CVS Health Enhances Medication Adherence Through Digital Patient Engagement Platforms

Treating complex chronic or acute diseases typically requires substantial investments of time and money, involving four key stakeholders in the healthcare sector—patients, healthcare providers, insurance companies, and pharmaceutical enterprises. These parties need to coordinate and collaborate to achieve optimal outcomes.

Reducing costs and improving the experience for high-need patients, particularly those who struggle with medication adherence, theoretically requires frequent communication and collaboration to ensure proper treatment.

However, in the fragmented and high-pressure environment of modern healthcare, patients are easily overlooked among the three parties: initial healthcare providers, specialists, and inpatient departments.

Adding another “P” to the medical process can effectively address issues, particularly in high-end healthcare services characterized by higher costs and greater procedural complexity.

CVS is the largest chain pharmacy and pharmacy benefit manager (PBM) in the United States, with nearly 10,000 pharmacies nationwide and hundreds of “MinuteClinic” locations. In recent years, CVS has been leveraging digital tools to manage patients and improve medication adherence. VCBeat (WeChat ID: vcbeat) has compiled this information.

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Dr. Surya Singh, Vice President and Chief Medical Officer of CVS Specialty Pharmacy, stated that telephones—or more accurately, smartphones—serve as valuable tools for enhancing digital engagement among patients of CVS Health Specialty Pharmacy.

In a pilot project, after patients engaged in specialized digital communications and relayed information to healthcare providers through CVS’s Epic Systems electronic health records, medication adherence and engagement among patients receiving specialty pharmacy services improved significantly.

This result has inspired CVS to further develop innovative digital initiatives and expand the scope of its specialty pharmacy business.

Singh explained, “Generally, to better engage with specialty pharmacy patients, we send out notifications on a monthly or biweekly basis to remind them to take their medications on time, among other things.”

“But, since everyone now carries a mobile phone, we should make full use of it. We need to make digital communication as rich and specific as possible.”

Specialty pharmacies represent a high-value testing ground for emerging health management technologies.

According to a recent report by IQVIA, specialty drugs account for nearly half of U.S. pharmaceutical spending. The cost of many treatment regimens can exceed $100,000 per patient. These expenses have prompted insurers, pharmaceutical companies, and healthcare providers to take measures to maximize therapeutic efficacy for patients.

However, Singh stated, “It is difficult for patients to maintain medication adherence throughout the entire course of treatment.”

“The issue lies in adherence—how many patients can persist with medication throughout the prescribed course of treatment, or indeed, whether they will take the medication at all.”

"In certain conditions, such as chronic myeloid leukemia (CML), 'the medications involved in treatment can cause some harm to the body, resulting in relatively low medication adherence. In some specialized care settings, including for certain cancers, medication adherence is less than 60%.'"

In 2016 and early 2017, CML patients at CVS Specialty Pharmacy were among the first to participate in a digital pilot program aimed at creating more personalized communication methods.

Singh stated, “We reviewed each of the provided medications and then stratified patients into different groups to assess the potential side effects or impacts that might arise when patients with different conditions take a specific drug under particular circumstances.”

“CVS uses clinical trial data and patient-reported outcomes to determine when patients are most likely to experience side effects from a specific drug.”

“We can now send messages when side effects are likely to occur, rather than sending standardized messages at the half-month or two-month mark. If patients feel unwell, they can promptly inform us by clicking on their mobile phones.”

“If the medication causes side effects, we provide real-time support, enabling patients to communicate with the corresponding medical team through a secure app. Face-to-face consultations are available if needed. Receiving relevant notifications shortly after side effects occur creates an excellent user experience, as it gives patients the sense that their needs are recognized and that help is provided precisely when they need it.”

Users can choose to receive messages asynchronously on their mobile phones or other devices, allowing them to read and respond to the messages at their convenience.

From personal experience, sending messages that align with expected changes can also help prevent “information overload,” particularly during the diagnostic process or when patients begin a treatment plan.

Singh also mentioned, “If you tell a patient once or twice that they may experience a series of side effects, it may just go in one ear and out the other.”

“Especially when they begin treatment for diseases such as cancer, patients may still be grappling with the psychological trauma of receiving their diagnosis and have not yet fully grasped what the disease entails. For them, it is often impossible to absorb and truly comprehend additional information at that stage.”

“However, when they reevaluate their actual condition and feel anxious, considering whether to take medication or see a doctor, providing them with this information at that point is an effective strategy.”

The CML pilot project truly demonstrated the significant impact of data-driven digital engagement. CVS Specialty Pharmacy found that medication adherence reached optimal levels, exceeding the control group by 30%.

In this trial, the highest medication adherence rate exceeded 85%.

Singh stated, “This represents an unprecedented advance for nearly all medication adherence programs. The results of this trial have had a significant impact, reinforcing our conviction that the program should be expanded to other patient populations.”

Approximately 80% of eligible patients agreed to participate in the trial through a secure information platform, which has been developed internally to meet the specific needs of patients with cardiovascular disease (CVD).

Singh also stated, “We are very satisfied with the trial results. While we would ideally like to see this figure reach 100%, there will always be individuals who choose not to participate for various reasons. We believe the saturation point will lie between 85% and 90%, which we consider an excellent outcome.”

As the pilot program has expanded to other diseases, Singh and his team have also observed exceptionally high engagement from other types of participants, including parents caring for children with special medical needs.

“For example, patients with cystic fibrosis are typically children and young adults who rely heavily on caregivers,” Singh stated. “Caregivers often focus solely on completing tasks, neglecting the patients’ mental health issues. These severe circumstances frequently leave caregivers feeling unable to manage the patients.”

“The most challenging aspect of caring for loved ones, especially children, is that caregivers often feel overwhelmed when multiple issues arise simultaneously. Therefore, this trial offered an alternative model, enabling them to receive messages at the most appropriate and needed times. Engagement was high because it helped patients know that support was available.”

“Patients or caregivers who have concerns about medications can directly contact the healthcare team through a secure messaging app.”

“Different medical teams will engage in communication based on varying needs.”

“If it is a specific medication-related case, the pharmacist who has established contact with the patient will receive the relevant inquiries and engage in discussion with the patient. If nausea occurs due to medications or other causes, nurses are better suited to manage such situations.”

Singh added, “The medical team plays a vital bridging role between the pharmacy and patients’ clinical care.”

Communication with the initial healthcare providers or specialists is a crucial component of this project, and such communication is also based on health information technology tools.

“Zero engagement is a critical metric for us,” he noted. “If a patient does not respond to the initial message reminding them to visit the laboratory or monitor their symptoms, we will contact them by phone to inquire about the specific situation.”

“If there is no response after three attempts at communication, we will contact the patient’s healthcare provider to inform them that the patient is not cooperating with us. The scenario we wish to avoid most is patients not receiving treatment. Typically, it is best for providers to ensure they maintain ongoing contact with their patients.”

If members of the specialty pharmacy medical team are concerned that a symptom requires intensified management or may alter the patient’s health status, they may also use clinical judgment to determine when to contact the healthcare provider.

And much of this communication is conducted through CVS Health’s electronic health records.

“Over the past year, many Epic Systems electronic health records tailored for specialty pharmacies have enabled us to improve communication with providers and achieve bidirectional data exchange.”

CVS Health has invested in multiple patient care domains within the Epic system, including retail clinics. This partnership enables CVS to better engage with a mature, data-driven healthcare ecosystem.

Singh stated, “We have now partnered with Epic Systems in the specialty pharmacy sector. We can integrate these digital communications into Epic Systems’ records, enabling clinical providers to access this data within Epic Systems. They can also navigate to the CareEverywhere module in Epic Systems to view the connections established between patients and CVS Specialty Pharmacy, and vice versa.”

Ensuring clear and comprehensive digital communication between CVS and providers is a critical component of the partnership, enabling us to manage patients through connectivity across different institutions.

“We want to avoid redundant work and spare physicians from being bogged down by such trivial matters,” said Singh. “As a physician, I know that receiving an excessive amount of information from partners without careful curation can become quite problematic.”

“Therefore, we are committed to refining our communication methods to ensure that the information we share is valuable to both patients and healthcare providers. The integration of technology is a crucial component; we are actively seeking ways to enhance our health information technology systems to ensure that everyone can make the greatest possible contribution to patient health.”

Original article link:

https://healthitanalytics.com/news/how-cvs-specialty-pharmacy-manages-patients-with-digital-engagement