Pay Flex CEO Shines Light on Opportunity for Payers, Providers to Collaborate on Revenue Cycle

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When it comes to health care costs, many consumers feel left in the dark. In fact, the No. 1 reason people do not pay their health care bills is due to confusion over the often antiquated and clunky payment process.

At the HIMSS Annual Conference & Exhibition in Las Vegas this week, PayFlex CEO and President Erin Hatzikostas hosted a session, “Equipping Consumers To Be The Chief Financial Officer Of Their Own Health Care,” to discuss how providers and health plans can work together to engage consumers to better understand and manage their health care expenses. PayFlex is a part of the Aetna family.

With the rise of consumer directed health plans turning patients into larger financial stakeholders in their care, “Consumers are left woefully behind in getting the information they need,” said Hatzikostas.

Consumers cannot make informed choices about their elective health care if they do not know what it costs. Furthermore, even after patients receive care, they are often left in a thicket of mail from providers and their insurer, including Explanations of Benefits (EOBs) which may look like bills, bills from providers that look like EOBs, etc.

While this is confusing for the patient, it also negatively affects doctors who performed services with the promise of getting compensated quickly. Collections typically take 3-5 months to process and only 17 percent of bills are collected. This delay is not linked to an unwillingness or inability by the patient to pay – three-fourths of people are willing and/or able to pay for their health care costs – but a lack of understanding of the payment system and process. “The No. 1 reason is that people were confused,” said Hatzikostas.

As a complex issue, the health care payment crisis requires a complex solution. Convenience and consumerism are hard to balance and simple solutions will not work.

In 2014, PayFlex launched Money Square for Health to help equip consumers to be better financial stewards of their health care. After just three years, the service earned over 200,000 users, with many repeat users. Beta testing confirmed the huge opportunity in the ecosystem to engage consumers and, with the learnings from Money Square for Health, Aetna launched AetnaPay to further empower consumers to become the CFO of their health care finances.

There is still much work to be done in supporting consumers to own their health care finances, but progress is being made. As we continue to shine a light on the payment black box, it will be imperative for providers to collaborate with health plans on solutions and work together to share quality data and advance work flows.

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Ben Wanamaker at HLTH conference: Don’t forget about providing value to the patient

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Too often, digital health tools are created with one party trying to hoard all of the value created, according to Ben Wanamaker, head of consumer technology and services at Aetna during a panel at the inaugural HLTH conference last week in Las Vegas.

The value must be distributed to the entire health ecosystem – especially patients – if they are to be successful, suggested Wanamaker.

“We need to figure out how to share the value [of Digital Health tools] with the technology purveyor, the payer, plan sponsor and deliver enough value to the patient for participating,” he said. “They deserve value.”

Wanamaker appeared on a panel titled “Who Will Rescue Healthcare?” with Lloyd Minor, dean of the Stanford School of medicine. The moderator of the panel was Annie Lamont, managing partner of Oak HC/FT.

Wanamaker also shared his vision for the role that digital health tools could fill in the current health care system.

“There’s a really huge gap we have to close, which is understanding what you want and what you need in health care. That’s where digital health becomes really important for us,” said Wanamaker.

“The points in time that show up in a payers’ dataset are too sporadic, too sparse to really understand what you want. The average American sees a provider approximately three times a year…although you’re spending 17 or 18 percent of your money on healthcare. That’s very imbalanced. That doesn’t work.”

With the recent Cambridge Analytica privacy scandal, moderator Lamont bluntly brought up one of the elephants in the room for digital health. What will health systems and insurers do with all this data?

We “believe users deserve a lot of say in how their data is used and shared and for what purpose,” said Wanamaker. “One of the principles we use to guide our work as we work with technology partners is your data is only used for good.

“A lot of people ask me questions like, ‘Well, Ben. If you use my health care data, wouldn’t you just use it to underwrite?’ The answer is an unequivocal no, because why would you ever share your data in any form or allow me to use the data you already shared if you had fear of me using it against you?”

The panel concluded by trying to imagine where the industry should be in one and five years.

“A one year view is that we need to increase the fidelity of vision in what’s going on in people’s lives,” said Wanamaker. “I think the five year vision would be to re-architect delivery around much more personalized entry points for patients… that are closer to home or in the home.”

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The School Employee Guidance Program: Meeting teachers where they are

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As one suburban school teacher put it: “The stress never ends.”

She was responding to a 2017 Aetna survey that proved she wasn’t alone. The findings showed school employees with a higher prevalence of depression, anxiety and turnover compared to other professions due to a variety of factors such as classroom behavioral issues, increased class sizes and the focus on standardized testing scores.

With more than 1 million public school employees as members, Aetna is addressing the unique needs of this group by launching The School Employee Guidance program, the latest in the company’s ongoing commitment to improve its members’ emotional, physical and mental health.

“A teacher’s workday doesn’t end when the last bell rings. With the School Employee Guidance Program, teachers can connect to support when and how they need us, so that when the first bell rings the next day, they have all the tools in their back pocket to do the job they were inspired to do,” said Brooke Wilson, head of Worklife Services, Aetna Resources for Living.

Many existing school programs have been created in response to a tragic event or crisis, but The School Employee Guidance Program is different because it uses a combination of proactive individual and onsite group training and counseling for student behavior-based conflicts. The program also includes workshops on relevant topics including:

  • Preventing burnout
  • Coping with anxiety
  • Managing challenging interactions
  • Handling stress
  • Addressing autism spectrum disorder (ASD) and ADHD

Additionally, school employees enrolled in the program have access to a 24/7 help line for clinician support, confidential self-assessments, online webinars and videos on stress management and ADHD, and more.

The program is the result of a 2017 research study  that Aetna conducted. The survey included teachers, professional staff and administrators nationwide from a cross-section of large and small districts in high and low communities to determine the top challenges in their industry. The research findings concluded that:

  • 80 percent of survey participants said managing class behavior for ADD and ADHD caused significant stress

  • 24 percent of survey participants expressed the need for an on-staff counselor, social worker or therapist

  • The average class size has almost doubled from 15.1 to 27.1 students over time

To learn more about the program, visit the Aetna Public Sector website or contact your Aetna representative.

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Personalized and protected: Health and wellness for the globally mobile

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The cover artwork of the "Personalized and Protected: Health and wellness for the globally mobile" report.

From vital signs to MRI results, and from wearable fitness trackers, genome sequencing to family history and more, health care consumers and their records are awash with data.

Accessing, analyzing and using that data can be difficult when the information is spread across disparate databases. What’s more, consumers who have been faced with countless data breaches in recent years are wary of who should have access to that data.

“More data has been created in the past two years than in all previous years combined,” says Aetna International Chief Information Officer Alan Payne. “Humans can’t comprehend this level of data, and this has driven innovations like cognitive computing and artificial intelligence.”

What are the potential solutions to ensure that consumers’ health and wellness benefit from all this health data?

In a new study, Aetna International examines the impact big data could have on the delivery of quality health care and explores some of the large and small ways that impact is already being felt.

Read more information here.

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Helping Increase Access to Health and Wellness Benefit Solutions

Helping Increase Access to Health and Wellness Benefit Solutions
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Health care continues to evolve at a rapid pace and with that has come new technological advancements and care models. This includes tools and programs to help patients manage a wide range of conditions, from insomnia to weight loss to solutions that provide disease management and medication adherence support.

To help increase access to these tools and solutions, CVS Health has introduced Vendor Benefit Management, a first-of-its-kind service that allows CVS Caremark pharmacy benefit management (PBM) clients to more easily and efficiently onboard and manage third-party vendors and make their solutions available to members.

Our Streamlined Service

Increasingly, employers are supplementing their standard benefit offerings with novel digital and non-digital health and wellness solutions. In 2018, the average employer offered 14 supplementary health care solutions from different sources, including health plans and third-party vendors.https://www.castlighthealth.com/press-releases/castlight-releases-first-of-its-kind-report-on-digital-health-in-the-workplace/

However, the process to onboard and manage disparate vendors can be complex, resource intensive and time-consuming. Vendor Benefit Management aims to make this process easier for our PBM clients.

Specifically, the new service enables:

  • A more streamlined process to onboard and manage multiple vendors
  • An easy way to access negotiated pricing and standardized verification of member eligibility in real time
  • Simplified and streamlined billing and payment processing
  • Standardized measurement and reporting across all vendors

Big Health’s Sleep Solution

Poor-quality sleep and insomnia affect nearly 30 percent of adults and can underlie or impact a wide variety of mental health conditions. Big Health, a digital therapeutics company, is the first participating Vendor Benefit Management vendor and Sleepio, its personalized digital sleep improvement program, is now available to PBM clients via the service. The program is based on Cognitive Behavioral Therapy (CBT), which helps individuals make the changes necessary to improve their sleep problems.

Moving forward, CVS Health will be actively working to identify and onboard additional vendors to participate in the new service. This may include solutions such as smoking cessation and substance abuse support, care management solutions, medication optimization and adherence, and tools that help members navigate their benefits.

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

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Health is the Real Win: Attain by Aetna, A New Step in Helping Consumers Transform Their Health, Now Available

Health is the Real Win: Attain by Aetna, A New Step in Helping Consumers Transform Their Health, Now Available
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This article was written by Alan Lotvin, M.D., Executive Vice President, Chief Transformation Officer for CVS Health.

Aetna medical members now have a new personalized way to encourage healthy actions every day and achieve better health. The Attain by AetnaSM app, the first-of-its-kind health experience designed in collaboration with Apple, is now available for download in the Apple App store.  

Attain  is unique because it’s built for people like you and me – not elite athletes, but people who could use a nudge every now and then to take simple actions each day to lead a healthier life. Health isn’t one size fits all, and Attain provides recommendations personalized for you.

The Attain program offers daily and weekly activity goals, and then rewards you when those goals are achieved. More than just steps taken, the app tracks other activities that improve overall health and are measured by the Apple Watch, such as getting more sleep, improving nutrition and being more mindful. In a little more than three months, almost 300 Attain users in our pilot burned more than 4.3 million calories! Additionally, the app uses your health history to create tailored notifications based on clinical guidelines that help you stay on top of key health moments such as refilling prescriptions, getting preventative vaccinations like the flu shot, scheduling annual primary care visits or finding lower-cost options for lab tests when needed.

Attain was built from the ground up to protect user privacy and data. Users consent to the use of their data in Attain with a very straightforward, plain-language consent process. Information collected and used in Attain will never be used for underwriting, premium or coverage decisions. Users who change their mind can stop participating and opt-out at any time.

Achieving your best health is important. CVS Health wants to make getting personal support in health care simpler, more affordable and convenient. With tailored app notifications combined with the technology of the Apple Watch, you can receive the support you need to more easily incorporate healthy actions into your everyday life. We are truly excited to be able to share Attain more broadly.  

Aetna medical members who would like to learn more can visit AttainbyAetna.com and download the app via the Apple App Store to confirm eligibility and rewards* that are available to you. 

Aetna is part of the CVS Health family of companies. 

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

*Not all members are eligible to earn an Apple Watch®. Download Attain and sign in to see which rewards are available to you.

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Clinical Secure Messaging Helps Improve Medication Adherence

Clinical Secure Messaging Helps Improve Medication Adherence
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Graph showing Medication adherence improved in both groups of patients who used secure messaging.
Medication adherence improved in both groups of patients who used secure messaging.
Graph showing more optimal medication adherence with secure messaging.
Optimal medication adherence improved for both groups of patients using secure messaging.
Graph showing a decrease in the first-fill drop-off rate for patients using secure messaging.
First-fill drop-off rate also decreased among patients using secure messaging.

Historically, people with complex conditions may receive telephonic or in-person support from a specially trained nurse or pharmacist with the goal of helping the patient better manage their condition(s), take their medication(s) as prescribed and improve their overall health outcomes. In this increasingly digital age, however, people are turning to technology for help with a range of things, including health care.

Recognizing this shift toward digital engagement, CVS Specialty is bringing patients innovative digital and online tools to help them better manage their conditions and access additional support online. This includes secure, two-way messaging that puts a nurse or pharmacist at the patients’ fingertips.

Powering this capability is a proprietary, company-built tool loaded with therapy- and indication-specific clinical information. Patients opt-in to receive personalized message alerts via their mobile phone asking if they are experiencing certain common medication side effects. The messages are based on clinical trial data, the drug’s label and feedback from other patients, and are timed to reach the patient when they are more likely to experience a specific side effect. The message also includes a link to enable the patient to ask the pharmacist a medication-related question.

Following the launch of this tool for patients with chronic myeloid leukemia (CML), initial results were promising, with high engagement rates and improved medication adherence, compared to more traditional support methods, including telephonic outreach.

Scaling to Other Specialty Conditions

With positive results in patients with CML, CVS Specialty quickly expanded use of this tool across all specialty conditions and recently conducted a retrospective analysis of specialty pharmacy claims and use of secure messaging in patients with rheumatoid arthritis (RA) and multiple sclerosis (MS).

These findings were recently presented at the Academy of Managed Care Pharmacy annual meeting and showed that patients with these complex conditions can also benefit from this type of digital support when compared to more traditional support methods. Specifically, patients who received the customized, secure clinical messages on topics including adherence, condition management or side effect management, every 30 days, were more likely to re-fill their prescription(s) and achieved significantly higher medication adherence than the control group. In fact, optimal adherence for patients in the study with either MS or RA receiving this digital clinical support improved by 3.82% and 2.12% points, respectively.

At CVS Specialty, the goal is to help patients on their path to better health by offering support where and when patients need it most. This data shows the promise of clinical support delivered digitally and, as part of a health care innovation company, CVS Specialty is committed to continuing to help more patients manage their diseases in a way that meets their individual needs.

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Moriarty at POLITICO Health Care Innovators

Moriarty at POLITICO Health Care Innovators
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Health Care Innovators is an event series by POLITICO, and sponsored by CVS Health, highlighting the new faces and best practices in health care innovation. At the series’ second event, Tom Moriarty, Chief Policy and External Affairs Officer, and General Counsel, discussed how the combination of CVS Health and Aetna is challenging the status quo in health care.

Moriarty emphasized how our newly created model can innovate from within the current health care system by tackling the key challenges that patients face and improving the overall patient experience. 

Addressing Health Care Hurdles

Our health care system was not built to provide patients with the coordinated care and tools they need to manage their conditions and easily determine what is best for their health. According to Moriarty, uncoordinated care can lead to inferior outcomes and higher costs. Today, a huge portion of health care costs is allocated towards chronic disease management and data show that close to $500 billion of these costs are avoidable.http://www.fightchronicdisease.org/sites/default/files/TL221_final.pdf

Moriarty highlighted how the CVS Health and Aetna combination provides the opportunity to address avoidable costs by providing patients with access to the right care locally.

In the case of diabetes, Moriarty noted that CVS Health can ensure that patients are healthier and costly adverse events are avoided. “We will have the ability to determine who is at risk of developing diabetes and provide them preventative counseling and services,” said Moriarty. “We can also improve health, reduce these numbers in the future and realize extensive savings by doing so – both for the patients and the system.”

Improving the Health Care Experience

CVS Health has set a very real goal of transforming the consumer health care experience. To meet this goal, Moriarty demonstrated how CVS Health can improve coordination across the care continuum and provide patients with more touchpoints to care.

Moriarty shared the example of a patient leaving the hospital to illustrate how the CVS Health and Aetna combination can simplify health care. Consider, for example, that while the patient may be well enough for discharge, she leaves with a complicated care plan in hand. It can be difficult to know where she should start and how to achieve better health outcomes. 

By fully integrating Aetna’ medical information and analytics with CVS Health’s pharmacy data and our 10,000 retail locations, the care plan prescribed by the doctor can be more seamlessly coordinated by CVS Health and the patient’s caregiver. We can provide adherence outreach to ensure she is taking her medications, or schedule a MinuteClinic follow up within 14 days post discharge if she is unable to see her provider. Whether it is filling the care gaps between visits to the doctor, providing clinical programs to ensure the patient stays well at home or increasing her utilization of lower-cost sites of care – we know we can make staying healthy easier and more affordable.

Moriarty also emphasized how CVS Health is working to improve health at the community level by providing patients with more engagement. Recently, CVS Health announced a five-year $100 million commitment to improve community health through increased access to free health screenings, additional volunteer hours in the communities we serve and expanded support for national and local organizations that are working on the front lines to improve health care. According to Moriarty, this investment will help address the social determinants of health, such as family, education, housing and access to fresh food, that impact patients’ health and well-being in communities nationwide.

For more information about CVS Health’s efforts to improve access to quality care across the nation, visit our Quality & Access information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

Tom Moriarty speaking at the Politico event.
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Pharmacies & Retail Health Clinics Lower Costs and Improve Outcomes

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What should communities have on their to-do list for 2018? According to a recent CVS Health survey, nearly 40 percent of Americans see access to care as the top health care priority to address locally. Already one of the most accessible points of care in many communities across the country, pharmacies offer a variety of convenient, affordable services close to home.

Quality, Affordable Care is Closer Than You May Realize

Eight out of 10 Americans live within 10 miles of a CVS pharmacy, and 62 percent of people report going to their local pharmacy at least once a month. With millions of Americans visiting these sites every day, pharmacies are well-positioned – and equipped – to support the health care needs of local patients.  

At CVS Health, our 30,000 pharmacists across the nation are trained to administer vaccinations, provide medication counseling, and deliver disease management support. What’s more, CVS Health has more than 1,100 MinuteClinic locations where patients can walk in without an appointment and receive care for acute and chronic health issues from nurse practitioners and physician assistants who specialize in family health care. MinuteClinic’s recently expanded health services provide easier access to immunizations, treatment for minor illnesses and injuries, travel health, skin conditions, women’s services, preventive health screenings and monitoring, and general wellness care.

Improving Health Outcomes and Reducing Systemic Costs

The preventive care services and chronic condition monitoring offered at retail pharmacies and health clinics help identify potential health concerns sooner and can prevent chronic conditions from worsening. One study found that increased use of preventive clinical services could avert the loss of more than two million life-years annually in the United States and save nearly $4 billion in personal health care spending.https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2008.0701

Additionally, access to care at retail pharmacies not only benefits individuals and their families, but also the health system as a whole. By providing a lower-cost alternative to more expensive health care settings, such as emergency rooms (ERs), where visits have been on the rise at a significant cost to the health system,http://newsroom.acep.org/2015-05-04-ER-Visits-Continue-to-Rise-Since-Implementation-of-Affordable-Care-Act pharmacy use can help communities cut costs while improving outcomes. In fact, it has been estimated that as many as 27 percent of ER visits could be treated at a lower-cost site like a retail health clinic, saving the health care system up to $4 billion annually.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412873/

From administering immunizations to providing medication counseling to delivering disease management support, pharmacies and retail health clinics play an important role in helping community members on their path to better health. 

For more information about CVS Health’s efforts to improve pharmacy care, visit our Health Care Delivery & Innovation information center and the CVS Health Impact Dashboard. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.

CVS Health MinuteClinic provider examining patient
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Managing Chronic Health Conditions Between Doctor Visits

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Chronic health conditions such as diabetes, heart conditions, and cancer affect half of all American adults.https://www.cdc.gov/chronicdisease/overview/index.htm What’s more, one in four Americans find themselves dealing with two or more of these diseases at a time. In between doctors’ visits, patients often face managing not only these health conditions but also the associated costs of treating them. Through our vast community touchpoints, CVS Health is uniquely positioned to help patients manage their chronic conditions, improving health outcomes and reducing costs.  

Challenges Managing Chronic Disease

Americans are often prescribed medications, such as beta-blockers or insulin therapy, to manage their chronic conditions, but it can be difficult to manage prescriptions to ensure they are taken as prescribed. According to a recent CVS Health poll, people reported that sticking to a dosing schedule, managing prescription refills, and understanding drug interactions are among the most difficult tasks associated with managing their medications. And these challenges become even more unwieldy when patients have to manage multiple prescriptions at a time.

In addition to medication, regular screenings and monitoring help Americans stay on top of what they need to do to avert or manage their chronic conditions. Routine screening and other preventive services have been effective in detecting and treating various risk factors for chronic diseases. However, only 25 percent of adults aged 50 to 64 years are up to date on preventive screenings and services, and that number increases to 50 percent among adults aged 65 or older.https://www.cdc.gov/aging/services/index.htm

Pharmacists and Retail Health Clinics Can Help Connect People to Needed Chronic Disease Management Support

Availability of preventive and disease management services through locally accessible care sites, like CVS Pharmacy and MinuteClinic, can help connect people to potentially life-saving care. CVS Health's pharmacists are trained to provide medication counseling and medication therapy management to help patients stay on track with their prescriptions.

In addition, MinuteClinic nurse practitioners and physician assistants are on call to provide key screenings and monitoring for conditions such as diabetes and rheumatoid arthritis as part of CVS Health’s Transform Care programs, which provide condition-specific and personalized care to those who need it. This type of specialized care extends into individuals’ homes with services like Coram, through which home infusion nurses and pharmacists provide tailored care either at patients’ homes or at outpatient infusion sites to patients dealing with a variety of acute and chronic conditions.

And regardless of location, CVS Health offers a suite of digital pharmacy tools, and other innovative programs for CVS Health customers and CVS Caremark clients to help individuals better manage their chronic conditions by addressing barriers to medication adherence. The recently launched ScriptPath Prescription Schedule tool – just one example – helps patients keep track of and manage their multiple prescriptions with easy to understand icons and the creation of a simplified personalized prescription schedule.

For more information about CVS Health’s efforts to improve the quality, outcomes and affordability of chronic disease care, visit our Chronic Disease information center and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our bi-weekly health care newsletter.

Doctor checks patient heart health vitals
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