CVSHealth's pharmacy benefit manager, CVSCaremark, is tackling the chronic conditions of diabetes and hypertension through the analytics of pharmacy, medical and lab data to identify and enroll at-risk members.
About 34 percent of adults have prediabetes, and approximately 90 percent of pre-diabetics don't know they have it.
The overall goal is to help reduce the incidence of diabetes in a given population by 58 percent in three years.
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Members eligible for Transform Diabetes Care will receive a connected digital scale, a CDC-approved app-driven prevention program and health coaching from nurses, dietitians and others on exercise and behavioral changes.
As hypertension is twice as frequent in diabetes patients, a new Transform Hypertension Care program will give members a connected blood-pressure cuff, which will automatically capture blood pressure readings and store them in a personal profile; an app-based hypertension management program including digital coaching, weekly challenges and education; and access to specialized experts on demand for personalized condition management and support.
Both groups also have access to practitioners and two annual metabolic visits at CVS Minute Clinics with no out-of-pocket cost for screenings, education, targeted physical exams and treatment to help prevent the onset of complications.
Payers, and providers, are looking to head off expensive chronic conditions through early intervention.
The integration between PBMs, pharmacies, and in CVS's case, with insurer Aetna, gives them access to patient data to coordinate care for better outcomes and lower costs.
THE LARGER TREND
Two years ago, CVS Caremark launched the Transform Diabetes Care program to improve medication adherence and better control blood sugar levels as measured by the hemoglobin HbA1c test.
More than 50 percent of members with uncontrolled diabetes who enrolled in the program moved to a controlled status and, on average, members improved HbA1c by 1.2 percentage points, CVS Caremark said.
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