Transitions
We’ve successfully transitioned millions of plan members, with an approach that has been tested and refined over time. Our access to robust member feedback, coupled with our size and scale, help us constantly enhance the member experience.
Every member has unique needs that change and evolve over time. Our primary goal is to understand where each member is in their health care journey and tailor their transition to CVS Caremark around their needs. We do this by:
- Delivering a personalized, proactive, multi-channel onboarding campaign
- Automatically transferring mail-order prescriptions to CVS Caremark
- Educating members on how to make the most of their benefits and helping them save money – using their preferred communications method
- Deploying a high-touch outreach campaign for members who need greater support (i.e., those with complex and/or specialty conditions)
- Proactively sending messages to members and providers about any prior authorization (PA) needs
Providing ongoing member support as cost and coverage strategies change
As the health care market changes, so will your formulary and/or network strategy. Members want help understanding the cost and coverage impacts through simple and clear communications. We send formulary change notifications to members and providers – offering appropriate, cost-effective alternatives to avoid disruption.
Transitioned over 3.66M new members in 2024*
Featured solutions
High-touch outreach
Case study
Avoiding bumps in the road
After 25 years with their previous PBM, a large employer transitioned to CVS Caremark to capture savings and ensure extra support for members with complex regimens.
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CVS Caremark.
Medical Center Partnership Case Study: Creating collaborative care transitions program post-hospital discharge.
Situation.
A large medical center formed a Congestive Heart Failure (CHF) Transitions Clinic to support newly discharged patients and reduce readmissions.
Approach.
They partnered with CVS Health to provide the care management infrastructure to reach qualified patients.
CHF Transitions Clinic is the outpatient follow-up destination for many patients in the program.
Medical Center & CVS Health teams ensure seamless, bi-directional transfer of information.
Solution.
Focus on patient medication reviews and education for 14 days following discharge.
Follow up with care management support for 30 days including: home health coordination, nutrition counseling, symptom/pain management, and transportation assistance.
Results.
Reduced 30-day readmissions for 1,500 patients discharged with a primary diagnosis of CHF.
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*The source for data in this document is 2024 CVS Health Enterprise Analytics. The 3.66M stat is inclusive of employees and their dependents.