CVS Caremark, Polk County partnership demonstrates role of pharmacist intervention in improving diabetes outcomes

WOONSOCKET, R.I Diabetes patients who participated in a special disease management program implemented by CVS Caremark experienced significant improvements in key clinical measurements, including decreased HbA1c — a critical measurement of blood sugar levels — and lower blood pressure levels, after one year. The results — part of a case study, conducted by CVS Caremark in conjunction with Polk County, Fla. — were published in the current issue of the American Journal of Health-System Pharmacy.

The program, dubbed Contract for Care, was first implemented in February 2005. The goal: to engage Polk County employees with diabetes in managing their health and to make them accountable for the components of their care. Enrolled members work with CVS Caremark clinical pharmacists — located at the Polk County employee health clinic — to develop individualized care plans and to coordinate regular follow-up visits. In exchange, members pay no copays on disease-related medications (generic and preferred brands), as well as related supplies and nonprescription products.

In addition to driving improved health outcomes, the program also led to significant cost savings by reducing emergency room visits and in-patient hospital admissions.

"Enabling members with diabetes to achieve optimal management of their underlying disease, as well as other related conditions such as high blood pressure, is critical to improving their health outcomes," said Troyen Brennan, EVP and chief medical officer at CVS Caremark. "As the prevalence of diabetes continues to rise, it is critical that these patients are educated about the impact of their disease, and presented with tools and programs to help actively engage them in their health care."

For Polk County officials, it was critical to convince their employees to take care of their condition, according to Michael Kushner, director of risk management at the Polk County Government. "We wanted to implement a program that would incentivize our employees living with chronic diseases, such as diabetes, to take an active role in their health care in order to improve their overall health," said Kushner. "Through our partnership with CVS Caremark we have seen positive results that reflect both improved health outcomes for our employees, as well as cost savings for both enrolled employees and the overall plan."

At the end of the first year of the program, 477 members were enrolled and were included in the analysis. The study's primary outcome was the change in clinical values for HbA1c. Secondary outcomes included changes in utilization metrics such as all-cause hospitalization, emergency room visits and blood pressure values.

After one year the reduction in HbA1c values was especially high among members in the critical risk group, with nearly 78% achieving a significant HbA1c reduction. In addition, mean systolic blood pressure decreased six points (from 134 Hg to 128 Hg), and mean diastolic blood pressure decreased four points (from 81 Hg to 77 Hg). Medical claims data also revealed a 30% decrease in all-cause hospitalizations and a 24% decrease in ER visits for enrolled members.

"These positive results provide compelling evidence about how the efforts of a motivated employer like Polk County combined with strategies to engage and educate members can make a difference in managing a chronic disease such as diabetes," Brennan noted. "The success of this type of program is particularly important when you realize that only about 28 percent of people with diabetes currently achieve optimal management of their disease, which includes adherence to anti-diabetic medications, as well as to other recommended therapies to treat comorbid conditions, such as high blood pressure."

Self-insured Polk County covers about 8,500 Polk County employees and dependents in all.

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