Using Pharmacists, More Information to Help Contain Costs

VIDEO

New technologies, old-fashioned personal contact, easily accessible care and cost transparency can make people healthier and reduce health care spending, according to Troyen Brennan, CVS Caremark’s executive vice president and chief medical officer. And retail pharmacies can play a key role in these areas.

Brennan shared some of the company’s strategies during his keynote speech at the University of Miami Global Business Forum, Jan. 12–14, 2011.

First and foremost, CVS Caremark is employing a variety of technologies to ensure patients receive the correct medications and use them effectively. “We want to make sure patients are taking the right medications, and then actually that they are taking the medications,” said Brennan, a physician who is responsible for the company’s MinuteClinic, Accordant Health Care, clinical and medical affairs, and health care strategy.

Troyen Brennan, Executive Vice President and Chief Medical   Officer, CVS Caremark

Not every person reacts the same way to every drug, and genetic testing is helping to determine how patients will respond. For instance, the company uses genetic testing to identify people who are slow metabolizers of certain drug therapies, such as Plavix, so doctors can adjust the dosage or prescribe an alternative. While it requires some upfront investment, ultimately, Brennan said, it should save money.

“There are costs associated with that genetic test and there are costs associated with the doctor’s visits,” he said. “But those costs pale in comparison to the costs associated with a catastrophic coronary event.”

Of course, making sure a patient gets the right medication doesn’t guarantee he or she will take it. Brennan pointed to data showing that up to 70 percent of hospital readmissions stem from patients not taking their prescriptions appropriately, and more than half aren’t complying because of cost, confusion, inconvenience or lack of help.

CVS Caremark set out to address a number of these factors. It is experimenting with having pharmacists make follow-up phone calls to patients and even visits to patients released from hospitals.

Brennan cited a recent CVS study that found that outreach from a retail pharmacist is about 10 times as effective as a call from a nurse and about 100 times as effective as sending a follow-up note in the mail. That, he added, is not because the pharmacists are especially empathetic but rather because patients are motivated to learn when talking with a pharmacist. This receptivity sets the stage for one-on-one patient education that helps ensure they take medications properly.

“Pharmacists are a critical part of the health care system,” Brennan said. “When you go talk to people who have chronic disease, they feel like they use their pharmacist almost as much as they use their physician.”

The company, which has 7,200 retail pharmacy locations across the U.S., is also experimenting with ways to use its 500 in-store MinuteClinics to educate patients and check on medication compliance.

The MinuteClinics are open seven days a week and are designed to be an affordable, convenient solution to diagnosing and treating common illnesses. Patients can usually see a health care provider in about 15 minutes without an appointment.

 “Different people are going to require different approaches,” Brennan said. “Some people are going to require in-depth counseling from a MinuteClinic nurse, whereas other people are going to do just fine with a telephone call or a two-minute conversation with the pharmacist at the pharmacy center.”
With any approach, the goals are to have better health outcomes and to save money. “This is a matter of taking your retail pharmacy and turning it into something that can really help individuals do better with regard to their health care,” Brennan said.
The MinuteClinics, too, are saving money for individuals, health insurers and employers, Brennan said. They accept most insurance plans and also take direct payments, with a typical visit costing less than the same visit to a doctor’s office. The clinics have been popular, with more than 7 million patient visits and a 95 percent customer satisfaction rating. CVS plans to expand them to 1,200 locations over the next three years.

CVS Caremark has looked for other ways to reduce health care spending by empowering consumers with information. For instance, it redesigned receipts to highlight the potential cost savings for patients who choose an equivalent generic drug rather than a brand-name drug.

That’s in line with a corporate movement toward consumer-directed health insurance plans, which typically have very high deductibles and require consumers to pay out-of-pocket for many kinds of medication, Brennan said. The goal is to make people pay attention to the cost of doctor’s visits and medications so they will, for instance, choose a lower-cost generic medication or get a mammogram at a less expensive center. With that movement in mind, CVS Caremark is also examining whether it has a role in advising customers where to obtain cost-effective medical services, such as colonoscopies. If consumers consistently choose the most cost-effective medical services, he said, it should force higher-cost competitors to reduce prices.

“The costs of health care are big. Providing access to health care to everybody in the United States is big and important,” Brennan said. “So we have to come up with big ideas to be able to maintain the system that’s in place and to be able to support the push for greater access. But in order to do those big things, we have to be able to do a lot of small things very well.”