Addressing out-of-pocket costs for diabetes patients

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Rising costs are a burden for too many people living with diabetes today. Patients with a high-deductible health plan shoulder all of their medication costs while in the deductible phase of their insurance, which means they may be forced to make difficult decisions about whether they can afford their medications and fill their prescription.

Recent data reveal there is uncertainty on how to manage and predict the out-of-pocket costs associated with diabetes management. For example, nearly one-third of patients (32 percent) do not feel they have the resources needed to manage their own out-of-pocket costs. To address this challenge, CVS Health is working to eliminate member cost as a barrier to medication adherence.

Improving medication affordability and adherence

Improving diabetes outcomes while reducing costs is a priority for CVS Health. We recently launched RxZERO to enable employers and health plan sponsors to leverage formulary and plan design approaches to offer all categories of diabetes medications at zero dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members. The new plan design enables plan sponsors to eliminate member out of-pocket costs for the entire diabetes therapeutic area — including oral medications for Type 2 diabetes — and fully adhere to American Diabetes Association standards.

“Traditionally, the focus of affordability for diabetes medications has been on insulin, which is the cornerstone of therapy for the five percent of people with diabetes who are living with type 1 diabetes. However, the new CVS Caremark solution expands affordable options to include the entire range of diabetes medications — improving affordability for the 95 percent of people with diabetes who are living with type 2 diabetes.”

— Troyen A. Brennan, M.D., M.P.H., is Executive Vice President and Chief Medical Officer of CVS Health

CVS Caremark analysis shows that members taking branded diabetes medications spend on average, $467.24 out-of-pocket per year, with nearly 12 percent spending over $1,000 annually.

A comprehensive approach to diabetes management

A person living with diabetes is required to take many tasks to manage their therapy annually. To make disease management affordable, accessible and local, CVS Health offers numerous programs to help people with diabetes effectively manage their condition and stay on track with their prescribed treatment plan.

We provide supportive care at our HealthHUB locations to complement the care that patients receive from their primary care physicians. Our HealthHUB model provides a first-of-its-kind community-based store that offers a broader range of health services, new product categories, digital and on-demand health tools and trusted advice. In these locations, people living with diabetes are able to receive the coordinated care and services they need all within our own four walls.

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Managing diabetes

Our integrated, coordinated care approach

CVS Health is harnessing the power of its unmatched community connections and industry-leading data analytics to help people with diabetes better manage their day-to-day symptoms and lead healthier lives.

Our integrated approach is rooted in early detection and personalized, holistic care management, and offers our patients, customers and members an array of products and services that work seamlessly together, while improving access to care that is more local, more affordable and easier to navigate.

In Our Stores

With locations in 10,000 communities nationwide, our CVS Pharmacy stores are uniquely positioned to help patients manage their chronic conditions such as diabetes in between doctor’s visits. Our pharmacists provide one-on-one trusted counsel to patients daily, reviewing prescriptions to ensure patients are getting the most out of their medicines, while the providers in our more than 1,100 MinuteClinic locations offer screenings to monitor a patient’s vital signs and glucose levels.

We carry a wide variety of diabetes care products in our CVS Pharmacy locations to make it easier for patients to manage their condition.

MinuteClinic providers can identify conditions — including diabetes and hypertension — that a patient may not know about and develop an initial treatment plan with appropriate prescriptions and ongoing monitoring and counseling.

And with our new HealthHub® concept, a new, first-of-its-kind community-based store that offers a broader range of health services, new product categories, digital and on-demand health tools and trusted advice along with expanded capabilities in chronic disease care such as diabetes.

In addition, under our Reduced Rx prescription savings program, patients with diabetes can receive their insulin at a reduced cost at any of the more than 67,000 pharmacies in the CVS Caremark retail network, including our CVS Pharmacy locations.

CVS Pharmacy is partnering with the American Diabetes Association on their November #CountMeIn campaign to highlight the numbers that matter most when it comes to those living with, at risk for and supporting those with diabetes. More information can be found at diabetes.org/CountMeInADA.

For Our Members

We launched our Transform Diabetes Care program in 2017 to help simplify condition management and improve outcomes for members of our CVS Caremark pharmacy benefit manager.

The results so far have been significant: More than 50 percent of enrolled members with uncontrolled diabetes have moved to a controlled status by utilizing the solutions offered by the program, including personalized coaching, monitoring at MinuteClinic and CVS Pharmacy, testing supplies and a pharmacist-led clinical team that reviews blood glucose readings.

Learn more about our Transform Diabetes Care program.

Since launching, the program has expanded to identify members at risk for developing diabetes and related conditions.

Additionally, our Pharmacy Advisor program helps our members with chronic conditions like diabetes do a better job of taking their prescription medications through targeted counseling from pharmacists and monitored pharmacy claims to keep members on track with refills.

In the Community

CVS Health provides philanthropic support across the country to fund prevention efforts as well as education for those at risk for or living with diabetes. 

Through our partnership with the National Association of Free & Charitable Clinics (NAFC), the CVS Health Foundation has provided support to 57 clinics across the country to support expanded services to treat those with diabetes and hypertension.

We also bring free health and wellness screenings directly to local communities through our Project Health events. At these events, participants receive on-the-spot assessments of weight, blood pressure, blood glucose and cholesterol levels – tests that can help detect risk for chronic conditions such diabetes.

CVS Health also supports colleagues who volunteer on behalf of organizations associated with diabetes and also provides sponsorships for events. In 2019, CVS Health has provided over $120,000 to support diabetes organizations.

Find out more about the results of our Morning Consult survey on diabetes care.

Patient stories, features and related content

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By the Numbers: Improving Diabetes Care

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A man using diabetic testing equipment.

Diabetes is a costly and complex disease that burdens patients and the broader health care system. Today, more than 100 million U.S. adults are now living with diabetes or prediabetes and estimates show that medical costs for people with diabetes are twice as high as for people who don’t have diabetes.https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

In honor of American Diabetes Month, CVS Health recently partnered with Morning Consult to conduct a survey to better understand how people living with diabetes and the providers who deliver diabetes care are grappling with the disease. We also examined what tools and solutions would be most impactful in improving diabetes care.

Among both people living with diabetes and providers, there is a desire to expand access to care locally, better manage and predict out-of-pocket costs and provide additional lifestyle support.

Expanding Access to Diabetes Care

Managing diabetes can be extremely time-consuming and complicated. Oftentimes, patients must visit different sites of care, facilitate multiple annual exams and communicate with various providers across their care team. The survey revealed that both people living with diabetes and providers believe the health care system could do more to expand access to diabetes care and services. For example:

  • A majority (64 percent) of people living with diabetes are not aware of extended hours for diabetes support, while 61 percent of providers do not offer extended hours.

  • The vast majority of people living with diabetes (89 percent) and providers (98 percent) believe that being able to receive testing and exams for diabetes in a single location would be beneficial.

  • Just 18 percent of diabetes patients see their primary care provider once or more a month, while 37 percent report that they see their primary care provider every two to three months and 35 percent report that they see their provider every four to six months.

This is where CVS Health is making a difference. Today, 71 percent of Americans live within five miles of a CVS retail location. And people come to their pharmacy frequently: Whereas a patient with diabetes might only see his or her physician four to five times a year, they will likely see their pharmacist as many as 18–24 times in the same year.

Through these touchpoints to care, we are expanding access to diabetes care locally. For example, our HealthHUB model provides a new, first-of-its-kind community-based store that offer a broader range of health services, new product categories, digital and on-demand health tools and trusted advice. In these locations, people living with diabetes are able to receive the coordinated care and services they need all within our own four walls.

Addressing Diabetes Costs

Cost is top of mind for both people living with diabetes and providers — and there is uncertainty on how to predict the out-of-pocket costs associated with diabetes management. When asked about managing diabetes, nearly half (47 percent) of providers do not feel they have the resources they need to predict out-of-pocket costs for their patients’ diabetes medications. On the other hand, nearly one-third of patients (32 percent) do not feel they have the resources they need to predict their own out-of-pocket costs.

CVS Health is working to expand visibility into drug cost information across multiple points of care. Through our real-time benefits program, we’re providing tools to doctors so they can see what a medicine is going to cost, and recommend lower-cost, clinically appropriate options to the patient. We’ve also pioneered digital tools, including the Rx Savings Finder, which helps our retail pharmacists find patients savings when they do reach the pharmacy counter.

Improving Disease and Lifestyle Management

People living with diabetes and providers would benefit from enhanced lifestyle support to better manage the disease, including nutritional counseling and access to public transportation. For example:

  • People living with diabetes (58 percent) and providers (80 percent) both report they are likely to utilize nutritional counseling services to help manage their diabetes.

  • Access to public transportation is seen as a barrier among both patients and providers. For example, people living with diabetes (27 percent) and providers (29 percent) rank access to public transportation as poor in their community.

CVS Health offers programs to provide people living with diabetes with personalized support when and where they need it — whether it be in the community, in the home or in the palm of their hand.

For example, our Transform Diabetes Care includes personalized pharmacist counseling and the support of a diabetes coach to help ensure members stay adherent to their care plans. Additionally, through our Pharmacy Advisor program, our members can get one-on-one counseling from pharmacists either in-person at a CVS pharmacy location, or through our URAC-accredited call center.

To learn more about our enterprise-wide approach to diabetes management and care, visit our Managing Diabetes with CVS Health page.

To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Everyday Steps Are Critical for Managing Diabetes

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A woman receiving a blood pressure check.

Donna Castillo was running her usual errands when she stopped by her neighborhood CVS Pharmacy in Anaheim, California, to pick up her new type 2 diabetes medication. She wound up walking unexpectedly into a free health screening event – and didn’t hesitate to take advantage.

The 57-year old former hairdresser, who also suffers from rheumatoid arthritis in her hands and who lives on disability, understands the importance of taking small, everyday steps to manage her health.

“People tend to ignore things,” she says, “but I've learned how the little things matter.” In addition to taking medication, Castillo says living with type 2 diabetes has taught her to carefully monitor her diet. She makes sure to eat breakfast every morning and that her breakfasts always include protein. “Birthday parties are the hardest with all that cake,” she says. “I just take a little piece. I have to be really careful about my sugar.”

The Project Health screening event taking place that day was one of 93 community health fairs across the greater Los Angeles region from September through December, with nearly 600 total events in CVS Pharmacy locations across the country. The free screenings monitor such vitals as blood pressure, blood sugar, and body mass index. CVS Health practitioners also offer advice on how to quit smoking, and give referrals to nearby primary care doctors and other resources.

Since it began in 2006, Project Health has delivered more than $127 million in free health care services to nearly 1.7 million people in multicultural communities with a large number of uninsured or underinsured Americans.

These screenings are particularly critical for people with chronic conditions, like diabetes, which can trigger other health problems such as heart disease and stroke if not monitored and maintained.

Castillo is very familiar with the risks. She was diagnosed around age 50, and the condition runs on both sides of her family, although she is relieved her three grown sons have all tested negative. She stopped by CVS that day to pick up a new medication her doctor had recently prescribed, canagliflozin, which she now takes in addition to daily doses of Metformin.

Type 2 diabetes affects one in 10 Americans, or about 30 million people, according to the Centers for Disease Control and Prevention. While the disease typically surfaces in people over age 45, young adults, teens and children are increasingly being diagnosed.

Nurse Practitioner Elsie Parra, who was onsite at the Anaheim CVS to provide screening tests, has been with Project Health for the past five years, and says too often, patients don’t know they have symptoms that could be red flags for serious health conditions.

“Diabetes, blood pressure, and high cholesterol are all silent killers,” says Parra. “These community screenings are a convenient way for patients to get a fast check-up without an appointment or feels the nervousness some might have when going to a doctor’s office.”

To learn more about our enterprise-wide approach to diabetes management and care, visit our Managing Diabetes with CVS Health page.

To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Alzheimer’s Association

Help us build a future without Alzheimer’s.

Every 65 seconds, someone in the United States develops Alzheimer’s.

Currently, more than 5 million Americans are living with the disease, and that number is expected to grow to 14 million by 2050. 

To show our support for all who are impacted by Alzheimer’s, including those living with the disease, their families and caregivers, we’ve committed to raising $10 million over the next three years for the Alzheimer’s Association.

All donations will provide care and support services to those affected, while advancing research toward treatment, prevention and ultimately, a cure.

Learn more about Alzheimer’s and dementia at www.alz.org.

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Developing Bilingual Pharmacists to Break Down Barriers

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A Hispanic pharmacist fills a prescription.

Ashley Mendez’s family fled Cuba in the wake of Fidel Castro’s rise to power and settled in Miami, rebuilding their life from scratch — with little money, few possessions and no ability to speak English.

Watching her family, Ashley understood from a young age how difficult even the simplest tasks could be when you didn’t speak the same language as everyone else. That was particularly true for health care: Ashley and her family believe her grandmother’s death may have been caused in part by miscommunication over the painkiller she was taking for a pinched nerve.

So when it came time to choose a career, Ashley knew exactly what she wanted to do — and where she wanted to do it. She wanted to be a pharmacist and she wanted to work somewhere she could help people who didn’t speak English.

It was the way she could honor her grandmother.

“She was one of the most influential people in my life,” says Ashley. “If we had known more about what was going on, we could have helped her.”

There are many different barriers that prevent people from getting the health care they need: They may live in an area without the right providers, they may lack the transportation to travel to the right facility, they may not have enough money to afford the right treatment.

But one critical barrier that frequently gets overlooked is the language barrier.

According to the U.S. Census Department, the number of residents who speak Spanish at home has skyrocketed 130 percent since 1990, up to about 40 million. That increase has created an overwhelming demand for bilingual pharmacists — but the supply has not kept pace. While Hispanics comprise 18 percent of the nation’s population, they account for less than 5 percent of the pharmacist workforce.

Ashley, 27, is part of CVS Health’s effort to close the gap. She spent the summer of 2017 in an immersive internship program that seeks to help develop bilingual pharmacists. Interns spend 10 weeks shadowing pharmacists who are fluent in Spanish and participating in the care of Spanish-speaking patients. They learn medical terminology, study diseases prevalent in the Hispanic community, and become familiar with the over-the-counter products most popular among Hispanic customers.

The program is an illustration of the company’s belief that you can’t build healthy communities unless you have a workforce that reflects those communities.

“People are looking for a pharmacist they feel comfortable talking to,” says Alex Acuna, 26, another intern in the program, who attended the University of Texas at Austin.

Alex grew up in an El Paso neighborhood that was 80 percent Latino, and in a household where his mother regularly spoke Spanish. But although he could speak a fair amount of Spanish himself, communicating technical details to his Spanish-speaking customers was difficult. Nuances were being lost in translation. In normal conversation, those nuances could be insignificant. When talking about treatments and medication, they could be critical.

Alex knew he had to learn “pharmacy Spanish,” as he described it.

“When was first starting, my Spanish was a little broken,” he says.  “Saying something a certain way could mean something different to a patient.”

The internship program is one of several efforts from CVS Health to address the language gap. Last year, CVS Health gave the Roseman University College of Pharmacy $25,000 to fund Hispanic recruitment and outreach initiatives and establish a pipeline of Spanish-speaking students.

Alex, who earned his license in May, is working now back in his hometown of El Paso. He says he’s grateful to be able to give back to the community that raised him.

Ashley, who attended Florida State University as an undergraduate and studied pharmacy at Mercer University in Atlanta, says she’d love to go back to Miami, where she grew up and where she served her internship.

But she also knows that in Florida, she’ll be one among many Spanish speakers — and that she might do more for the Latino community by staying where she is now.

“There’s a need for Spanish speakers in Atlanta,” she says. “You can tell that the language barrier is a big issue.”

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Accordant: Holistic Support for Patients with Complex Conditions

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A photo of a doctor putting hand on patient’s shoulder.

Managing rare or complex conditions can often be challenging for patients. They can feel overwhelmed by the condition, medication side effects, complex dosage instructions, comorbidities, complicated provider directions, and experience challenges trying to navigate the health care system.

Health plans and employers, can adopt and offer our Accordant program for their plan members. Accordant provides holistic support for patients with rare conditions through targeted interventions designed to meet each patient’s unique needs.

The specialized care team is composed of registered nurses, pharmacists, social workers, and a medical director – all backed by a medical advisory board. These skilled practitioners set mutually agreed-upon health goals with the patient, discuss symptom management, explain proper use of medications, and even deal with resource issues such as lack of transportation to doctors’ appointments or cost of care. In addition, social workers help patients with community resources such as negotiating utility bill payments, identifying support groups, and grants for home modifications.

In a recent Blue Cross Blue Shield blog post, Accordant Medical Director Dr. Andrew Krueger discusses the importance of comprehensive care management services for patients with complex conditions such as multiple sclerosis and the difference this kind of care can make.

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Rewriting Their Stories: Collaborative Treatment for Trafficking Victims

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Utilizing the resources of our combined companies, our commitment to improving health community by community includes everything from free neighborhood health clinics to the difficult, personal issues of treating addiction.

In Arizona, it involves going into communities dealing with the growing epidemic of human trafficking through a public-private effort that involves Mercy Care, a Medicaid managed care organization managed by Aetna, as well as the Phoenix Police Department and other social services programs.

In the video above, learn how a holistic, first-of-its-kind treatment program, the Maricopa County Child Sex Trafficking Collaborative, is working with multiple health care partners to get victims off the street and on a path to better health.

As Skye Steel, CEO of Street Light USA says in the video: “Children who have been trafficked can recover. It does take a lot of time, a lot of people, a lot of energy, a lot of love…but their story can be rewritten.”

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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Free Screenings, Helpful Advice and a Visit from Pro Athletes at Project Health

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A customer receives a free health screening.
This Project Health event in Atlanta was one of nearly 600 targeting underserved communities.
A customer receiving a free health screening.
More than 87 percent of patients who attend Project Health events report following-up with their primary care physician.
A CVS Pharmacy store with Project Health sign.
Nearly 600 Project Health free health screenings were held in CVS store locations across the country.

Jean Peterson dropped by the City Line Avenue CVS Pharmacy in West Philadelphia to pick up pictures she’d dropped off at the photo department. Moments later, she also came away with a better picture of her own health — and the chance to snap a selfie with two local heroes: former Villanova basketball star Donte DiVincenzo and state Rep. Morgan Cephas.

Peterson had happened upon one of the many free screenings that CVS Health is offering across the country. During the next four months, nearly 600 Project Health events will take place in multicultural communities with a large number of uninsured or underinsured Americans. At each event, participants receive on-the-spot assessments of weight, blood pressure, blood glucose and cholesterol levels – tests that can help detect risk for chronic conditions such diabetes, hypertension, and heart disease.

Since its founding in 2006, Project Health’s free health and wellness screenings have delivered more than $127 million in free health care services to nearly 1.7 million Americans.

One of those Americans was Peterson. The 70-year-old retired nurse learned that her blood sugar was a bit high, most likely due to medications she was given after a recent back surgery. “I always take advantage of things like this,” she said. “It doesn’t hurt and it keeps me in touch with what I need to take care of.”

Know Your Numbers

Sometimes, the people who think they need the testing the least are the ones who benefit the most.

Brenda, a screener technician at the Project Health event in the Kendall neighborhood of Miami, said a lot of very fit people come in to be screened, usually because they want to know their BMI. But other tests are just as important. One of her patients was diagnosed with high blood pressure.

“The guy said, ‘I’m very fit, I go to the gym and stuff like that, I train people, too,’” said Brenda, who is applying to medical school. But they tested him three more times – once manually – and the results were the same. “And the doctor was like, ‘Hey, you need to go to your doctor and follow up. Please.’ We were very shocked. He looked extremely healthy, very muscular.”

Speaking Their Language

Many of our Miami stores sit in Hispanic neighborhoods, emphasizing the importance of having bilingual screeners, says Elena Ferrales, a health screening manager for Project Health.

Cristina, a young mother, wheeled her seven-month-old into the Miami store and signed up to have a screening while her baby slept in the stroller. She had diabetes while she was pregnant, and though her levels have gone down, she tries to check them regularly. After her screening, she sat with the doctor and, conversing in both English and Spanish, they discussed her results and he gave her food recommendations.

Later, a similar conversation with an older man was conducted entirely in Spanish.

A Slam Dunk for Health

As much as anyone, professional athletes understand the importance of good health. They also understand that it’s not always easy for people to access the care they need to achieve it.

“If I wake up feeling something is wrong, I know there’s a handful of people ready to check me out,” says Donte DiVincenzo, a two-time NCAA basketball champ with the Villanova Wildcats, now a point guard with the Milwaukee Bucks. “But I shouldn’t get special treatment just because I’m a pro athlete. Everyone should have these resources.”

A handful of athletes were featured speakers at Project Health events. In addition to DiVincenzo, who appeared in Philadelphia, Los Angeles Clippers forward Mfiondu Kabengele spoke in Anaheim and Heat player Bam Adebayo attended the Miami event.

Kabengele says he learned during his first year with the NBA the importance of undergoing regular checkups. Small everyday steps, he says, can add up.

“When you have poor health, everything dumbs down,” he says. “When you're healthy, your motor is good. Preventive care is a reality check to make improvements.”

Being good sports, the athletes joined the customers to be screened. Adebayo – a player for the Heat – noted how easy it was to get screened inside the store.

“You don’t have the anxiety, you don’t have to have an appointment, you don’t need to be there at 8, the anxiety of waiting around, what if something is wrong with me?” he said. “You just walk in, get it, see how it goes.”

Access for All

Morgan Cephas, a track and field star at Central High School in Philadelphia and now a Pennsylvania state representative, knows the importance of health care from the perspective of both an athlete and a policymaker. As vice chair of the House Democrats’ Women’s Health Caucus, she noted that 10 percent of those in her district are uninsured or underinsured.

“Not everyone is the daughter or cousin or friend of a state representative,” she said. “They shouldn’t have to choose between managing their health and keeping a roof over their heads.”

An Immediate Impact

What happens after the screenings is up to the individual. But for one participant, the consultation had an immediate impact.

Zita James, 68, had been on her way to the nearby coffee shop when she noticed signs outside for the free screenings at the Philadelphia location. After her detour to CVS, she chose to make a positive change to her health.

“It stopped me going next door and getting two jelly doughnuts!” she laughed.

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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A Lifelong Struggle, a Tearful Reconciliation

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In the year since Jeff Balek began working for the Guardian Angels program, where he reaches out to Aetna members who have survived an opioid-related overdose to connect them with support and resources, Balek estimates he has spoken to hundreds of people who nearly died from an opioid overdose, and he has heard hundreds of heart-wrenching stories.

A counselor talking on the phone.
Jeff Balek, a Guardian Angels program clinical lead, works one-on-one with members recently released from the ER following an overdose.

But one story stands seared in his memory above the others: A man in his 40s named Kevin, who struggled with addiction for most his life and was now sober for the first time in decades, whose greatest wish was to try to rectify his greatest regret — his estranged relationship with his mother.

The problem was that he had no idea how to find her. Or whether she even wanted to see him. He searched desperately for six months to locate her, and when he did, the news was staggering. She was living out her final days in hospice care, more than a thousand miles away in Florida.

Could he find the money to arrange the trip? Could he get there in time? And, most importantly: Would she welcome him if he did?

“All I want is to at least have a chance to make things right,” he told Jeff.

Closing the Gap Between Overdose and Much-Needed Treatment and Support

Kevin’s story is a poignant example of the devastation that opioids can wreak on a family, but also of the redemptive opportunities for people who seek and receive help.

Those opportunities are why Aetna launched the Guardian Angels program as pilot in 2018. The company’s data showed hundreds of people were visiting emergency rooms each month with opioid-related overdoses. They all had complex needs for treatment and recovery, but the ER doctors’ job was limited to helping them survive an overdose. Once they survived, they were on their own again. It was like being treated for frostbite but then sent back outside into frigid temperatures. Without a coat.

Guardian Angels is part of our company-wide commitment to help address the abuse and misuse of prescription opioids, which includes everything from a safe medication disposal program in Ohio to Pharmacists Teach, an outreach program that’s reached more than 450,000 students and parents since 2015.

“We noticed patients would be discharged with minimal ongoing support,” says Daniel Knecht, MD, Aetna’s vice president of health strategy and innovation.

The Guardian Angels program was designed to close that gap. Clinicians who specialize in addiction recovery call members after they’ve been discharged to lend support, to offer education, and to connect them to community resources.

To date, the program has helped more than 600 members and their families, and the Guardian Angels staff has gone from a single person to two — Balek works alongside clinician Ramona Zarate — and is looking to expand again.

“We reach out when the individual is most needing help and most susceptible to intervention,” Balek says. “They had a near-death experience. Their defenses are broken down. They’re on the brink of emotional deterioration.”

“Talking about substance use is difficult,” Zarate says. “It’s important to give the person a safe space to discuss their experiences, their fears and their hopes for the future.”

There is no shortage of need. More than 70,000 people in the United States in 2017 died from drug overdoses, and that number continues to grow. Balek estimates that he and Zarate each talk to as many as 10 people a day. Outreach and perseverance are key; it sometimes takes up to eight calls just to reach someone.

Once the connection is made, the angels’ conversations with the members can stretch for months. The idea is to continue providing support until the patient reaches what they call “early remission,” which usually takes about three months. But Balek says he never cuts anyone off. As long as they’re willing to talk, he’s willing to listen. There’s always a goodbye, eventually, but Balek wants to make sure it’s “goodbye for a good reason.”

A Second Chance

In Kevin’s case, Balek stayed in touch for almost a year, as he struggled with facing the pain of his estrangement, as he searched for his mother, and as he wrestled with doubts about whether to approach her.

In the end, with Balek’s help and support, Kevin took the leap of faith and visited. To his relief, she welcomed him with open arms, glad to see him, and thrilled that he had shed his demons, at least for now. They shared the few good memories they had, back before addiction dug its claws into his life. They shared tears.

“The joy in his voice was incredible,” Balek says.

A few weeks later, Kevin’s mother died.

As he does with most of his patients, Balek eventually lost touch with Kevin. Last he heard, Kevin had found a job and a girlfriend, and had moved to Florida — almost as if he wanted a way to feel closer to his mother, as if her love and acceptance before she died made Florida feel like a safe, welcoming place.

Last Balek heard, Kevin was still sober.

Recently, Balek found notes from his last conversation with Kevin. These were what turned out to be the final words Kevin said to him: “I really didn’t think my Mom would see me doing well again. She got to see me looking good and clear-eyed and smiling. She got to see the real me, who always loved and cared for her.”

For more information about CVS Health’s efforts to improve care across the nation, visit our News & Insights page and the CVS Health Impact Dashboard. To stay informed about the latest updates and innovations from CVS Health, register for content alerts and our Leaders in Care newsletter.

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