telehealth services, again for primary care, urgent care, and mental health services. Now, as I think about the future of Medicare Advantage, I have to reference an article that was out recently that really talked about how the volume of members in Medicare Advantage is expanding, but it's also becoming significantly more diverse.

So as the population shifts, we also need to change our approach to how we interact with members and make sure that we are addressing any inequities in healthcare that might exist for our senior population. So far, we've done a really good job of that with our Aetna Medicare Multicultural program that launched January of 2020. It was designed to drive a culture of health equity. We started our work in this area with a lot of research in the form of focus group. We interacted with internal clinicians, with providers, but most importantly had an opportunity to interact with over 500 Medicare beneficiaries. I can't stress enough how powerful, how meaningful it was to hear directly from the voice of members. And the resounding message was that people have a deep seated need to be heard, to be understood, and to feel that they're cared for. We were able to take the learnings of the focus group work and transform that into guiding principles, which still drive all of our activities today.

And those guiding principles include boosting community involvement as we have activities to include members families, and loved ones. To address whole health. If someone has four conditions, don't just talk to them about one condition, educate them so they have a full picture of their health and better understand where they need to prioritize. We also want to alleviate barriers and then use food as a way in. Now, that's an interesting one because food is often an immediate emotional connector, but it's also often a pain point for people as they are trying to better manage their chronic conditions.

The other thing that we learned through our work is that the number one success factor in this area is establishing trust. And to better do that, we decided on a multifaceted approach that includes member engagement, provider engagement, and community engagement. Now, for our members, as we work with those members who have chronic conditions, diabetes and hypertension, for example, we connect those members with care managers of similar backgrounds so that commonality can facilitate the development of really deep trusting relationships that help as you try to promote behavior change, which can be tough. For our providers, we have exposed them to education around cultural sensitivity and implicit bias. We've delivered over 800 hours of training to providers, to internal clinical staff and outreach staff. And as we work with the community, we are very deliberate in our approach, making sure that we engage leaders in helping us identify what the needs are for those communities, and also participate in developing the interventions that are used to address the needs of the community.

We've been very successful with this and have had multiple events where we have vaccination clinics, there have been other educational forums. We've sponsored virtual healthy cooking shows, and right now we are building out a peer support arm of our work and testing that out in the South Florida market where we're using community health educators and community health workers to support and mentor members with chronic conditions who are at a little lower acuity level. In other words, they're a little less sick than some of the other members that we work with with our care managers. The hope is, the plan is for in 2023 to expand all of these activities. What I'll leave you with is this, at Aetna CVS Health, we work with community, we work with members, their families, with providers to again establish that trust, which is the key critical success factor in this type of work. We want to be part of the solution and want to be recognized as the organization that clearly understands and cares for the diversity needs of our member population. Thank you so much for having me.

Jessica DaMassa:

All right. Thank you, Dr. Baquet-Simpson. It's such a pleasure to meet you, and we're so glad that you were able to join us for this very last episode of the year, but don't think for a minute, this means you're off the hook. We are going to have to have you back for a full episode of CVS Health Live in 2023. All right, so this year we also talked about the various ways in which healthcare is being delivered, and this last question really takes this point home. We discussed the benefit of having the ability to access healthcare wherever you are, whenever you need it, and the expectation that consumers now have for this convenience. A few months ago during an episode of CVS Health Live, Hannah C asked, do you offer other delivery services other than prescriptions? Do you have doctors who do house calls?

This is a great question, Hannah, especially with cold and flu season coming right around the corner. So I'm excited to introduce our final guest and also a brand new guest. Let's please welcome Michael Vollmer, Vice President and General Manager of Home Health at CVS Health. Michael, it's a pleasure to have you here, and can you tell us a little bit about CVS Health's Home healthcare delivery offerings?

Michael Vollmer:

Well, thank you so much for having me, and it's really fantastic to be with you as well. And I do want to thank Hannah for her exceptional question. It's such a pressing and important question for us to have some answers to, so let's get into it. So I'm excited to share a whole host of things with you, but as the leading health solutions company for consumers, CVS Health is really focused on delivering healthcare when, where, and how our patients need it most. And yes, that includes in the home. And while we're working to develop new ways to meet patients at home, we've actually been there with them for more than 35 years. More than 50,000 patients receive home-based care each month through Quorum, which delivers exceptionally high quality specialty infusion medications provided by world-class nurses. We also offer virtual primary care, giving members access to primary care on demand or chronic condition management services, and even mental health services, virtually from the convenience of their home or anywhere else they may be when they need it.

And there's a new way that we're starting to serve people at home by helping them head home from a hospital admission. This is a super risky time for patients, and roughly 14% of patients that leave the home actually get readmitted within their first 30 days of discharge. This results in really complicated outcomes for the patients. It's incredibly difficult for their families and their caregivers, and it's also very costly. In 2018, just as an example, there were 3.8 million adult hospital readmissions within 30 days of a discharge from a hospital. Now, that's an average readmission rate of 14%.

Just think about it, 14% of all the people that are discharged from the hospital in this example, had to go back into the hospital. Medicare patients, interestingly enough, make up 60% of these readmissions, the vast majority of those readmissions. Now, imagine that you are a loved one, a vulnerable patient leaving the hospital after an acute event like a stroke or heart failure, and you're about to get discharged, and you begin to realize how very difficult it's going to be once you're no longer in that hospital and at home on your own, to be able to coordinate the care that you need, find the medications that you need, and have the right conversations with the people that you need in order to stay healthy.

This is where we hope to be able to bring real value to our patients and to our partners. This is where CVS Home Health comes into play. Our program is designed to support a person's transition out of the hospital to help them recover in the home. Patients who received home healthcare services saw better health outcomes compared to patients who didn't. In fact, a 60% reduction in those readmissions happened after that 30 day period. By us partnering and being in the patient's home, we can better anticipate their healthcare needs and provide the right services at the right time to be able to help maintain their health, to help them recover while they're in the home, and to prevent them from having to go back into that hospital on another complicated journey. There are a few very important components to our program. I'll go over a couple of them now.

The first example is that our nurse practitioners will be able to contact your primary care doctor, the person that you trust the most, to make sure that he or she knows that you're in the hospital, knows that you've been discharged and can stay connected to your care. Secondly, we'll take a look at the full range of prescriptions that our patients are taking to make sure that there aren't any unintended complications or adverse drug interactions. This is really important and is a leading cause of additional complications at home. And then lastly, we'll help to make sure there's a smooth landing when you do get home, helping to make sure that you adhere to your discharge plan, that you understand that plan and can take full advantage of all the healthcare services that would be available to you as you recover at home.

Through this program our goal is quite simple: help people stay out of the hospital, help them stay at home, help them stay healthy, and have the best possible experience at the lowest possible cost that we can. Let me just give you this very interesting fact. In one study, costs were reduced by 67% when patients were recovering in the home versus recovering in the hospital. And because we'll be meeting patients where they are, this initiative will also serve to help reduce health disparities and social determinants of health, like insecure access to transportation. And because we'll be meeting patients where they are, this initiative will serve to help reduce healthcare disparities and help improve social determinants of health. We'll be able to improve access to things like transportation and general access. We do hope to have this program live in one market with Aetna in the spring of 2023, and then rapidly start to expand that program to other markets and other geographies later that year.

But this is just one example about how CVS Health is investing in providing in-person, in the community, or even in the home care. We also plan to expand our portfolio of products and services to make it easier to serve our patients where and how they need it most. Thank you so much for giving me the opportunity to be here today. It was so exciting to help answer this question and have a wonderful day.

Jessica DaMassa:

All right, thanks again, Michael. You really brought the whole show home with the answer to that question, so thank you again for joining us. Well, you guys, that's it. Those are the top questions that were submitted to CVS Health Live this year, and we can't thank you enough for bringing those questions to the forefront. We think it's really important to address what it is that is most top of mind for you. I mean, that's why we have this show in the first place. We not only want to bring you some of the news about the latest innovations that are happening here in healthcare, but we want to make sure that your questions about those innovations are answered. So thank you so much for watching us all year long, for tuning in, for sharing your comments, for sharing your questions, and for just bringing that overall energy of curiosity to each and every episode.

We really appreciate it. We want to wish you guys all a happy holidays and we want to make sure that you know that we will be back again next year. So if you haven't already, please make sure you're following us here on LinkedIn, on Facebook, or you subscribe to our YouTube channel so that you never miss an episode in the new year. If you want to catch some replays, if you miss us during the holidays and want to binge watch, be sure to check out the URL on your screen right now. You can find all of our old episodes of CVS Health live there, so you can catch up and start fresh in 2023. We'll see you guys on the other side. Thank you again for watching us. Happy holidays and take care. Bye.