Reimagining diabetes treatment

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Managing diabetes can be complex. Achieving and maintaining one’s best health for this chronic condition, which causes higher than normal blood sugar levels, depends on a person’s ability to monitor symptoms, manage complicated medication regimens, control blood glucose and practice healthy behaviors.

“There are 50 different things — or maybe more — that a person with diabetes could be doing at any time to best manage their condition,” says Stella Wong, Senior Director for Product Development at CVS Health. “It's overwhelming.”
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In the U.S., more than 34 million people live with diabetes and deal with these challenges, according to the Diabetes Research Institute Foundation. And only about 23 percent of people with Diabetes have it under control, says Peter Simmons, RPh, Vice President of Chronic Care Optimization. “Given the array of solutions available, that's a shame. We feel like we can do better.”

To do that, CVS Health created a proactive, integrated and holistic plan that reimagines diabetes treatment for its members. The goal is to reduce the complexity of self-management and improve health outcomes for plan members with diabetes — while preventing its onset.

Available with Caremark and Aetna benefit plans, the Transform Diabetes Care program uses CVS Health data insights and analytics to create personalized care plans for individuals across five clinical areas. The plan can be communicated through local CVS pharmacists and HealthHUB® professionals, digitally and virtually. Members are provided myriad tools to support their personalized care plan.

Peter Simmons, Vice President of Chronic Care Optimization for CVS Health.
“We always seek to be consumer-centric, consider how to deliver care locally and make care as simple as possible for customers and patients,” says Peter Simon, CVS Health’s VP Chronic Care Optimization.

The data also allows CVS Health to identify gaps in care and respond to patient needs before they arise. This proactive approach sets it apart from most other treatment plans, says Kyle Smith, head of CVS Health Transformation Marketing. “I think that's the most compelling thing about the work that we're doing.”

The program also utilizes a Pharmacist Panel to help patients stick to their plans, says Pharmacy Services Market Support Coach Rebecca Rice. “Pharmacists continue the conversation with their patients about their health while building trust and rapport,” she says.

“We think about our purpose every day: how we can help people on their path to better health,” Simmons says. “We always seek to be consumer-centric, consider how to deliver care locally and make care as simple as possible for customers and patients, especially those managing chronic conditions such as diabetes.”

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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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NAFC grant spotlight: Broad Street Clinic

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CVS Health Foundation has partnered with the National Association of Free & Charitable Clinics (NAFC) on a multi-year program, awarding grants to increase access to care, improve health outcomes and lower overall health-care costs across the country.

Among the 2019 NAFC grant recipients is the Broad Street Clinic, a North Carolina-based clinic that was founded in 1993 by a group of local physicians and is dedicated to providing care to the uninsured and low-income members of its Morehead City community.

The Communities Served by the Broad Street Clinic

Broad Street Clinic (BSC) serves Carteret County and the surrounding areas. Currently, BSC serves 850 patients with about 3,000 visits annually for adult primary and specialty care. The majority of BSC patients are employed by the local commercial fishing, hospitality and tourism industries.

Community-Focused Chronic Disease Care

BSC provides free medical and pharmaceutical services to uninsured and underinsured, low income people with certain chronic illnesses, including diabetes, hypertension, thyroid disease, pulmonary and cardiovascular disease, and hepatitis C. BSC also provides gynecological and limited dental and vision services.

How the CVS Health Foundation Grant is Helping

BSC has been using the CVS Health Foundation grant to provide health coaching for diabetic patients. By learning to use the clinic’s electronic health records reporting, clinic providers have been able to target patients with diabetes and then further check A1C levels and last testing dates.

Since receiving the CVS Health Foundation grant, Broad Street Clinic has held two diabetes workshops. Participants have gotten to know one another and are sharing personal tips and tricks for managing their condition.
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These patients are encouraged to attend diabetic workshops held at the clinic to learn more about the disease and how to manage it. Clinic nurses and diabetic educators work with patients to teach them about healthy lifestyle changes and to develop their individual self-care plans.

A Group Effort to Better Manage Diabetes

Since receiving the CVS Health Foundation grant, BSC has held two diabetes workshops, with plans for more in the works. At each, participants got to know one another and share personal tips and tricks for managing their condition. They also filled out self-management goal worksheets, which they placed in self-addressed envelope to be mailed a month later so that they can check their own progress.

In addition, each participant received a pair of support stockings to help with leg and foot circulation and reduce swelling, a common symptom of diabetes. One woman, a cashier, called the clinic to report that the stockings helped her to feel more comfortable while on her feet all day.

To stay up-to-date on the latest CVS Health Social Responsibility news and content, sign up for email news alerts.

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Taking control of diabetes with HealthHUB

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HealthHUB, our first-of-its-kind concept store now open in select locations nationwide, connects patients with health care services, advice and personalized care right at their neighborhood CVS Pharmacy. 

This ease of accessibility was what prompted Luis to stop by his local HealthHUB to see someone about abdominal pain he was experiencing.

What he and the nurse practitioner discovered was that the issues he was having went beyond simple pain: He was diabetic, but wasn’t currently being treated for the condition. Within his 40-minute visit, the HealthHUB team set Luis up to meet with both an eye doctor and a dietician and he left with a treatment and management plan in place.

Watch the video to learn more about how Luis’s trip to his local HealthHUB got him back on track.

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

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For diabetes patients, a Care Coach is just a click away

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CVS Health pharmacist Matthew Scarnecchia could see the concern on the face of his patient. Richard, a 59-year-old man who suffered not only from Type 2 diabetes but also high blood pressure and high cholesterol, was alarmed by the results of his latest blood-sugar test. His A1c was 7.5 percent — above his goal range of below 7 percent.

With a few questions, Scarnecchia learned that Richard was worried about also getting low blood sugar from his diabetes medication. It turned out that Richard was taking his diabetes medication in the morning, but not eating until he was at his workplace after a long commute. “I recommended that he take his Glipizide with his breakfast at work to see if that would help,” Scarnecchia says. It did. Just a few months later, Richard’s A1c had dropped to 6.3 percent and he was no longer having low blood sugar readings.

Nearly as satisfying, this one-on-one consult took place without either man leaving his desk, even though they were 2,000 miles apart – one in Arizona, one in Florida. Through his insurance provider, the patient had signed on to CVS Health’s Medication Therapy Management program and met with Scarnecchia face-to-face via an online app that can be accessed through any computer or mobile device.

Personal Consultations from Anywhere

Once enrolled in the program, patients can slot in a video consultation from anywhere. In addition to their regular doctor’s appointments, they can talk with a specialized pharmacist who can advise on medication compliance, interactions and side effects, and, most importantly, suggest some everyday adjustments, such as diet and exercise, that can make an immense difference in controlling diabetes.

CVS Health’s Medication Therapy Management program provides patients with one-on-one care with a specialized pharmacist who can help them better manage their chronic condition from the comfort of home.
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A video meeting benefits patients and pharmacists alike. A patient can show his or her latest blood-sugar results or other medical reports without needing to mail them. If a patient is having issues injecting insulin, the pharmacist can point to possible alternative injection sites on a visual model. The one-on-one view also allows pharmacists to pick up on nonverbal cues. “I can see if a patient seems confused about their results and give explanations that might be helpful,” says Scarnecchia.

Patients can take advantage of this face-to-face coaching even before they might need medication. With diabetes tied to so many other health concerns — high blood pressure, nerve damage, heart disease — it’s especially vital to try to halt or slow down the condition’s progress.

Small Changes Can Make a Big Difference

When an A1c of 5.8 percent tipped him into the prediabetic range, 60-year-old Jeff welcomed the chance for video chats with pharmacist Brian O’Halloran, and has kept those appointments every three to four months. “During our visits, we’ve discussed healthy lifestyle changes,” says O’Halloran. “Jeff decided to stop drinking diet sodas, and reported, nine months later, that he’d stayed off them.” 

Small but attainable goals are easier to meet, explains O’Halloran.

“In March 2018, Jeff said he wanted to lose 5 pounds before his next time we talked. I told him ‘Don’t shop the aisles.’ That’s where grocery stores stock all the processed foods. Instead, I suggested he shop the perimeter — where he could pick up fresh vegetables and meats. When we spoke again in July, he’d lost 6 pounds.”

Both pharmacists find that patients look forward to the on-screen sessions, which often last for 30 minutes. Even a patient’s family member may stop by to wave hello, says Scarnecchia. Patients can also contact the pharmacist in between scheduled sessions. When a patient shares good news about improved bloodwork, O’Halloran warmly congratulates them on their success.

For diabetes patients, a video visit is part of the “big picture” of managing of their condition. Patients can ask questions that may not have occurred to them while in their doctor’s office. “It’s more like a conversation,” says O’Halloran, “and more comfortable for the patients.”

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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Helping patients better manage diabetes

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As CVS Health’s Senior Director of Transformation Stella Wong explains, diabetes is a difficult condition to manage. There are a number of things patients need to do on a routine basis, such as checking blood glucose levels, eating right, exercising, or taking the right medications at the right time.

“The list is literally hundreds of items long,” Stella says.

CVS Health is in a unique position to help. From new, innovative programs to in-store screenings at MinuteClinics and HealthHUB locations, learn how we’re helping people with diabetes better manage their condition and lead healthier lives.

From new, innovative programs to in-store screenings at MinuteClinics and HealthHUB locations, watch this video to learn how CVS Health is helping people with diabetes better manage their condition and lead healthier lives.
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“Our tremendous reach into people’s communities (and) our focus on new technologies will allow us to add an entire other layer of support and care for patients,” says Dr. Alan Lotvin, Chief Transformation Officer. “We have the opportunity and the ability to fundamentally reshape and augment the care delivery system in the United States.”

Watch the video above to learn more.

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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Why Building Trust is Key to Delivering Crucial Care to Pharmacy Patients

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CVS Health pharmacists are often called on to employ not only clinical services, but a fair amount of detective work as well. Patients often report that their diet, exercise, and medications are all in check, but if they’re not experiencing results to match, then it’s time to dig a little deeper.

Elderly or infirm patients can pose special challenges: They can be mistrustful of medical professionals, stuck in old habits, and might not even be physically able to visit their local CVS for prescription recommendations and tests. Often, all the pharmacist has to go on is phone consultations and lab results. And yet, often that’s enough to produce life-changing results.

Pharmacist Angela Stigliano realizes that building trust with patients is a necessary part of the job. She’s a clinical pharmacist for CVS Health’s Medication Therapy Management (MTM) service, and provides care to members over the phone or via video chat.

She shared a recent success story about a patient with diabetes that demonstrates why trust is so important. The percentage of Americans 65 and older with diabetes is high, at about 25.2 percent or 12.0 million seniors (diagnosed and undiagnosed).https://www.diabetes.org/resources/statistics/statistics-about-diabetes It is a disease that can be well-controlled with diet and lifestyle changes — but they’re not always easy to make and adhere to without a helping hand.

Asking the Right Questions to Get a Diabetes Patient Back on Track

In March 2018 Stigliano began working with Vicki, a woman in her sixties who reported having a stroke that had left her with mild physical impairments. Though she had a long history with diabetes and high cholesterol, her doctors were confident that she would make a full recovery.

In their initial phone call, Vicki insisted that she followed a strict diet and was very mobile, but given the precarious state of her health, that “didn’t make sense,” says Stigliano: She was gaining weight, her A1C was unstable, and she wasn’t taking her cholesterol medication as prescribed. These factors put her at risk not only for another stroke, but heart disease as well.

Through a series of thirty-minute phone calls every few months, Stigliano fostered a friendly relationship with Vicki.

“I would use phrasing like ‘Tell me about your diet these days,’ instead of saying, ‘Have you been dieting?’ This allowed her to tell me about her diet without the feeling I was searching for a ‘correct answer,’” she says. “It can be difficult to be forthcoming with a stranger about a sensitive topic like being overweight or unable to walk and care for yourself properly.”

These days, there’s a lot of confusion about what a “healthy diet” actually means. Vicki reported trying a keto diet, and skipping meals, both unwise choices for a diabetic.

“Purposely not eating enough can be just as unhealthy as eating fast food every day. Not having enough range in your diet can also become unhealthy as well,” says Stigliano. She recommends the easy-to-follow MyPlate tactic to patients like Vicki. “You’re not telling them what to eat and what not to eat, but to focus more on portion sizes; to look at their diet and their plate a little bit differently.”

A CVS Health clinical pharmacist shares a recent diabetes patient success story that demonstrates the importance of relationship-building in her work.
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After several months, Stigliano was pleased to hear that Vicki had begun to be more honest with herself and her medical team. She compromised with her prescriber, and was put on a low-intensity statin three times a week. And, as Stigliano had gently suggested over the course of their interactions, she began a low-carb, high-protein diet, and increased her physical activity.

All of these changes started to pay off. Vicki’s A1C had been steadily improving due to her adjusting her insulin, but after taking the initiative to make lifestyle changes, she had lost approximately twenty-five pounds, reduced her A1C to consistent readings at or around 7 percent, and mentioned that her LDL cholesterol had come down by 100 points on her latest lab test. And she felt positive, healthy, and empowered.

“When we first started talking, Vicki was not in good spirits,” says Stigliano. “She was very upset about her stroke, and really down, very defeatist. But, after Vicki began to take control of her health, Stigliano says, “It sounded like I was speaking to a whole different person. She was excited to tell me about her lifestyle, the change in her as person. She ended our most recent phone call by saying, ‘I’ll talk to you soon. I need someone to stay on top of me!’”

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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The importance of bringing diabetes care into the community

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This article was written by Dr. Dan Knecht, Vice President of Health Strategy & Innovation at CVS Health.

1.5 million: That’s the number of Americans who are diagnosed with diabetes each year. 327 billion: That was the total cost of diagnosed diabetes in the United States in 2017, according to the American Diabetes Association.

These are big numbers, but they don’t tell the whole story. In addition to my day job as Vice President of Health Strategy and Innovation at CVS Health, I practice as a physician at Mount Sinai West Hospital in New York City. During my weekend rotations, I see firsthand the very real and negative impacts of uncontrolled diabetes on my patients. Diabetes can cause vision loss, kidney failure and neuropathic pain, in addition to accelerating and worsening cardiovascular disease.

Thankfully, the news is not all bad. As the number of people diagnosed with diabetes rises, so are the resources and treatment options available to them.

CVS Health recently partnered with Morning Consult to better understand the needs of people living with diabetes and the providers who deliver diabetes care. What we heard from patients and doctors is a desire to:

  • Expand access to local care
  • Better manage and predict out-of-pocket costs
  • Provide additional lifestyle support in the form of nutrition, exercise and social services

In honor of Diabetes Awareness Month, I sat down with fellow diabetes experts Dr. Steve Edelman, M.D., founder and director of Taking Control of Your Diabetes, and Joy Pape, R.N., a nationally known family nurse practitioner and certified diabetes educator, to discuss how we can address some of these needs through real action.

Watch our full CVS Health Live discussion above.

Read Dr. Knecht’s full article on LinkedIn.

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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How a Trusted Partnership Helped One Type 2 Patient Live Healthier

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When Regina Wu first met Kenneth, she asked him about his diet and exercise — as CVS Health pharmacists routinely do with their patients. Kenneth, a 77-year-old man with diabetes and a sweet tooth who once weighed 286 pounds, said he often drank a liter of soda per day.

Regina immediately sensed a red flag.

“I know that soda is something people can become addicted to in a way,” she says. “It’s caffeinated, high in sugar, and people start to crave a soda fix. And soda is a big problem for blood sugar control.”

Research shows drinking sugary beverages like soda every day could increase a person’s risk of developing type 2 diabetes by 26 percent. For those already diagnosed with type 2 diabetes, soda consumption can hamper their efforts to keep their blood sugar at an acceptable level.

That certainly was the case with Kenneth. He took his medications diligently, but his A1C reading was 10.1 percent. A normal A1C is less than 5.7 percent, and the goal for type 2 diabetes patients is to keep their A1C levels below 7 percent. Kenneth was struggling enough with his blood sugar that his doctor increased his insulin dosages.

Losing weight and changing eating habits can be challenging if the problem seems large and insurmountable. Regina saw an opportunity to focus on a small, manageable change: reduce Kenneth’s soda intake.

It’s these kinds of interactions that CVS Health had in mind when we created our Medication Therapy Management program. The program is designed to allow CVS pharmacists to engage one-on-one with patients, identifying any barriers in their treatment, recommending lifestyle changes, and creating an ongoing dialogue to ensure that patients are taking their medication and getting the follow-up care they need.

Regina and her colleagues frequently work with type 2 diabetes patients: Approximately 1 in 10 Americans — or about 30 million people — have type 2 diabetes, 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.

Regina spoke every few months with Kenneth, urging him to drink even just one less can of soda. Then, in 2018, Kenneth was hospitalized with an infection, and he was hospitalized a second time about a year later. After Kenneth came home from the hospital, he cut back to two Diet Cokes a day. By May 2019, his A1C reading was 8.6 percent, much closer to his target level, and he now weighs 240 pounds. He’s on a 50-gram-carbohydrates per day diet, walks more often, his blood pressure levels have improved and his medication dosages have been reduced. He has kicked the soda habit completely, and has become an advocate among his family members to minimize soda drinking.

“I see the pharmacist as part of the care engagement team,” Regina says. “It really takes a village and the pharmacist is someone patients can talk to in between doctor visits or after hospital discharge. They get to know me, I get to know them, and it becomes a friendship, and with that trust, we talk about how to make small changes that can add up.”

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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By the Numbers: Improving Diabetes Care

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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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