Managing Complex & Chronic Disease
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?
Diabetes. High cholesterol. Hypertension. Asthma. We talk about these conditions every day with no hesitation. Mental health conditions however are a different story. A silenced and stigmatized story.
We are disrupting the silence by bringing you Evernorth inMyndSM. This new clinical program offers a thoughtful and connected solution that helps both patients and payers better recognize, treat and support mental and behavioral health conditions.
Combined with medication-centric coaching, prescriber outreach and digital cognitive behavioral therapy, inMynd features the industry’s first predictive models for the progression of anxiety, depression and insomnia, allowing us to meet each member on their personal mental health journey, proactively.
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.
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.
Each year, plans enrolled in Evernorth 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 to HIV, and many more.
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.
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.
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.
Adherence is key to managing complex conditions and preventing the development of commonly occurring comorbidities. Yet, many are putting their health at risk by prioritizing other expenses over their medications out of financial necessity. Diabetes and cardiovascular disease are among the most expensive chronic non-specialty conditions for plan sponsors year over year.3 That's why we're improving member affordability of select brand-name single-source diabetes and cardiovascular drugs, leading to increased adherence and lower downstream medical costs. Members who use participating medications will pay no more than $25 for up to a 34-day supply, any time they fill at Express Scripts® Pharmacy or any in-network retail pharmacy, leading to:
- Better Affordability: 100% of the Patient Assurance value is provided directly to the member at point of sale to reduce their out-of-pocket costs
- Improved Predictability: Help ease the burden of high out-of-pocket costs, particularly for people with coinsurance or who have to satisfy a high deductible
- Increased Adherence: Members are more likely to continue to take their therapies as prescribed when cost is not a barrier.
- And, we've seen incredible results. Learn more about member and plan sponsor savings here.
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.
The Inflammatory + Atopic 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 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.
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.
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.
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
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.
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.
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.
The universe of innovative gene therapy is expanding every minute for those who live with complex condition. But with every potentially life-changing or life-saving therapy, the stakes are higher for people needing access to cures–and for plans and employers expected to cover these expensive drugs.
Evernorth Embarc Benefit Protection℠ works with plans to fund expensive, potentially curative therapies on a predictable, per-member-per-month basis. Embarc helps plans and employers avoid the price shock of suddenly paying millions for one therapy, while ensuring access to potential cures. Eligible patients will not pay any out-of-pocket medication costs.
Explore related insights
2 Deloitte 2018 Study: The Convergence of Health Care Trends
3 2020 Evernorth Drug Trend Report
4 Journal of the American Medical Association: Internal Medicine, January 2019, Vol. 179
5 National Cancer Institute study on the effects of nutrition and cancer. http://www.cancer.gov/cancertopics/pdq/ supportivecare/nutrition/healthprofessional/allpages. Accessed September 2, 2010