Health plan growth strategies to maximize your financials and improve clinical outcomes

Creating effective growth strategies is critical for the long-term success of your organization. The right strategies help you adapt to evolving market forces, increasing competition and changing member preferences, all while effectively managing costs. Choosing the right partner who can help bring innovations that not only function as advertised, but work well within your specific organization, is crucial.

Our extensive experience working with health plans means that we can help meet your goals like no one else, with a unique model that provides connections in care to help drive down costs while improving member outcomes and experiences. 

Unmatched enterprise connections create opportunities for customization, innovation and controlling costs  

Connections in care across CVS Health make a healthy difference for members and their providers, and you and your clients benefit from our scale and expertise to drive lowest net cost. 

Take Intelligent Medication Monitoring (IMM) as one example. IMM uses advanced analytics, digital outreach and live clinical support to optimize drug therapy for members, reducing costs for you and your clients by:

• Uncovering intervention opportunities with proactive monitoring
• Working together with patients and providers to discuss adjusting therapy as needed
• Bringing transparency and highlighting the impact of clinical outcomes on savings

The results speak for themselves:

Gaining more control over the largest portion of your spend: Specialty

To contain specialty costs while maintaining clinical integrity, we’re focused on combining clinical expertise with innovative technology to streamline processes and ensure patients get the right medications at the right time.

For example, we've created a smoother, quality-focused prior authorization (PA) experience for providers that helps ensure oncology patients receive clinically appropriate radiation therapy with minimal delay as part of their overall cancer care. This may help improve health outcomes for patients, as well as increase value for health plans.

Combined with another innovation – Novologix technology – payors get more visibility across the pharmacy and medical benefit, enabling greater cost control across benefits for overall savings.

Building on the above example, Novologix offers a single-step, cross-benefit, full-regimen PA process linked to the recommendations contained in the NCCN Clinical Practice Guidelines to simplify oncology management. It also allows prescribers to get an automated approval for an entire treatment regimen, even one that includes elements covered under both medical and pharmacy benefits. And there is connectivity with AccordantCare care management for those with rare and complex conditions, for a 360-degree view. 

Novologix delivers:

• Visibility across benefits to achieve cost control
• Flexibility to choose features that fit your strategy
• Efficient processes so patients get started on the right therapies, faster
• Dedicated team committed to your success and satisfaction

Complementing your strategies with customized clinical programs

You can choose a comprehensive solution to reduce costs and support patients living with rare or complex conditions with a proactive, integrated, whole-person care approach.

AccordantCare programs are led by highly trained and specialized nurses who provide patient education, medication and symptom management. They also help coordinate patients’ care with their other health care providers to help ensure the most appropriate approach. AccordantCare support and interventions add up to substantial savings, while members get the assistance they need, when they need it.

AccordantCare:

• Helps close gaps in care with evidence-based interventions, improving clinical outcomes
• Enhances connectivity and coordinated care with a more complete and timely view of the whole patient through electronic health records, fostering collaboration and better outcomes
• Prevents avoidable disease complications and unnecessary ER visits and hospitalizations, reducing cost

Constantly innovating so you can stay ahead of marketplace trends

Continuously monitoring the marketplace is essential to evolving plan benefits strategy. So we’re laser-focused on finding innovative ways to help clients control costs while providing valuable benefits for members.

As the U.S. pharmaceutical environment continues to evolve, biosimilars represent one of the biggest opportunities for reducing drug costs. We recently introduced Cordavis, a new venture that will increase availability and affordability of biosimilars and help to ensure a consistent, long-term supply.

As its first product, Cordavis has contracted with Sandoz to commercialize and bring to market Hyrimoz (adalimumab-adaz), a biosimilar for Humira, in the first quarter of 2024 under a Cordavis private label. The list price of the Cordavis Hyrimoz will be more than 80 percent lower than the current list price of Humira.

Your success is our success.

Through our partnership, unique connections in care, and extensive experience working with health plans, we can create innovative, customized solutions and strategies for growth that help drive down costs, while improving member outcomes and experiences.