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      Best-in-class point solutions

      Simplified management of third-party offerings to help minimize spend, maximize benefits

       

      Sree Chaguturu, MD, Executive Vice President & Chief Medical Officer, CVS Health

      Briefing

      With the pandemic still a reality, and many plan members continuing to avoid going to the doctor’s office because of safety concerns, digital solutions can help them maintain healthy habits and manage chronic conditions.

      Point Solutions Management is a full-service offering that can help plan sponsors simplify contracting, secure lowest price and monitor ongoing performance of third-party health care point solutions. We continue to expand the range of services and solutions available through the program to help payors choose the ones best suited to their plan goals.

       

      Clients and their members can get access to 11 point solutions vendors:

      Carrum Health

      A value-based Center of Excellence platform that helps reduce plan sponsors’ surgical and cancer spend by over 45 percent through delivering quality care at upfront bundled prices.

      Daylight

      Personalized digital program based on cognitive behavioral therapy for reducing worry and anxiety.

      Hello Heart

      Helps members understand and improve their heart health. It offers a U.S. Food and Drug Administration-cleared blood pressure monitor coupled with an app that tracks blood pressure readings, weight and physical activity, alerts for out-of-range hypertension and has patient-enabled medication adherence reminders.

      Hinge Health

      A coach-led digital program for members with musculoskeletal conditions such as chronic back or joint pain. Hinge Health combines wearable sensor-guided exercise therapy with behavioral change through 1-on-1 health coaching and education to reduce chronic pain, opioid use, and surgeries..

      Progyny

      Progyny’s fertility solution provides a positive member experience, cost efficiencies, and greater success rates for members.

      PrudentRx

      Innovative specialty cost management strategy and best-in-class member experience to optimize savings from manufacturer copay cards and reduce plan and member costs.

      RethinkCare

      Evidence-based behavioral health and clinical support platform for working parents, caregivers, and their families. A global solution with the depth and breadth of content across the person, the family, and the workplace.

      Sleepio

      A fully automated mobile and desktop app that uses cognitive behavioral therapy (CBT) to help plan members dealing with poor sleep. CBT is meant to assist members in changing unhelpful behaviors, improving emotional regulation, and developing personal coping strategies that target specific problems.

      Spark Direct

      Spark Direct is an evidence-based digital program for adults and adolescents 13+ with depression delivering tailored support available anytime, anywhere via their smartphones. Solutions are accessible to Enrolled Members 24/7 and feature cognitive and behavioral techniques to help individuals make changes to their behavior and lifestyle.

      Torchlight

      A caregiver support solution that guides families through the complexities of educational, financial, social, health, and legal demands related to caring for a loved one, no matter the age, stage, or concern. With a digital platform and team of expert advisors, Torchlight helps reduce stress and enhance caregiving outcomes.

      Weight Watchers Reimagined

      Digital weight loss and wellness program based on nutritional and behavioral science for weight management, through coaching, community, customized food plans and tools to log food, activity and sleep.

      Wondr Health

      A digital behavior change program clinically proven to improve physical and emotional health to prevent and reduce the impact of weight-related chronic conditions. Wondr teaches members practical mind/body skills to lose weight, sleep better, and move more.

       

      As always, selection of vendors for our offering is based on a detailed process of identifying solutions that are most relevant to plan sponsors, and which utilize the latest technology and engagement tools to offer a clear clinical value, are cost-effective and can provide outcomes tracking.

       

      CVS Health Point Solutions Management offers clients:

      Rigorous vendor vetting

      • Comprehensive clinical, security and business review, including end-to-end plan member experience

      Ease of contracting

      • Full contract negotiations, including agreement to terms that are critical for our clients — across security, indemnification, data sharing, privacy protections, etc.

      Lowest price

      • Vendors obligated under their contract to offer most competitive pricing for clients
      • Billing integrated with pharmacy benefit management (PBM) invoice

      Real-time member eligibility verification

      • Clients pay only for utilization that aligns with their criteria
      • Client can focus usage based on clinical criteria

       

      Prioritizing areas of need, curating a vendor list

      Our rigorous vendor evaluation and selection starts with identifying what specific areas of health and well-being meet the needs of our clients and where vendor point solutions are most likely to have a positive impact.

       

      To do this, we developed a three-step process that:

      1. Ranked clinical conditions by medical and pharmacy costs, highlighting areas of the largest health care spend
      2. Reprioritized the ranking based on additional areas of need — and their biggest health care challenges — identified by a representative set of clients
      3. Mapped the availability of point solutions against each area of need, noting where they could have the greatest positive impact on health and well-being outcomes

      Based on the findings, we identified three major categories of client need:*

      • Metabolic condition management across diabetes, hypertension, and cardiovascular health
      • Musculoskeletal health
      • Respiratory health, to a lesser degree

      6 out of 10 Americans have a chronic condition, accounting for 90 percent of the nation’s annual health care expenditures.1

      • Mental health/stress reduction and sleep management
      • Prediabetes management, weight management, fitness and nutritional support
      • Substance abuse and addiction counseling
      • Social determinants of health — factors preventing at-risk individuals from having access to care and services that help close economic and social gaps

      • Caregiver support — for members who act as primary and secondary caregivers to their elderly or preadolescent dependents who have special care needs
      • Women’s health and fertility solutions
      • Symptom and care triaging

      Based on these priorities, we identified a list of more than 300 available vendor solutions. These were vetted by multiple sources including review of public literature, opinions from subject matter experts and early adopter feedback. These further underwent rigorous clinical safety and outcomes review including:

      Clinical safety: Solution has been evaluated for potential direct harm as well as corresponding responsibility to address emergency situations when members provide alarming information such as low blood sugar, elder abuse or suicidality

      Alignment with evidence-based clinical guidance: Solution provides recommended actions that are in line with existing clinical guidelines

      Validated outcomes: Vendor has performed randomized controlled trials demonstrating improved member outcomes

       

      So far, eleven vendors have completed the evaluation process and passed the final step comprising demonstrations of their solution, actual usage testing by in-house clinical and product experts, a thorough examination of their clinical evidence and return on investment and outcomes data.

       

      Lowest cost, ongoing monitoring

      Vendors who are selected for the Point Solutions Management offering are obligated under their contract to offer the most competitive pricing for clients. We have also made significant investments to ensure a truly seamless administrative experience for our clients. During onboarding, vendors connect directly to the CVS Caremark system for automated and accurate real-time eligibility verification.

       

      Rigorous vendor vetting, evaluation and ongoing performance monitoring

      1. Vendor scan

      Identifies solutions based on:

      • Client priority
      • Impact to health care spend
      • Health care technology trends

      2. Clinical review
      Tested by CVS Health clinicians:

      • User safety review
      • Clinical trial results
      • End-to-end member experience

      3. Security review
      Ensures compliance with:

      • Applicable regulations
      • User privacy (HIPAA)
      • CVS Health third-party data security policy

      4. Business review
      Evaluates model to ensure:

      • Ability to support CVS Health clients at scale
      • Financial viability
      • Review of ROI claims (if applicable)

      5. Ongoing monitoring
      Oversight of:

      • Member-eligibility and real-time billing verification
      • Clinical and security standards
      • Performance and outcomes

       

      Point Solutions Management is a simple, efficient way for plan sponsors to add carefully evaluated health and well-being point solutions to the traditional benefits they offer their members.

       

      Originally published on March 11, 2020 and updated on June 30, 2022.

       

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