Advancing our clinical agenda
Due to their size, scale, and data insights, pharmacy benefit managers (PBMs) can play a key role in improving population health. This effort is a foundational plank in CVS Caremark’s platform to advance our clinical agenda, which includes finding opportunities along the care continuum to close gaps and improve health outcomes. With more than 110 million members, we sit “at the intersection of pharmacy and population health,” according to Chief Medical Officer Michelle Gourdine, MD. As she notes in this talk, providing personalized support along with prescription drug therapy improves access, adherence, and, ultimately, member health.
Michelle Gourdine, MD, explains how CVS Caremark is working to improve population health at Forum 2023.
“Population health” can be a confusing term so I think it's important
to start with a definition that makes sense for the work that we're doing.
Stated simply, it is the execution of care solutions that improve health outcomes for a defined population.
It's just as simple as that. And it really centers on data
and how we use data.
Using data to identify those populations of members who are at highest risk who need additional support in order to be healthy, and then identifying what matters to those members.
But the core theme within population health is that everybody has a role to play.
Payers, our policies, our providers and so forth.
You might be asking, so what does this have to do with the PBM?
What is the PBMs role in population health?
And I really view the PBM as sitting at the intersection of pharmacy and population health.
And so what that means is when you think about conditions that individuals may struggle with, and they may have multiple conditions, the good news is that there are advances in prescription drug therapy that can really provide life-saving or life-sustaining options to manage the health of individuals and to be able to address their health needs.
That's exciting.
We play a big role in all of that as a PBM, and clients...you...choose
to collaborate with us to make sure that we provide access to appropriate
drug therapy that's also affordable.
And so we strive to ensure that members have coverage of clinically appropriate treatment across every therapeutic category.
And that's really important in order for us to be able to to do things like provide medication optimization and adherence.
If individuals need additional help, we can provide help with that.
We can help with coordinating care and we can help with overall disease management. So those three sort of pillars of the work that we do really do roll into our responsibility that you contract with us to provide, again, which is providing access to appropriate and affordable drug therapies.
Access to the medication and being able to obtain the medication is one thing.
Understanding how to take the medication and actually taking it is something different.
The ability to be able to remember to take the medications, when to take them, how to take them, oftentimes requires a bit more help and support to be able to do that.
So we talk about this in general terms, about medication therapy management, how we assess an individual's ability to take medications and
whether or not they need support.
Sometimes we can use technology to do that in terms of providing cell phone reminders, text messages to remind people to take or refill medications.
But there are a number of options that allow us to be able to support individuals in being adherent to their prescription medications.
But it really starts with having that conversation with that individual and understanding where their challenges are and striving to meet those challenges.
Channeling and championing the patient perspective and needs at every turn is what I feel like I'm obligated to do in this role. And that's why I'm here.
