CVS Health Live: Managing Diabetes

CVS Health Live: Managing Diabetes

Hello. Welcome to CVS Health Live, focused on awareness. My name is Steve Edelman I’m a physician at the University of
California in San Diego and Veteran Affairs Medical Center and I am the
founder and director of a not-for-profit organization called taking control of
your diabetes a patient focused organization and with me today is Dr.
Dan connect VP of Strategy Innovation at CVS Health. Dan why don’t you say a few
things about yourself. [Dan] Absolutely Steve. Thanks for having me.
As you said, my name is Daniel Knecht. I am a practicing physician and I work at
CVS Health. I have the privilege of working across the enterprise to develop
and implement a strategy around diabetes to make sure the care we help coordinate
and deliver to our customers and patients are individual focused and
addressing unmet health needs of those of those individuals, so thanks for
having me today. [Steve] You’re welcome. Most of our viewers, they think of a
pharmacy where you go and just pick up your prescriptions, but I think all of
you viewers are going to learn a lot more what CVS is doing to improve
patient care and awareness. We have Joy Pape who is a very famous certified
diabetes educator in New York City. Joy, tell us something about your background. [Joy] So, my background is I was born into a family that has a lot of diabetes both
type 1, type 2, obesity, and I myself have pre-diabetes. I’ve been a diabetes
educator for many years. I specialize in diabetes and in obesity. And, so what
excited to me today is that we’re teaming up with CVS. I’ve been a diabetes
educator a long time and from day one, I realized that the pharmacy ,the
pharmacist, was very much a part of the health care team, the whole team. Who do
you see more, of the professional health care team? Would be the pharmacist
than anybody else so to see CVS be involved is very exciting and very real. Thank you. [Steve] We’re going to hear a lot
about that too, and I personally have type 1 diabetes. I see a ton of folks
with type 2 diabetes in my practice and we’re gonna we’re going learn about what
CVS is doing, and I was quite impressed preparing for today’s program as well.
Well, I think the first topic we can talk about cost and access. I think taking
care of yourself as someone living with diabetes can be costly, however you know
if you’re a bean counter and Dan knows as well, you may spend a little bit more
on medications but if you can control the condition you save a lot more money
down the road in terms of complications. So, Dan, you might want to comment on the
cost and access of medications and everybody’s had hassles getting their
stuff from the pharmacy and their providers. [Dan] Absolutely and from a
cost perspective what we’re seeing across the country is that an individual
with diabetes generally accounts from at double the amount of medical spend and
somebody without diabetes, so that’s from a cost perspective but from a sort of a
patient perspective I still work in the hospital as a hospitalist that
once a month, and I see sort of firsthand the long-term complications associated with diabetes. So, unfortunately I often times see patients needing
amputations for diabetic foot ulcers that cannot heal. As you both very well know,
diabetes is the number one driver of dialysis in the country, and also
it’s the leading cause of blindness, so I see firsthand, and I’m
sure you both see firsthand, the implications are from the human
perspective as well as of cost perspective. [Steve] We don’t want you to put in that we’re
in our viewers too much night leagues in the treatable condition. Let me say one
quick thing about statistics and the different type of diabetes two square
everybody up, and then we’ll get Joy’s comment. The statistics on
diabetes, I’m not going to go into all of them but just to give you an idea, there’s type 1 diabetes the type that I got when I was a kid. Someone
in Joy’s family has that, as well, and it takes up the minority of people
with diabetes, it’s an autoimmune condition, and the therapy is insulin, insulin, and insulin, and now we have lots of
technology, like continuous glucose monitors. And about a hundred and ten
people in the US are diagnosed with type-1 every day now in common
distinction type-2 used to be called adult onset diabetes. If you can believe
this, every day in America six thousand people are diagnosed with diabetes and
the cause of type 2 diabetes is quite complicated, completely different than
type 1, we have our toolbox has grown tremendously, and in terms of type 1
diabetes, what are the unmet needs and we’re going to focus mostly on type 2
and pre-diabetes, but type 1 diabetes is really trying to get your glucose
under control without hypoglycemia, and having a lot of fluctuations in the
blood sugar, and we still have issues with heart disease, and weight as we
get older, and Joy what are some of the challenges most of the viewers on
today’s show have in terms of pre-diabetes and type 2 diabetes? [Joy] Well, I
think that we’ve already opened that up to a point and that would be the cost.
First of all, I want to say access. Access to care, access to education, which all
comes together. So, access to education just understanding that you don’t have
to have the complications of type 2 diabetes. So, that’s not a given. A lot of
people hear: ‘I’ve got diabetes,’ they get afraid of all these things they’ve heard
all their lives, and we teach them it doesn’t have to be like that, but you do
need to understand. So, access to education, people live far away from
where education is even available the when you go to your physician, your
endocrinologist, your nurse practitioner, the professional health care provider,
they don’t have the time to spend. What happens is we go to our pharmacy, and we
pick up our medications, or we need information and as Dan will tell us a
little bit later, how easy it is to get somewhere or even to bring diabetes to
the patient. Because people who have diabetes either type 1, type 2 , they’re
the ones that live with diabetes everyday and need to
understand how to manage their diabetes. So, I would say access to treatment
and education. [Steve] I would add to that. That’s a whole segment, but certainly people with type 2 have weight problems, and their
condition makes them more susceptible to weight gain, and we’re
going to talk about nutrition a little later on. And, I think there’s no sense of
urgency because there’s there’s not a lot of symptoms when your blood sugar’s
high, when your cholesterol is through the roof, and when your blood pressure is
high. And, we know that those are some of the quote unquote metabolic conditions
associated with type 2, so if you have type 2 diabetes out there it’s tough
because you have a lot of conditions, you have to take a lot of medications to
control your blood pressure, cholesterol, and it’s costly, and
it’s complicated, and it could be scary especially looking at some of these TV
ads. Well, Dan one thing I was quite interested in preparing for our show
today was the data that you got from the Morning Consult data that you did. Maybe
you can tell us about that information that you collected? [Dan] Sure, absolutely. So, in honor of American Diabetes Month we teamed up with Morning
Consult to survey patients living with diabetes as well as providers and
caregivers who help these patients around sort of unmet needs and just to
sort of better understand where these individuals are coming from, and
three key themes popped up. One as Joy mentioned earlier, it’s access to
local evidence-based care. The second is understanding, managing, and predicting
out of cost pocket costs associated with therapies for diabetes. And, a third is
looking at additional services whether it be nutrition or exercise or perhaps
even social services for these individuals, so those sort of
themes popped out, and I would love to discuss a little bit more about that, but
Steve, I think it might be helpful to just bring the group, our audience,
up to speed. How do we find ourselves as a society in the middle of this
diabetes epidemic? [Steve] It’s interesting because
the government and private institutions put a lot of effort into slowing down
the rate of type 2 diabetes, and it turns out that the number of people coming
down with pre-diabetes and type 2 diabetes, is close to 25 million
with diabetes now, and another 80 million with pre-diabetes, and we know a certain
percent of those will convert to type 2 every year. The rates aren’t slowing down.
Despite all of the new medications we have and I’m sure most of you have
seen those on television, the new medications for type 2 diabetes, we see
that trying to get folks their diabetes under control is still difficult and if
you look at national statistics, the number of people who have adequate
diabetes control over the past decade has really not changed. So, I think
initiatives like the one CVS is doing and other initiatives to improve
education, awareness, motivation, activating the patient into action will
help improve diabetes at the community level. And, I think Joy, you might have
some comments on that as well. [Joy] Yes. When you talk about that with all these
treatments, we have sometimes we forget the basics, which are things that we can
learn through CVS. For example, some people are checking their glucose either
by continuous glucose monitor, or self blood glucose monitoring, but
they don’t even know what the targets are. That’s how much education we’re
lacking. For example, when people take medications they don’t know really how
do the medications work, when do they work, what are actually the effects and what are the side effects to be aware of?And,
how do you treat those? Something else that really stands out to me, that has
been said today is cost. A lot of times we think of cost of medications, our cost
of going into the pharmacy for medications, or for a copay, or insurance.
But, what about the other costs? This is what I think so great about having
something local. The cost of needing to take off work, to park, to sometimes, as I said take off work, not be at work. All of those are additional costs that add up for diabetes. And, if we
can learn more about preventing the complications, how to manage our
diabetes, or even have somewhere close that we don’t have to take off a whole
day of work to get access to care. [Steve] Dan, if you could, thank you Joy. Dan, if you could briefly talk about the results of the Morning Consult which is sort of what
patients want and also some of the data that came from the caregivers because I
think that will lead us into the next part of the discussion which is what CVS
is doing to address those issues. [Dan] Sure, absolutely. So, there was one
question that brought some very interesting insights and that was
around where patients and providers want to deliver care, lab services, tests,
and 90% of patients and almost 100% of providers said they would like a center
or a place where all care testing and services can be provided certainly in an
evidence-based manner. And, my observation is still being in the
clinical space, and Steve would love your thoughts. This is such a
complicated condition, there are so many moving parts, there are preventive care
with an ophthalmologist, at the dietrist, there’s nutritionist counseling,
there’s your primary care doc, sometimes an endocrinologist. It is just
such a fragmented system that our patients need to navigate. [Steve] You’re lucky you just stay in the hospital and take care of people and then you throw
them out, and we take care of them. You’re absolutely right Dan and Joy knows, is
quite well because she’s part of the outpatient as I am. When you
have diabetes, it’s not like having a thyroid issue, for example.
It’s complicated and you’re absolutely right you have the primary care doctor,
you have the endocrinologist, you might have to see a
cardiologist, a kidney doctor, and also if you don’t have access to a
good diabetes educator, they can talk to you about some of the lifestyle modification.
That’s a big part of it, and the thing is most caregivers have
fifteen minutes to not only take in all the information, review what ruled and
then get into what the issues are with deities, and that’s why a lot of folks
have a hard time getting under control. Their doctors, caregivers, nurse
practitioners, they rush in, they rush out and they’re not doing it because they’re
going to go play golf later on. They’re doing because they’re three
patients behind, and they got three patients to see before lunch. So, it is a
complicated condition which brings at this idea of centralized care, it’s easier said than done, and I’ll be anxious to see, hear a little bit
more about the HealthHUB model and how it’s going to roll out. But, I think
it’s definitely needed, and it can really be one of the determining factors
that can help people get under control, but also get a little bit more motivated
about their diabetes. Joy, any comments on that? [Joy] Well, just you saying it
can help them manage their diabetes, but also be more motivated. It’s hard to be
motivated when you don’t see someone you can talk to for three months, for six
months, but when it’s at your local pharmacy or even another way if there’s
anything going to be happening online which you’ll tell us about, you could be
more in touch and you can connect more and keep motivated. That’s something I
always ask people when I see them is why do you want to manage your diabetes, why
do you want to lose some weight if they’re overweight or have diabetes, but
a lot of times for weight people say they don’t want to get diabetes. So,
what’s your motivation and something else even just mentioned what you’ll
tell us more about, about nutrition. People are so confused today,
there are so many messages about what to eat and with type 1 diabetes I always
think first insulin. People need to have insulin, but for the rest, and for the
majority, we look at else the eating. Well, what is that? Our patients are so
confused. Can you speak to what will be happening at CVS on this topic? [Dan] Sure, so a lot of great points both of you made. So, first of all roughly 70% of
Americans live within 5 miles of a CVS. I actually remember growing up next to CVS, so I have a special spot in my heart for CVS, not just because they’re my employer. But,
that’s really a pretty exciting statistic. Think about the reach and access of
individuals living in, perhaps, rural parts of the country or areas where they’re just not
providers or specialists that are seeing new patients. So, that I think it’s a
really exciting statistic the other point that Joy made is the
trusted pharmacist, the role of the pharmacist. I think the statistic was
about a patient with a chronic condition sees a pharmacist about 20 times a year
versus about three to five times a year of a physician so that is
such an important sort of connector, or point of engagement of the
health care system that were really excited to unlock. So, we’re
rolling out the concept of the HealthHUB, so this is a an enhanced CVS store that
provides health products, services engagement points with with clinicians,
but also with nutritionists or diabetes educators. And, actually this is a really
important role of digital here. I know having sort of a physical place where
people can go is really important, but some individuals like to engage with the
health care system through digital assets, so that’s another enhancement there. In
terms of the HealthHUB, we’re aiming to rollout 1500 across the United States
he next few years, very ambitious ,but what we’ve been seeing is really great
uptake and appetite by our customers and patientswhere we’ve already piloted
the HealthHUB. And, then just another point I think it’s important as a
physician is that we will have electronic medical connectivity with providers to make sure any for interventions we provide or services we
provide our patients at the HealthHUBs is fed back to our provider partners
so that’s the HealthHUB in a nutshell. Really exciting, core tenant of what
we’re trying to achieve at CVS Health. [Steve] So just to hear that again,
you’re going to set up 15 of these HealthHUBs across the United
States, and how will viewers find out where they are
and how could they access them? [Dan] Absolutely, so it’s going to be 1,500.
So, we will we work closely with provider partners in the local
communities we serve, and Aetna members will be receiving communications and
education, and additional services that they can come to the HealthHUB for, but this is an open platform and it’s really just an offering to the
entire communities we serve. [Steve] Yeah, that was going to be one of my questions, I mean, this reminds me of the phrase point-of-care and that’s
basically refers to being able to get for example your hemoglobin a1c right at
the time of your visit, but this point-of-care really seems to me refers
to a lot of different things. Education, access to the care, the information that
you pick up goes to your caregiver. So, they’re not saying ‘Gee
what are CVS folks teaching you?’ So, it’s keeping everyone in the loop and
I think that’s part of it, and as we mentioned before there’s so many
different cogs on the wheel when you take care of someone with diabetes. It is a
big initiative and you’re going to actually have CDEs and physicians at these 1,500
sites? [Dan] Yeah, absolutely. We’ll have
providers so we’ll have nurse practitioners and physicians assistants,
we’ll have diabetes diabetes educators nutritionists. The objective here
is to supplement the great work our provider partners are already doing in
the community. I’d like to give you a pilot concept we’re working on it’s around insulin
titration so, as you know Steve, it’s sort of time intensive and it requires
multiple touchpoints with the provider so we feel that we would be able to help
patients that either are about to start insulin or are on insulin, but need some
titration and additional counseling. So, what we hope to do is provide education
around insulin, how to check blood glucose to appropriately,
titrate insulin, and then ultimately what we want to do is just support the care
that’s already being provided by the physicians and clinicians their community. [Steve] Yeah, it’s a big undertalomg. And I think it’s also important to realize that we have continuous glucose monitors
these are little devices for you folks that aren’t familiar that measure your
blood sugar every five minutes and we know that this technology is coming to
people with type 2 diabetes and that’s going to help with insulin titration
as well. And, then you look at all the injectables and people with type 2 the
home glucose monitors it’s just nice to have support and be able to ask
questions, and as a caregiver, Joy and I know that people come in back from
a doctor, from a caregiver visit, and the caregiver thinks they’re very clear and
they’re instructions but you know there’s a lot of things going on in that
visit and information that a patient takes home may not be the right
information and may be completely different. It’s just nice to get support. So, I
want to apply for a job at one of these places so they can’t have any in San
Diego. I wanted to just quickly turn as we get near sort of near the end is to
talk about big data for those of you viewing today’s show, big data refers to
analytics like you’ve heard of Google Analytics. Now that CVS is partnered with
Aetna, all being a health care company, are able even collect data that can help
them serve their customers better. So, Dan maybe you can talk about that a little bit
and explain it to the live audience what big data is and what CVS is going to do. [Dan] Yeah, absolutely. So, we’re very lucky in that we are sitting on a vast repository of claims data, demographic data on our customers and members and what the
idea here is to mine these data insights in a HIPAA compliant way
and certainly respecting privacy of our customers to identify. I’d say interesting
insights we can provide additional level of support or services and so I would
say that big data is necessary, but not sufficient to get us where we need to go.
We need to have clinical insights to look at this data and understand what’s
actually happening sort of in real life, but also it’s important to have an effector arm and what I mean an effector arm is
we need to have a way to support our customers and patients whether it be
through case managers, through our clinicians, through email, through mailers,
and serve up actual clinical insights for these people
where we can help close gaps in care, and ultimately achieve a healthier outcome. [Steve] You mention a compliant data that’s important for the viewers to know. They’re taking
information on you as an individual making large groups of people and
looking at trends and patterns. I did some research on
administrative claim database for people with type 2 diabetes, and what we looked
at was the adherence and persistence. The refill prescription rate and I’m not
going to go into the data in detail, but we saw that a lot of folks that are put
on injectable medications, like insulin for example, had a very low rate of
being on these medications after a year, and this is where support at the local
pharmacy with insulin titration, explaining the fears and the concerns
and the issues and hooking them up with people like Joy who have a wealth of
experience talking to people about their diabetes and educating them how to use
their insulin pens and how to titrate, very importantly, that could make a big
difference, so I think the big data is really important to pick up trends and
what people with diabetes need and other health conditions as well. Joy, do you
have any comments on that at all? I don’t [Joy] Briefly what comes to
mind as you say that is just understanding and continuing on
injectable medication. I got a call the other day that someone’s been taking or
thinking she was taking her injectable medication for the last three months
since she goes ‘Joy, I never took off the second top of the pen, so this is why my
numbers haven’t changed. And that’s common. [Steve] Yeah, it’s very common.
This is one reason I started the not-for-profit organization taking
control of your diabetes because people need education, they need motivation,
these conferences around the country where people hang out
with themselves, their brethren, Other people with type 2, and they
undertake and realize that living with type 2 diabetes, when you control it is
really what can make you live a longer and healthier life once you actually control the
different issues that go along with that condition. Well, I’m gonna say a few words
closing in and I want Dan to finish up today’s show but you know I mean I think the
world is changing and I love the fact that CVS is partnering with other health
care solutions to improve the care of people with type 2 diabetes by making
local community centers where you can coordinate care. And I think that is just
key and type 2 diabetes is a such important condition it’s got all these
side effects that Dan tried to scare us whether they’re in the beginning, but
it’s important for you to folks to realize type 2 diabetes is a treatable
condition. You take care of it you’ll live a longer and healthier life than if
you were not diagnosed with type 2, and that is absolutely true.
So with that, Dan, why don’t you say a few words and we’ll close out today’s
episode. [Dan] You got it. Well, first of all I wanted to thank Joy and Steven for this great
conversation I learned a lot, it was a lot of fun as well. As a physician, an
employee, and a customer of CVS Health, I’m really excited to see this strategy unroll to
make health care more accessible, affordable, and person centric so thank
you again.


  • Christine D'Allaird says:

    You are right about access. If someone has insurance they most likely have a case management benefit and can get additional, personalized support and coaching through this venue as well. Drawing the resources together is hard. I speak to my patients on their schedule and we work on a variety of things including pharmacy partnership. I have many patients achieve great results. When you talk about reach and accss, telehealth is a profound barrier breaker.

  • RN nowNP says:

    Please introduce her as NURSE PRACTITIONER AND CDE.🤷‍♀️…just had to say that I can watch

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