Managing Complex & Chronic Disease

A young boy has an IV put in by a nurse sitting next to him.

Overview

Health care remains uncoordinated and costly. Consider diabetes, one of the most expensive conditions to manage. Prevalence continues to rise, despite advancements. Plus, more than 36% of patients are nonadherent to their medication and at risk for serious medical events.1

By 2030, it’s estimated that 80 million Americans will have been diagnosed with three or more chronic health conditions.2  That’s a fast-approaching future that will place an unsustainable burden on patients, plan sponsors and the entire health care system. Do you have a strategy to manage it? 

Offerings

Health Connect 360
A 360° view drives a 180° change

Health Connect 360SM is a new model of clinical management – delivering guaranteed outcomes in targeted states such as diabetes, cardiovascular disease, behavioral health and many more, using:

  • An outcomes-based approach: Customized, guaranteed clinical goals
  • A care coordination platform: Care providers are better connected and better coordinated
  • Personalized health care: Tailored patient interventions

With this model, every patient receives personalized engagement. This means the best interaction and outreach for their specific condition needs and health risk, using optimal engagement methods based on patient preferences, including timing and channel. By enabling true personalization, we’re delivering better clinical outcomes at the patient level and realizing a bigger impact at the population level.

With Health Connect 360, your members get only what they need, when they need it – and nothing that they don’t. Customized care plans for each patient allow us to deliver the population-level results you want. Guaranteed.

SafeGuardRx
Exposing and acting on opportunities

For patients with complex and chronic conditions, how do you achieve better health without tradeoffs? You need a single platform that helps your members with better medication adherence, higher therapy completion rates and greater compliance with clinical guidelines, all while mitigating your financial risk.

$2.4B+ $2.4B+
saved by enrolled plan sponsors enrolled in SafeGuardRx in 2018

Each year, plans enrolled in SafeGuardRx® achieve better outcomes and increased value. It’s our first-to-market answer to the call for value-based contracting strategies. While others talked, we built SafeGuardRx as our platform to continuously take on the most complex, highest-cost challenges – from hepatitis C to diabetes to oncology to inflammatory conditions, and many more. 

Therapeutic Resource Centers
Personalized care, focused expertise, better health

People living with a chronic health condition deserve responsive, straightforward answers from experts who understand what they're going through, with the training and experience needed to help. That’s why we believe the best care for these patients comes from specialists, not generalists.

Our Therapeutic Resource CentersSM (TRCs) are individual centers of focused expertise, dedicated to serving members diagnosed with complex disease states. With more than 20 individual TRCs, we're committed to connecting patients with the right care, specific to their individual need.

For example, patients with cancer are served by pharmacists, nurses and other health care experts in our Oncology TRC, which offers compassionate, comprehensive cancer-specific care.

We help patients achieve their best health outcomes, by providing personalized care and resources they may not get anywhere else.

Diabetes Solutions
Diabetes Care Value program: Changing the diabetes trajectory

From the moment you’re diagnosed with diabetes, your life revolves around managing your condition. Patients living with diabetes often struggle with adherence and comorbidities. And, for plan sponsors, diabetes is the costliest traditional therapy class.

The Diabetes Care ValueSM program, part of our value-based SafeGuardRx platform, encourages healthy habits for patients living with diabetes. It may also help members at risk of developing diabetes avoid a diagnosis altogether. And value-based contracting strategies help enrolled plan sponsors realize lower overall costs.

19% 19%
more members began potentially life-saving statin therapy through the Diabetes Care Value program

Through patient engagement technologies, formulary and utilization management tools and high-touch support from Diabetes Therapeutic Resource CenterSM clinicians, the program is changing the trajectory of the diabetes dilemma by lowering costs and improving outcomes.

Patient Assurance Program: A step closer to a healthier life

Although patients diagnosed with diabetes depend on insulin to live, studies show that 1 in 4 patients ration their dosage due to cost. Skipping just one dose can increase the risk of expensive and serious eye, kidney and nerve complications, requiring otherwise avoidable medical treatments. Plus, a non-adherent patient incurs an average of $5,427 per year in annual medical expenses.

People living with diabetes need to stay focused on their well-being. They need peace of mind, not continual worry about how they'll afford to pay for their insulin.

25% 25%
of patients ration insulin due to cost3

By removing cost as a barrier to accessing insulin, plan sponsors can help improve adherence and better contain the total cost of care for people living with diabetes. For plans enrolled in our Patient Assurance Program,SM eligible patients using preferred and participating insulin products pay no more than $25 per 30-day supply.

Diabetes remote monitoring: Empowering personalized care

Living with diabetes is a real challenge, but remote monitoring offers a proven solution that fits within a patient’s daily routine. Our diabetes remote monitoring program helps patients better control their diabetes – combining a Bluetooth-enabled glucose meter, personalized analytics for tracking, and one-on-one clinical coaching by phone and email from specialist pharmacists in the Diabetes Therapeutic Resource Center.SM

60% 60%
of patients in a pilot program lowered their A1c levels by at least 0.5 percent
42% 42%
of patients in a pilot program saw a drop in hyperglycemic episodes
Inflammatory Conditions Solutions
Inflammatory Conditions Care Value program: Tackling the #1 driver of specialty spend

On average, more than 1 in 4 patients living with chronic inflammatory conditions discontinue therapy within the first 90 days, leading to poor health outcomes and higher plan costs. 

9x 9x
lower spend on inflammatory conditions for plans participating in this program in 2018

The Inflammatory Conditions Care ValueSM program, part of our value-based SafeGuardRx platform, helps patients get the right drug at the right time while remaining adherent. It also drives greater pricing competition, helping to shift patients to more effective and affordable medications so plan sponsors can better manage spend for inflammatory conditions, the costliest therapy class.

Accredo: Data-driven, condition-specific clinical protocols and screenings

Accredo develops and deploys more than 350 proprietary clinical protocols that help predict and resolve patient issues before they occur.

For patients with inflammatory conditions, adherence coaching, an “activities of daily living” screening and a “quality of life” assessment are critical components of therapy management. Protocols like these help personalize patient care,  drive cost savings and avoid adverse outcomes for patients and plan sponsors.

Oncology Solutions
Oncology Care Value program: Aligning medication costs with outcomes

Because oncologists and patients have more treatment options than ever, everyone needs help determining which options deliver better value, based on proven outcomes. The Oncology Care ValueSM program, part of our value-based SafeGuardRx platform, uniquely aligns the cost of a medication with its outcome for various types of cancer, while providing payers with drug discounts, early discontinuation reimbursements and pharmacogenomic testing.

With clinical specialization through the Accredo Oncology Therapeutic Resource Center,SM patients receive greater care and improved outcomes. And genetic testing puts even more information in the patient’s and physician’s hands, allowing them to make better, more personalized decisions.

Accredo: Lower-cost medication alternatives

Generic medications allow patients to receive quality treatment for their condition, typically at lower overall costs for both patients and plan sponsors.  

Thanks to the specialized nature of clinicians and staff at Accredo, we’re better at identifying and taking action for patients who could benefit from a specialty generic medication. In fact, we’re delivering generic fill rates for plan sponsors that are several percentage points higher than others in the market. For example, for a newly launched oncology generic drug, Accredo has maintained a generic fill rate of 90%, compared to about 81% at retail and at other specialty pharmacies.

Support extending beyond pharmacy
Healthy foods displayed on a table

TherapEase Cuisine

Malnutrition and weight loss are contributing factors in 1 in 5 cancer deaths.4 Because severe malnutrition and weight loss can impact cancer patients, Accredo offers resources such as TherapEase Cuisine,SM a web-based tool that helps patients with cancer understand the importance of nutrition, guides them to the best food choices, and provides tips, tools and recipes. Patients may also engage one-on-one with an oncology-registered dietitian.5

15% 15%
increased medication adherence achieved with TherapEase Cuisine for a patient on a common oral oncology therapy

Patient counseling with a social worker

Connecting patients with a social worker is another key component of holistic oncology care. Support involves counseling patients through an emotional journey that can include financial hardship and depression. Coordinating local resources to help patients with childcare, patient support networks, meals, transportation to appointments and financial assistance are just a few support functions offered.

Pulmonary Solutions
Pulmonary Care Value program: High-tech tools and expert care

Asthma and chronic obstructive pulmonary disease (COPD) affect people of all ages and in all stages of life. Poor management can have life-changing and life-threatening consequences. Our Pulmonary Care ValueSM program, part of our value-based SafeGuardRx platform, offers a holistic approach to patients, helping them better manage their complex conditions while driving lower health care costs for plan sponsors. 

By giving patients access to specialized support, remote monitoring devices and gamification apps, we help them take control of their asthma and COPD. And through value-based contracting strategies only available through Express Scripts, enrolled plan sponsors can realize lower costs.

Pulmonary remote monitoring: Empowering personalized care

Remote monitoring empowers patients living with asthma or COPD to improve their health by using connected inhaler sensors, viewing personalized insights on our mobile app, and getting one-to-one coaching from specialist pharmacists in the Pulmonary Therapeutic Resource Center.SM In just one year, this support led to a 72% decrease in rescue inhaler usage and a 25% increase in days without asthma or COPD symptoms.

 

37M 37M
Americans have asthma or COPD
75% 75%
don't take their medication correctly
50%+ 50%+
don't know how to avoid pulmonary condition triggers
LET'S CONNECT
Where others see problems, we see possibilities. Let’s start the conversation.