Path to Better Health Study 2020

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CVS Health’s 2020 Path to Better Health Study finds that consumers are seeking a more accessible, affordable and technology-enabled health care experience than ever before. 

The American health care system is undergoing a time of accelerated innovation and transformation. Consumer expectations for convenient and personalized health care support, coupled with the exploding use of technology and data analytics, are just several trends driving critical change. The unprecedented COVID-19 pandemic has also provided an opportunity to further advance health care delivery and utilization to better meet the needs of our patients, our customers and our communities.

According to our 2020 Path to Better Health Study, now in its third year, consumers and providers are hungry for this care transformation and want health solutions that meet them where they are — in store, in home and in hand.

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40%

of consumers said they would be very likely to receive care for mental and behavioral health virtually.

71%

of consumers indicated they were greatly concerned with treating chronic illness due to cost. 

81%

of providers reported that they always, often or sometimes recommend that their patients establish health goals during routine office visits.

Importance of accessibility and affordability

Delivering accessible, high-quality care at any time is a key health care priority — and has become even more significant during the COVID-19 pandemic. According to our study, consumers agree, with 92% indicating that it was very or somewhat important that health care be convenient. 

We found that people’s desire for accessibility is pushing them to explore new avenues of care. While a majority of consumers still go to their primary care physician (PCP) to treat a minor illness or injury, nearly one-third of consumers are likely to visit a non-emergency walk-in clinic.

Consumers are receiving routine support for minor illnesses or injuries at several sites of care: 62% report visiting their primary care physician; 31% report using emergency walk-in clinics; 18% report visiting a hospital emergency room; and 15% report visiting community health clinics.

“Consumers are demanding convenience and ease in how they access health services. Technological solutions have the power to simplify health care and significantly expand the ways we deliver it,” said Larry Merlo, CEO of CVS Health, adding that COVID-19 has provided an unprecedented opportunity to accelerate transformation and drive lasting and systemic change in the American health care system. “Our growing local presence and expansion of virtual care, telemedicine, and other omnichannel programs will be critical to meeting the health needs of our members and customers, both during and after the pandemic.”

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Affordability is also top-of-mind for consumers. About one-third (35%) of people said health care costs are an obstacle to staying healthy, while close to half (49%) have not visited a doctor when they had a minor illness or injury due to cost, suggesting that consumers could use additional support in this area.

Increasing appetite for technology-enabled care

The use of technology across the health care continuum has been rising at a rapid rate. As a result of COVID-19, the pace of technological transformation will only quicken and greatly influence the future of care delivery.

The use of digital tools to facilitate communication between patients and providers is on the rise. Digital messaging among consumers is up 7% from 2019 with an overall usage of 48%. Among providers, digital messaging is down 2% from 2019 but overall usage is at 36%. Telehealth services, have shown a 14% increases among consumers, with a 32% overall usage rate. Among providers, usage of telehealth services increased 18% with a 40% usage overall.

Our study shows that people want to use technology to enhance communication with their health care providers, by adopting tools like digital messaging, telemedicine and virtual office visits. Among providers, their use of digital technologies to care for and connect with patients is also expanding. Telehealth is of particular interest, with 40% of providers saying it is very valuable for communicating with patients, up from 22% in our 2019 study.

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Our Path to Better Health Study also found that:

  • Mental health is of critical concern for consumers, especially among those aged 18 to 34 and 35 to 50, with the issue of social isolation being a top concern.
  • Consumers, as well as their friends, family and other household members, are struggling with chronic conditions, including high blood pressure, obesity, mental illness and diabetes. 
  • Health care providers still need more support in accessing important community-based resources, such as nutritionists and social workers, but this access is improving. 
  • Many providers are experiencing burnout symptoms at least some of the time. 
  • Awareness of and involvement in value-based care models is growing.
A woman sits at a dining room table eating a salad and a piece of bread while quietly smiling and reading a tablet computer.

Methodology 

The Path to Better Health Study by CVS Health, first released in 2018 and called the Health Ambitions Study, was conducted in March 2020 and included two surveys fielded by Market Measurement, a national market research consulting firm. The consumer survey comprised 1,000 participants 18 and older, located throughout the U.S. It also oversampled 12 metropolitan statistical areas — Atlanta, Austin, Boston, Cleveland, Dallas, Houston, Los Angeles, New York City, Philadelphia, Providence, Hartford, San Francisco, Tampa and among two ethnic groups: African Americans and Hispanics. The survey of 400 providers focused on primary care physicians and specialists with at least two years’ experience, as well as nurse practitioners, physician assistants and pharmacists.

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Expanding precision oncology care

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Tech entrepreneurs talk as much about working “on their business” as working “in their business” — another way of saying that innovating is as important as working on the day-in and day-out needs for a business to succeed. While the daily demands of patient care take a majority of their focus, oncologists, like smart tech executives, see technological advances and innovative oncology therapeutics as essential to improving the patient journey.

Today’s health care environment includes expanding the use of precision medicine, genomics, and technology, as well as increasing access to appropriate treatments to help improve patient experiences and outcomes. 

Precision medicine and the role of genomics

The late Clayton Christensen, renowned author and Harvard Business School professor who wrote at length on “disruptive innovation,” noted that precision medicine could aid in driving down health care costs without compromising quality or outcomes. Oncology evidence-based guidelines have been shown to improve treatment, outcomes, and costs by quickly starting patients on the most effective treatment, often with fewer side effects and less treatment time.https://ascopubs.org/doi/pdf/10.1200/JOP.17.00091

CVS Health’s Divisional Head of Enterprise Oncology Dr. Roger Brito describes the company’s precision approach that employs disruptive innovation: “The critical period between diagnosis and starting on therapy is an incredibly stressful and scary time for a patient. The ideal situation is to formulate the optimum treatment plan and get the patient started on the appropriate therapy as soon as possible.” 

Still, with approximately 700 updates in 24 months across 59 different National Comprehensive Cancer Network (NCCN) treatment and supportive care regimens, and a 63 percent expansion in oncology drugs in development in the last decade (IMS Health, R&D Focus, IMS Institute for Healthcare Informatics, May 2016.), applying the most current therapies in daily practice is difficult for many oncologists.

“Keeping up with all of the changes in treatment, like the rapidly expanding oncology drug pipeline and evolving clinical guidelines for cancer treatment, can be very challenging for oncologists. 60% of community oncologists regularly use cancer pathwaysHigh-quality oncology clinical pathways are detailed, evidence-based treatment protocols for delivering cancer care to patients with specific disease types and stages. When properly designed and implemented, oncology pathways can serve as an important tool in improving care quality and reducing costs. https://www.asco.org/practice-policy/cancer-care-initiatives, so there is an opportunity to better support them in delivering the latest in cancer care,” says Brito.

On top of that, consider the exciting opportunity to enhance precision medicine with the latest genomics science and technology. “Identifying the genomic landscape of an individual patient’s tumor enables oncologists to treat the root cause specifically and more effectively,” says CVS Health’s Transformation Vice President for Complex Chronic Disease Anne Claussen.

CVS Health’s analysis suggests that broad-panel genomic sequencing may result in cost savings, and a pilot is underway that will explore this in depth.

With little debate over the efficacy of genomic testing, many wonder why 60 percent of advanced cancer care patients receive no genetic testing.https://www.foundationmedicine.com/blog/uncovering-insights-in-pancreatic-and-prostate-cancers “There are currently 125 approved cancer drugs and 86% of those in late-stage development that require genetic testing, yet few eligible patients receive a companion lab test. And even when advanced testing is administered, patients often receive the less comprehensive single gene mutation test, which does not provide a patient’s complete genetic profile,” says Claussen.

Testing a patient’s tumor, looking at DNA and RNA sequencing, and pairing that data with a patient’s health information is complicated and requires expertise in pharmacogenomics to interpret. Further, oncologists also need experience and training with such data to explain results to their patients. Here again, time is critically important to get the patient on the appropriate therapy as soon as possible.

Using technology to speed and expand support

CVS Health is building on its experience and bringing together capabilities across our health plan and pharmacy businesses to make precision medicine and genomics more accessible while easing adoption for oncologists with our Transform Oncology Care program.

Claussen stated, “We are proactively partnering with oncologists to develop and enhance our oncology care solutions by facilitating frequent, two-way feedback and providing reporting that highlights opportunities and gaps to improve health outcomes.”

CVS Health is helping oncologists employ broad-panel gene sequencing tests with the latest NCCN treatment and supportive care guidelines that help in the selection of the most precise and appropriate treatment regimen based on the patient’s clinical and genetic profile. Additionally, providers are notified of applicable clinical trials that their patients may qualify to participate in. “Here is where we see the power of precision medicine and evidence-based tools such as our Transform Oncology Care program, which allows providers to request an authorization online and receive approval within minutes. Patient anxiety is eased because they will get their treatment in a timely manner, and the provider’s process flow is streamlined, resulting in a much better patient experience,” explains Dr. Brito.

Transform Oncology Care strives to provide targeted strategies for every step of the cancer care journey.

Read the infographic.

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CVS Health reports first quarter results, provides update on COVID-19 response

CVS Health reports first quarter results, provides update on COVID-19 response
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CVS Health Reports Fourth Quarter and Full-Year 2019 Results, Reflecting Strong Execution Across the Enterprise

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CVS Health Reports Third Quarter Results

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Antibiotic Resistance: Toward Better Stewardship of a Precious Medical Resource

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When 18-month-old Simon Sparrow woke up one morning in spring 2004, he was ill. By the afternoon, his face was swollen and he was having difficulty breathing. His parents brought him to the hospital, where he was diagnosed with septic shock and received antibiotics.

The next morning, Simon was dead.

Simon’s death was caused by methicillin-resistant Staphylococcus aureus, or MRSA. An indirect cause of Simon’s death was antibiotic resistance and the decades of overuse and misuse of drugs like methicillin, a synthetic version of penicillin.

Antibiotics are used to fight infections caused by bacteria. The overuse and misuse of antibiotics is accelerating the creation and spread of resistant bacteria, otherwise known as “superbugs.”

In a January 2018 white paper called, “Antibiotic resistance: Toward better stewardship of a precious medical resource,” Aetna International argues the antibiotic resistant bacteria crisis must be addressed through a global effort. The company believes the world must be better stewards of the antibiotics available today, while also working to develop more antibiotics for the future and address the underlying issues that led to the crisis.

“Stemming the rising tide of antibiotic resistance will take a global, multi-pronged effort. The industry must become better stewards of the antibiotics we have today, whilst working to develop more antibiotics for tomorrow,” said Mitesh Patel, M.D., a medical director at Aetna International. “A focus on harnessing big data will inform strategies that create better care for patients, as well as significantly decreasing the financial cost from antimicrobial resistance.”

The Centers for Disease Control and Prevention (CDC) estimates at least 2 million people become infected with antibiotic resistant bacteria each year in the U.S. Of those infected, about 23,000 dies from difficult to treat infections.

Although the biological causes of antibiotic resistant bacteria can’t be prevented, Aetna believes the societal causes – over-prescribing and misuse, use of antibiotics in agriculture, lack of research and poor hygiene and sanitation – can be addressed.

In the U.S., about 13 percent of outpatient visits, or 154 million visits each year, result in an antibiotic prescription, according to the Pew Charitable Trusts. Thirty percent of those prescriptions, or 47 million prescriptions, are deemed unnecessary.

Aetna sent letters to more than 1,100 clinicians in the United States in July 2017, who prescribed antibiotics to treat acute bronchitis, which is caused by a viral infection. The letters included information from the CDC on antibiotic resistant bacteria. This correspondence resulted in a significant percentage of the clinicians requesting further engagement with Aetna to tackle the issue.

The white paper also describes how health systems across the world are working to address the antibiotic resistant crisis. In India, multiple factors, such as high burden of disease, poor public health infrastructure, rising incomes and unregulated sale of cheap antibiotics, led to the country becoming one of the world’s largest consumers of antibiotics.

Indian Health Organization, an Aetna company, is taking a three-pronged approach to combat this. There is an emphasis on antimicrobial stewardship in clinical training. Audited medical consultations also include checking antibiotic prescriptions for dosage, duration and rationale for use. Physicians are also identifying and correcting antibiotic usage during consultations.

Aetna is also working with providers and members to increase awareness and education about antibiotic resistant bacteria and appropriate antibiotic use. The approach has led to antibiotic utilization across Aetna International’s membership to drop from 27 percent in 2014 to 18 percent in 2016.

Other organizations have also starting to take an increased look at combatting the antibiotic resistant bacteria crisis, according to the white paper. After Simon’s death in 2004, his mother partnered with the University of Chicago Medical Center and found the MRSA Research Center. The Research Center seeks to prevent, control and treat MRSA through scientific and clinical research, according to its website.

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Aetna Foundation launches funding initiative to help fight opioid epidemic

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The Aetna Foundation is launching a funding initiative to fight the ongoing opioid epidemic in the U.S. and help communities and states that have been particularly hard hit. Grants totaling $6 million will fund state and local projects with the potential to make a real difference in addressing opioid-related challenges.

North Carolina will be the first state to receive a grant through the Aetna Foundation’s initiative. The North Carolina Harm Reduction Coalition will receive $1 million to help fund its “Rural Opioid Overdose Prevention Project.”

“While this is a national health crisis, there is no single solution that can be applied across the country,” said Harold L. Paz, M.D., M.S., Aetna’s executive vice president and chief medical officer and member of the Aetna Foundation Board of Directors. “These grants will provide important resources to empower local communities to address the unique characteristics of the opioid-related problems they are facing.”

In a survey conducted by Morning Consult, 77 percent of respondents said the role of local communities and community organizations are important in fighting the opioid epidemic. The survey was conducted from Feb. 8 through Feb. 12, 2018, and 2,201 adults participated.

With one of the highest rates of opioid overdose deaths nationwide, the funding will help provide community-level risk education in five rural counties in North Carolina; distribute naloxone kits to rural, high-risk opioid users; and increase adoption of best practice policies on overdose prevention.

More than 12 million people in the U.S. misuse prescription opioids, according to the most recent data from the United States Department of Health and Human Services. The number of overdose deaths involving opioids in 2016 was five times higher than in 1999, according to the Centers for Disease Control and Prevention.

In 2010, drug overdoses overtook motor vehicle crashes to become the leading cause of injury death in North Carolina. An average of five people a day died from drug overdoses in North Carolina in 2016, according to the North Carolina State Center for Health Statistics.

“There’s no question that rural communities in North Carolina have been especially hit hard by this epidemic. There are far too many tragic stories of lives being lost and families bearing the burden,” said North Carolina Attorney General Josh Stein. “North Carolina Harm Reduction has been doing excellent work to confront these challenges. I am grateful to Aetna for supporting North Carolina Harm Reduction to save lives in North Carolina communities.”

The Aetna Foundation will be announcing grants to other organizations in additional states over the next several months as part of its mission of Building Healthy Communities by supporting locally-based programs, dynamic partnerships, and proven models that can help accelerate progress everywhere.

“For the first time in our history, our children’s generation is not expected to live as long as our own. That is due in large part to the epidemic of opioid abuse, which presents a clear and present threat to our communities and health care resources,” said Garth Graham, M.D., M.P.H, president of the Aetna Foundation and vice president of Community Health for Aetna. “The innovative work that the North Carolina Harm Reduction Coalition is doing on the ground is promising, and it’s our hope that it can also offer a road map for outreach in other rural communities.”

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2018 Health Care Trends

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Download the 2018 Health Care Trends report, provided by Aetna.

Despite the United States’ position as an economic powerhouse at the forefront of the tech boom, our health lags behind some countries. World Health OrganizationWorld Health Organisation – Global Health Observatory data http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/ (WHO) figures show that our average life expectancy is lower than 30 other countries, including Switzerland, Australia and Canada. But the tide may finally be turning, with a monumental shift in how we approach health care, towards a personalized approach that focuses on each individual and all aspects of their well-being. Rather than concentrate solely on treating people when they’re sick, health care providers are placing a greater emphasis on keeping them healthy. Instead of visiting clinical facilities for the majority of their care, people are using technology to monitor their health and receive treatment in their homes.

Doctors, hospitals and health companies now have insight into all factors that can affect patient health – from lifestyle to income to genetics. And they are using that information to connect people to a wide range of health and social services within their communities.

The Aetna 2018 Health Care Trends Report explores the key factors driving this shift: New strategies that yield better results from our country’s investment in health care; innovative ways wearables could reduce spending on chronic diseases; the role of diversity in shaping a new health care system; how health companies can help conquer the scourge of opioid addiction. Read on to see how the development of these trends in the years to come can result in healthier communities, happier individuals and better health outcomes for all.

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Partnership and promise: Improving the health of a community

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Three research studies of programs and services offered by Mercy Maricopa Integrated Care (Mercy Maricopa), a Medicaid managed care plan, to address social determinants of health found some components of the programs can reduce cost and improve quality of care for people with serious mental illness in Maricopa County, Arizona.

Mercy Maricopa and one of its sponsors, Mercy Care Plan, are fully administered by Aetna Medicaid, which assumes the operational and management oversight of the health plans, including the hiring of all health plan staff and the provision of financial, clinical and operational services and systems. Mercy Care Plan and Mercy Maricopa are not-for-profit 501(c)(3) organizations.  Mercy Maricopa is sponsored by Mercy Care Plan, Dignity Health, Ascension Health, and Maricopa Integrated Health System.  Mercy Care Plan is sponsored by Dignity Health and Ascension Health.

The studies, published on Jan. 10, 2018, were commissioned by Aetna, but conducted by the independent research institution, NORC at the University of Chicago.

The NORC studies looked at the experience of members enrolled in supportive housing, supported employment, and Assertive Community Treatment services, as well as the applicable program’s effect on the cost and quality of care and the utilization of services by adults with serious mental illness. The services in Maricopa County are combined at single community provider locations to make sure members have access to supportive services, as well as physical and behavioral health care.

The research findings suggest shifting services from more intensive inpatient and residential stays to outpatient and routine behavioral health care focused on chronic illness can affect cost and quality of care.

“Working collaboratively with providers, local stakeholders, the City of Phoenix, Valley of the Sun United Way, and the state of Arizona, we have shown that fully integrated care addressing social factors is the right way to meet the needs of Medicaid members with complex conditions,” said Mark Fisher, CEO of Mercy Care Plan.

“These studies validate the critical importance of addressing basic social needs to improve members’ physical and mental health,” said Laurie Brubaker, head of Aetna Medicaid. “Working with our community partners, Aetna Medicaid continues to invest in innovative tools and programs that can significantly improve the lives of our members, and the members we manage, right in their own communities.”

Addressing social determinants of health leads to positive health outcomes

The research found that members enrolled in the supportive housing intervention experienced decreases in total cost of care of 24 percent after enrolling in the program, while members in the Assertive Community Treatment intervention experienced significant reductions in certain costs, including a 6 percent relative decrease in per member per quarter costs in behavioral health professional services, an 11 percent relative decrease in health facility costs, and an 8 percent reduction in emergency department visits.These reductions were per member per quarter and represent the approximate difference in total cost before and after the receipt of supportive housing services and are not necessarily directly attributable to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. For housing, this analysis found that there was a reduction in total cost of care of $5,002 per member per quarter relative to a comparison group.

Members enrolled in the Scattered Site housing program had an average health care cost of about $20,000 per member per quarter in at least one quarter before starting in the supportive housing program.2 After enrolling in the supportive housing program, members experienced a $4,623 reduction per member per quarter in total cost of care. These members also had fewer psychiatric hospitalizations than they had before enrolling in the program.

While supported employment led to an increase in overall costs for enrolled members, likely because of the cost of the supported employment services and increases in other services, members who received supported employment services experienced varying degrees in reduction in both inpatient medical and psychiatric hospital stays, including a 35 percent decrease in inpatient medical hospitalizations.These reductions were per 1,000 members per quarter and represent the difference in total cost of cost before and after the receipt of services and may not be directly attributed to the programs themselves. Each evaluation also included an analysis comparing those in the program to a matched group not in the program. Members in the Assertive Community Treatment program, averaged 187 fewer outpatient emergency department visits per 1,000 members per quarter relative to those who did not receive the services, which was a significant decrease in utilization.

Continuing support for better community health

Mercy Maricopa and its partners showed a commitment to prioritizing member needs and a dedication to working with community stakeholders to ensure those needs were identified and addressed. Qualitative findings from this research suggests, that the increase in social support led to increased focus by members to obtain and regularly use sources of care – decreasing the need for emergency or inpatient services.

Integrated care streamlines the process of accessing care for members with serious mental illness. Having services within the clinics, for example, allows clinical teams to send a direct referral to a supported employment provider – enabling members to access these services immediately and reducing the interruption that occurs when members need to seek care somewhere else.

Continued education among clinicians and staff is also important to ensure they’re familiar with changes, additions, or new programs to help them provide better care to members. Mercy Maricopa created educational toolkits, known as Placemats or decision trees, to inform its staff of the discharge referral process. This way, members are provided with support and resources to help them remain healthy.

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