FLAACOs 2014 Conference - CVS Health: Collaborating with Providers

©2013 Caremark. All rights reserved. This presentation contains confidential and proprietary information of CVS Caremark and cannot be reproduced,
distributed or printed without
written permission from CVS Caremark.
Collaborating with Providers
Fall Conference
September 2014

2
© 2014 Caremark. All rights reserved. CVS Caremark proprietary and confidential information. Not for distribution without written permission from CVS Caremark.
Medical Home is it enough?
MEDICAL HOME PRIMARY CARE BY THE NUMBERS (EST.)
Projecting the Supply and Demand for Primary Care Practitioners Through 2020
Health Resources and Services Administration
published November 2013
Number of PCP’s 2010
• Total 205,000
• Demand 212,500
7,500
• Patients in need Over 18 Million
Number of PCP’s 2020
• Total 220,800
• Demand 241,200
20,400
• Patients in need about 51 Million

3
Medical Home Evolving to Neighborhood
SNF’s
Urgent
Care
Retail
Health
LTAC
Retail
Pharmacy
Home
Health
Home
Infusion
Specialty

4
Early Alignments – Strait Forward
SNF’s
Urgent
Care
Retail
Health
LTAC
Retail
Pharmacy
Home
Health
Home
Infusion
Specialty

5
00000
Health System Affiliate Relations
Pharmacy
Benefits
Management
programs
CVS retail
pharmacy
care programs
Retail clinics
primary care
support and
connectivity
Specialty
medications
and pharmacy
programs

6
Global
Capitation
Changing Health Care Environment: Providers
are Adapting Rapidly
Our goal is to improve pharmacy care and
complement primary care to help providers
reach their patient care goals
Fee for
Service
(FFS)
FFS with
Pay for
Performance
Bundled
Payments
Shared
Savings
Shared
Risk
Evolving Contracting Arrangements

7
00000
Only Half of Patients Adhere to Evidence-Based
Drugs Prescribed by Physicians
• Largest drop in adherence occurs
within the first six months of
treatment
• Consistently observed for multiple
diseases and drugs in multiple
clinical settings
• Adherence rate two years after
MI:
– Statins: 33%
– Beta-blockers: 53%
– ACEI/ARB: 50%
• 50% of patients have an evidence
based gap in care
Sources: Benner et al. JAMA 2002; 288: 455; Jackevicius et al. JAMA 2002; 288: 462; Akincigil et al. JGIM
2008; 23: 115.
%Fullyadherent
100%
43%
34% 32% 30%
27%
0 6 18 30 42 60
Months since statin initiation

8
All Retail Pharmacies are Not Alike
Source: CVS Caremark Quarterly Adherence Report.
Comparing Adherence of Retail
Chains
(medication possession ratio (%))
80
81
83
70
72
74
CVS Top 3 Competitors
230+ million interventions have helped drive best-
in-class adherence results
Comprehensive Pharmacy
Interventions to Support
Adherence
 New Script Pickup
 First Fill Counseling
 Refill Reminder
 Adherence Outreach

9
00000
Challenging Health Trends Call for More
Advanced and Integrated Clinical Strategies
1. Milliman Specialty Medication Benchmark Study, 2013 analysis of 2011 data. 2. Cassil, Alwyn, “Rising
rates of chronic health conditions: What can be done?” Center for studying health system change 2008;
no.125. 3. DeVol, R., Bedroussian, A. An Unhealthy America: The Economic Burden of Chronic Disease.
Milken Institute. October 2007. 4. Milliman analysis, 2013. 5. Per Member Per Month (PMPM) . Source:
CVS/caremark Enterprise Analytics, 2013. 6.Targeting Cardiovascular Medication Adherence Interventions,
Journal of the American Pharmacists Association, May/June 2012.
CLINICAL
MANAGEMENT
CHALLENGES
X
X
Timely, actionable
clinical messages
delivered to patients and
providers, ACOs/PCMHs
improves outcomes;
Targeted interventions are
1.75X more effective6
1 in 2 Americans have a
chronic condition;
Health care costs for
patients with at least one
chronic condition is 5X
greater1
Growing emphasis on
quality measurement
across all lines of
business; Clinical
metrics account for 38%
of Medicare Part D Stars
½ of patients
do not adhere to their
medication therapies,
resulting in $290B in
health care costs 2,3
31786
Specialty patients drive
25% of your total health
care costs4; Spend
expected to double to
$70 PMPM in 5 years5

10
00000
Reduce Costs by Improving Pharmacy Care
*Projections based on CVS Caremark data. Individual results will vary based on plan design, formulary status,
demographic characteristics and other factors. Client-specific modeling available upon request. This is a forward-
looking statement and actual results may be different.
Source: CVS Caremark Enterprise Analytics, 2013.
Calculates the savings associated with
providing good pharmacy care
27%
Reduction
$3,028
Annual Savings
per Patient
$11,100Global capitation payment
($30)Moving to generics
($2,340)Improving adherence
Closing gaps-in-care ($658)
Payment after savings $8,072
Medicare Example: 100K Lives, PMPY
Pharmacy Care Economic Model*
Effective pharmacy management significantly improves ability to reduce cost of care

11
How? Supporting Providers From Prescribing
Through Practice Transformation
 Bedside delivery
of medications
 Home infusion
services
 CVS onsite
pharmacy
 340B program
HOSPITAL
TRANSITIONS
Convenient
medication
dispensing
Effective care
management for
rare conditions
SPECIALTY
MANAGEMENT
Chronic disease
management
Wellness Support
Acute minor
episodes
Vaccinations
Two-way clinical
messaging
Performance
Guarantees
FOCUS ON YOUR
PATIENTS
 Actionable
reporting
 Data analytics
 Shared savings
 Shared risk
POPULATION
HEALTH

12
00000
MinuteClinic® Provides Access to High Quality
Care at a Lower Cost
900+ full time
clinics in 29 states
with over 21M
visits to date
Largest employer
of board-certified
Nurse Practitioners
Over 2,300 NPs
Walk-in care,
7 days per week
including evenings
Up to 80%
savings over
higher costs of
care
92%
overall patient
satisfaction1
50% of patients
indicate no PCP
THE FIRST AND LARGEST
RETAIL HEALTH CARE
PROVIDER TO BE
ACCREDITED BY THE JOINT
COMMISSION
1. Press Ganey Satisfaction Survey Results, 2012.
85% of patients
use third party
coverage
50% of visits occur
after 5pm or on
weekends

13
• EMR integration and
exchange of clinical data
• Participate in ACO and care
system development
• MinuteClinic providers
collaborate with health
system medical directors
• Joint clinical programs for
chronic care and wellness
• Affiliations now incorporate
full pharmacy collaboration
Current Health System Affiliations
Our goal is to have affiliations in all major markets by 2017

14
00000
MinuteClinic is Adding New Services to Support
Population Health Management
Non-acute services are now 18% of total volume and growing
ServicesExpansion
• Weight Loss
• Smoking
Cessation
• Hyperlipidemia
• HIV Screening
• Health Risk
Assessment/Visit
• Hypertension
• Advanced Point-
of-Care Testing,
including A1c
• Medicare
Wellness Visit
• Additional Chronic
Care Support in
Collaboration with
Health Systems
2013 2015201
4

15
00000
Case Study: minute clinic® Helps Lower
Total Health Care Costs
• Large employer compared total health care
spending (medical and pharmacy claims)
for members using minute clinic® vs.
members seeking care in other settings
over a 1-year period*
• Subjects matched for age, gender
and health status
• minute clinic® patients had lower physician
visits, ED visits, and hospital days
minute clinic® users had 8.3% lower total health care costs when
compared to non-users.1
8.3%
Reduction
minute clinic®
Users
Non-minute clinic®
Users
Total Health Care Costs
(PMPY)
~$3350
~$3100
*Using de-identified data. medical and pharmacy claims for employees and their dependents who received care at a retail clinic between June 1, 2009, and May
31, 2010, were matched to those of subjects who received care elsewhere.
1. Sussman, Andrew MD., et al. Retail Clinic Utilization Associated with Lower Total Cost of Care. The American Journal of Managed Care. April, 2013. 19:4.

16
Clinical Affiliation – What does it look like?
• Located in Southern NJ
• 4 Acute Care Hospitals
• 5 Ambulatory Locations
• 3 Imaging Centers
• 3 Urgent Care locations
• 2 SNF’s
• Oncology, Lab services, Occupational
Heath, Sleep Centers, Health and
Wellness
• About 1B in annual revenue

17
Evolving Relationship CVS Health & Virtua
Collaborate on Clinical
Risk Relationships
Improve Hospital
Transitions
Improve Pharmacy
Care
Complement Primary
Care
Streamlining
Hospital
Transitions to
Outpatient Setting
• CVS DeliveRx™
(Bedside Delivery)
• Exploring Coram
Home Infusion
• Exploring
Medication
Reconciliation
programming
Ensuring patients
are
adherent to their
Medications at
retail
• Collaboration on
improving
adherence, closing
gaps in care
• Transparent
Pharmacy Care
• Actionable
Reporting
Affiliation with
CVS/Pharmacy
and MinuteClinic
• Access
• Chronic disease
management
support
• Wellness support
• Seamless
connectivity to
physician EMR
SliverScript
• Helping manage
pharmacy for
MSSP
• Cost savings and
• Quality
improvement
• Shared savings
Caremark PBM
• Helping manage
employee
pharmacy needs
Increasing Provider Risk

18
Messaging the Integrated Approach –
The Where & Why

19
Retail clinics are they here to stay?
What retail clinic growth can teach physicians about patient demand – Lisa Zamosky Published in Medical
Economics Jan 2014
MinuteClinic® Today
900+ = over 50%
MinuteClinic® Planned
~1600-2000 = 50%-67%

20
Where is the Value?

21
Re-thinking the Clinical Neighborhood
Retail
Pharmacy
Specialty Urgent
Care
Home
Infusion
Retail
Health

22
00000
Additional CVS Health Programs Add Value for
Providers and their Patients
Bedside Delivery*
Coram Home
Infusion
340B Program*
CVS Onsite
Pharmacy*
In-home
Pharmacist
Consultation*
PATIENT
FOCUS
Accordant
Specialty Care
Management
Specialty 340B*
Specialty
Connect
NovoLogix Cost
Management
HOSPITAL
TRANSITIONS
Pharmacy
Advisor @ CVS*
HealthTag
in-store
messaging
POPULATION
HEALTH
Patient and
Provider Insight
Tool for
SilverScript
members
PBM Services for
Health System
Employees
Medicare ACO
Support through
SilverScript
SPECIALTY
MANAGEMENT
*Available in some areas

23
00000
Pharmacy Advisor® Counseling:
Focused on Improving Medication Management
*Conditions addressed vary by line of business.
**Specific interventions may vary by line of business.
Collaborating with case managers for better care coordination and optimal results
• One-on-one pharmacist counseling for
patients with most prevalent and costly
conditions* at more than 7,600 CVS/pharmacy
locations
• Proactive, patient-specific interventions at
key events in therapy**: new to therapy,
non-adherence and gaps in therapy
Offering the focus, access and expertise to complement your health
management strategies and support your quality improvement goals:
31790

24
00000
 Early identification of Home Infusion
Sensitive Conditions (HISCs) and
patient flow management
 Clinical Liaisons to provide assessment,
risk stratification, education and
discharge planning assistance
 IV expertise, therapy specific protocols,
and expert compounding standards help
ensure patient safety
 Real-time outcomes dashboard
demonstrates program success
Coram Provides Market-Leading Home Infusion
• Services include:
– Anti-Infectives
– TPN and Tube Feeding
– Cardiac and Transplant
– Immune Therapies
– Alpha-1 Therapies
• Home infusion
arrangements guaranteed
prior to discharge
WORKING TOGETHER TO
IMPROVE HOSPITAL
TRANSITIONS
All-cause readmission rate for Coram patients is <5%1Compare to 18% for post acute
care2 and 24% for skilled nursing facilities3
*Source: 1Coram National Infusion Results, Q1–Q4 2013 2MMRR: 2013: Volume 3 (2) 3The Revolving Door Of Re-hospitalization From Skilled Nursing
Facilities, Health Affairs, 29, no.1 (2010):57-64
Improved Care Coordination
and Patient Transition
Improved Readmissions
and Patient Satisfaction
Improved Hospital
Financial Performance

25
00000
Medicare Part D Expertise
• Second largest national Prescription Drug Plan Sponsor - 3.6M members
• Medicare Part D coverage in 50 states, and D.C.
• Full and timely visibility of all adjudicated drug claims across our
national network of pharmacies (includes Wal-Mart, independent
pharmacies, Walgreens, etc.)
• Competitively priced plan options - Ex., $0 annual deductible and $0
copay for all Tier 1 generic drugs at any preferred pharmacy (CVS,
WalMart and independent pharmacies)
• Mail order prescription delivery option at no extra cost for 90 day
supplies
SilverScript Insurance Company - Wholly-
Owned Subsidiary of CVS Caremark
Well positioned to help ACOs and providers manage their Medicare
population
22643

26
00000
Interactive Pharmacy Analytics Tool Supports
Your Population Health Management Strategy
Identifying high-value patient outreach for targeted impact
• Identify patients for cost
savings, adherence
outreach and therapy
changes
• Practice and patient level
views
• Drill-down reporting for
physicians, nurses, and
case managers
Sample report: Report specifics subject to change

27
00000
Helping to Achieve ACO Quality Measures
• Pharmacy Data Sharing to Manage Chronic Conditions
• Improve Quality Measure Results
• Improve Patient Health
Diabetes Hypertension
Coronary
Artery
Disease
Ischemic
Vascular
Disease
ACO Clinical Quality Measures Related to Key Disease States
Impacted by Improved Medication Adherence

28
00000
Pharmacy Care Provides Support for Key
Segments of Your Patient Population
High Risk/High Cost
Reduce costs and improve
outcomes through specialty
management and
condition-specific counseling
Moderate and Rising Risk
Support through chronic disease
management, ongoing therapy
monitoring, and care transitions
programs
Low Risk
Engaging low risk patients
to help keep them healthy,
providing easy access to
adherence and primary
care support when needed
5%
20%
40%
35%

29
Thank you for your time today…
James Dold
James.dold@cvshealth.com
Mark Bowen
Mark.bowen@CVShealth.com

FLAACOs 2014 Conference - CVS Health: Collaborating with Providers

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FLAACOs 2014 Conference - CVS Health: Collaborating with Providers