CVS Health eyes faster pace of health innovation

BY David Orgel

Helena Foulkes, CVS Health EVP/CVS Pharmacy president

CVS Health is poised to boost its health innovation efforts in response to a rapid-fire series of marketplace changes. That was the message at a Drug Store News forum from top CVS Health executives, who demonstrated their desire to push the envelope further — and faster — and challenged suppliers to join the effort.

Much of the focus will center on embracing emerging health trends — from connected health technology to DNA testing. Efforts will address empowered health and the consumer’s journey from sick care to self care. The company will take a deeper dive into understanding how digital innovation can solve pain points for consumers. “We are committed to bringing innovative products and solutions to our customers and we are focused on finding ways to make it happen even faster,” said Jon Roberts, EVP and COO.

New market realities make it imperative to find different routes, he added. “The pace of change over the next five years will be greater than what we’ve seen over the past 30.”

The Health Innovation Summit, held over the summer in Providence, R.I., was hosted by CVS Health, in partnership with DSN and Mack Elevation. Presenters included a range of thought leaders both from within and outside of the industry, who addressed how emerging trends are reshaping the healthcare industry.

Roberts said CVS Health is aiming to address some of the biggest challenges across its expansive footprint, such as how to navigate omnichannel. “We are well positioned to bringing unique solutions to customers with our expansive retail footprint and our commitment and leadership within digital.  We have an opportunity to leverage our bricks and mortar in an omnichannel way to redefine convenience beyond how it’s defined today in the consumer’s mind,” he said.

He pointed to opportunities for rapid home delivery of pharmacy and front-store products via an enhanced Maintenance Choice offering.

Amplifying Roberts’ comments, Helena Foulkes, EVP of CVS Health and president of CVS Pharmacy, talked about what it means for an organization to have an “innovation mindset,” and shared some of the ways in which the company is working to advance its digital offerings by “getting into the shoes of the consumer to solve for pain points.” These efforts gained momentum through the launch of the company’s digital innovation laboratory in Boston in 2014, which was created to spearhead new initiatives.

It included the development of CVS Pay, not just for mobile payments, but also as a tool to reduce the amount of information consumers need to provide at each pharmacy visit. It also included CVS Curbside to enable mobile or desktop ordering and pickup for busy consumers.

Foulkes said that even basic technologies can turn into “game changers” for solving consumer pain points. For example, the adoption of a technology as seemingly simple as two-way texting is helping CVS solve for interruptions that come when patients change insurance plans; now its patients can simply send a photo of their new insurance cards rather than wait until they arrive at the store to find that their prescription has not been filled because of an insurance issue.

“These are the kinds of innovations that really make a difference and ultimately drive the outcomes we’re all looking for,” she said.

Shifting to how the pace of innovation is impacting its stores, George Coleman, VP merchandising and consumer health care, talked about the company’s efforts to re-imagine the customer experience around health and wellness — from healthy food to healthy skin care. A range of new efforts target the omnichannel experience, new brands and products, as well as new services such as optometry and audiology, he shared. The enhanced services will leverage a range of clinicians at the company, including pharmacists, techs and nurse practitioners.

“We’re looking at telemedicine,” he said. “We’re looking at bringing health services into our stores. We’ve done pilots in optometry and audiology, and we’re scaling them further.”

The front store is being transformed into a “new health and beauty destination,” he explained. These advances come against the backdrop of a shifting consumer healthcare environment and changes in the insurance landscape. Consumers “put a premium on prevention, because it’s more costly to get sick,” he said. This reality supports the journey from sick care to self care, which makes it imperative that CVS adapts for the new climate, he explained.

Coleman highlighted some of the most important emerging trends the company is tracking in consumer health care:

  • Self-knowledge: The emergence of DNA test kits will evolve into even more targeted forms of analysis, such as what kind of skin care may be most effective for a particular consumer. It’s “individualized literally to your DNA. This stuff is coming. It’s getting better,” he said;
  • Connected devices: New devices, including wearables with data that’s integrated on apps, will continue to become more important for monitoring everything from blood pressure to temperature. “There will be more ways to integrate the apps and data, and we want to be one of those integrators,” he said;
  • Nutrition and supplementation: How to best integrate healthy foods with pills, supplements and OTC’s is a big topic of focus. Consumers give top priority to eating healthy foods, but “90% of Americans don’t get enough of the recommended daily allowance of minerals and vitamins in food alone;”
  • Sleep: Consumers are increasingly recognizing that adequate sleep is required for good health, and they are seeking a wider range of solutions to help facilitate this. This includes traditional OTC-type products, and also more natural remedies, including “solutions outside the bottle,” extending even into general merchandise and
  • Immunity: “Immunity is becoming a big deal” to stave off sickness, and consumers are looking for natural solutions in addition to traditional supplements. “We’ve had a lot of success with smaller brands who are basing themselves in their ingredients stories,” he said.

The comments from the CVS Health executives set the tone for the presentations and discussions that followed throughout the day. In this special report, DSN recaps the major highlights and key themes from the event.


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Which area of the industry do you think Amazon’s entry would shake up the most?

Pharmacies turn to automation as workloads, data needs rise

BY Jim Frederick

Retail pharmacy is being squeezed.

Even as an aging population and expanded insurance coverage under Obamacare propel rising dispensing rates and add to pharmacists’ workloads, they’re being called on to practice “at the top of their license” by filling an ever-expanding role as front-line patient-care specialists and fully engaged members of collaborative care provider networks.

With “the healthcare landscape … undergoing its most rapid transformation in a century,” to quote the National Association of Chain Drug Stores Foundation, chain and independent pharmacies are facing an existential challenge. How do pharmacists — no matter how highly trained and motivated they are — juggle rising prescription counts with expanding clinical and such preventive-care services as medication therapy management, diagnostic screenings, immunizations, medication adherence programs, appointment-based patient counseling sessions, and chronic disease monitoring and management? And how do they link those efforts to a broader, more holistic model of patient care in collaboration with doctors and health systems?

Technology firms say their solutions will enable community pharmacy to keep pace with the explosive changes occurring in health care. In an era of collaborative and accountable care, outcomes-based reimbursement models, rising prescription volumes, a shrinking pool of primary care physicians and urgent cost-cutting imperatives, pharmacy retailers and their technology vendors are more closely linked than ever. And automation is more critical than ever — both as a labor-saving tool and as a means of capturing, sharing and applying prescription data on behalf of healthier patients and lower health costs.

Some pharmacists might argue that those labor-saving tools aren’t being applied fast enough to keep up with the added burdens of clinical care. But massive investments in robotic dispensing systems and other tools are clearly shifting some of the dispensing workload away from pharmacists and onto more highly trained technicians — and into high-volume, highly automated central-fill facilities.

‘Amazing transition’
At the same time, systems to mine, measure and analyze patient data are advancing rapidly, giving pharmacists more powerful decision-making tools to support patient interventions and connect more seamlessly with the broader health network.

“We’ve seen this amazing transition taking place in community pharmacy with it becoming more clinical in nature,” said Brian Glaves, director of sales for ScriptPro. “Today’s incoming pharmacists are chomping at the bit to be a healthcare provider to their customers —developing those personalized relationships and helping set up prescribed medication therapies.”

For its part, “ScriptPro is keeping abreast — developing new technologies that enable pharmacists and their teams to stay connected across their network and with their patients and prescribers,” Glaves said.
Glaves called robotic dispensing systems “a game changer” that “go a long way to streamlining workflow, saving time and improving accuracy.”

“Now you can seamlessly integrate all these new technologies that keep patients and their pharmacies connected,” he added, citing ScriptPro’s own RefillPro and PharmacyPro mobile point of sale systems. Within “our industry’s growing collaborative care mindset, the retail setting is facing a huge need for organized case management and treatment plans for patients undergoing chronic disease, pain management and specialty drug therapies,” Glaves told DSN.

It’s about applying technology and patients’ electronic health records “to integrate pharmacy care from the payer to the provider to the patient,” CVS Health president and CEO Larry Merlo noted earlier this year. The company’s “truly integrated assets,” he added, give CVS “a full view of each patient and a single patient record for prescriptions and care regardless of the CVS Health channel used.” And it allows the broad-based retail pharmacy and pharmacy benefit management giant “to offer innovative services and to deliver additional value to [other healthcare] stakeholders.”

Supporting health provider status
The American Pharmacists Association calls health IT “an effective vehicle for exchanging information between practitioners, patients and pharmacists.” To that end, “Pharmacists need access to pertinent clinical information about their patients, and in turn should contribute information to the health care team in order to improve patient outcomes,” APhA noted.

“Information technology plays a major role in monitoring any adherence program. That’s especially true when it comes to tracking outcomes,” said Sandy Canally, founder and CEO of the Compliance Team, the first certified, woman-owned healthcare accreditation organization to hold “deeming authority” from the Center for Medicare and Medicaid Services.

“In this day and age, nearly every pharmacy uses some type of software program that enables them to submit data to payers and referral sources,” Canally added. “The best use of IT is utilized in the patient monitoring follow-up. Careful documentation is key to providing proof of a positive patient outcome.”

For that and other reasons, she told DSN, “Obtaining a complete medication history is critical in assessing the appropriateness of the prescribed medication therapy, and to create a reconciled medication list and care plan for the patient. Equally important is the coordination of care by the pharmacy with a patient’s prescribers.”

Automation experts agreed. “Technology, integration and interfaces are the way of the future,” said Crystal Ratliff, market analyst for technology provider QS/1. “As pharmacy’s role in the patient care team expands, technology is becoming a greater factor in removing barriers between the pharmacy and a patient’s other healthcare providers. This expanded team provides a more collaborative, efficient process to improve patient outcomes.

“Pharmacists’ ability to substantiate their value in improving patient outcomes will be crucial to their recognition as healthcare providers,” Ratliff pointed out. “Pharmacists are already providing services beyond filling prescriptions, but this work must be documented and shared with the healthcare community for the pharmacist's value to be realized.”

As for QS/1, she said, its role “is to provide pharmacies with the tools necessary to adapt to this rapidly changing market and to give them a substantial competitive advantage. We provide the technology to speed workflow and track compliance and reimbursement, thereby increasing the time available for important counseling opportunities.”

Another critical benefit community pharmacies can bring to the new health paradigm is their proven ability to improve patients’ adherence to medication therapies — a key core competency that can lead to reduced hospital readmissions and healthier patients long-term. The installation of unit-dose or multi-dose packaging systems within the pharmacy can be a powerful tool for improving adherence rates, said Mark Rinker, senior director of sales for Synergy Medical.

“We continue to strongly … advocate the use of packaging to improve patient outcomes,” Rinker told DSN. “The FAME (Federal Study of Adherence to Medications in the Elderly) study and others clearly indicate a patient is better off with their medication organized by the pharmacy by day and time of administration in a blister card, opposed to patients self-medicating with multiple vials.”

“Adherent patients drive plan Star ratings, and in turn this improves their reimbursement and plan inclusions,” Rinker noted. “Blister packaging as part of a broader medication adherence strategy is a means for community pharmacy to survive and thrive.”

‘Balancing expense and investment’
Meanwhile, the quest by pharmacy leaders for the right tools to free their pharmacists from most of the basic mechanics of dispensing and tracking scripts goes on. They’ve made — and continue to make — huge investments in both behind-the-counter robotics and other automation, and in offsite central fill facilities that can churn out and track hundreds of scripts an hour with multiple robots and other fast-track technology to ease in-store dispensing pressures.

“Pharmacy providers are constantly balancing expense versus investment,” said Doyle Jensen, executive VP of global business development for Innovation. “In these times of shrinking margins, money invested in pharmacy operations must provide the best possible return. That’s why more and more providers are turning to central fill; it’s the best way to leverage their technology spend.”

“Dispensing technology deployed at retail is severely underutilized, while centrally deployed technology supports hundreds of stores — and the volume of the stores can best leverage each dollar spent,” Jensen told DSN. “With up to 60% or more of the prescription production handled at central fill, retail pharmacists have much more time to deliver patient-facing care and other patient-related services.”

Other technology solutions providers also are focused hard on that quest for higher levels of productivity behind the counter and more time for pharmacists to practice at a higher level of care. Bobbie Riley, pharmacy director for LexisNexis – Health Care, said, “Our focus is on getting pharmacists the technology they need to be compliant and to be able to work as efficiently as possible.”

“As provider status progresses and prescriptive authority expands, these types of validations and insights become even more important,” Riley said. “And as reimbursement continues to shift from fee-for-service to value-based payment, treating the patient more holistically is key.”

“In addition, we are seeing more and more how social, economic and environmental factors are impacting the health of patients. Providing insights to help better understand behaviors [that] could influence medication adherence is becoming critical. The LexisNexis Socioeconomic Health Attributes and Scores is a solution that can help offer greater visibility into these key factors,” Riley told DSN.

Technology firms have developed a range of increasingly specialized tools to solve different aspects of pharmacy automation and pharmaceutical processing. PerceptiMed, for instance, was founded in 2013 to reduce pharmacy-based medication errors through its VeriFill automation processes.

PerceptiMed’s IdentRx proprietary technology “enables pharmacies to place the pharmacist at the top of their license by utilizing a remote-verification platform that rebalances verification workload across its footprint,” said Frank Maione, chief business officer. “Other benefits include labor savings from the time devoted to the Schedule 2 double-count and tracking process through a one-pour, triple-count, image-capture and record-retention [process], all in under 15 seconds.”

For its part, Morris Plains, N.J.-based Temptime has focused since 1987 on developing solutions to the safe storage, handling and transportation of medical products and pharmaceuticals. According to Chris Caulfield, VP of global customer development, “Temptime offers an entire range of temperature-monitoring solutions from low-cost, chemically based products to sophisticated, data-driven devices equipped with low-energy Bluetooth capabilities and cloud-based data storage.”

“Temptime understands that pharmacists are taking on an ever-growing responsibility of assuring that highly valued, temperature-sensitive medications are received by the patient per the temperature requirements of the manufacturer and … the state board of pharmacy,” Caulfield added.


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Which area of the industry do you think Amazon’s entry would shake up the most?

Online search fuels healthcare decisions

BY Mark Hamstra

Ryan Olohan, Google industry director for health care

Internet search activity, particularly on mobile devices, has become an important element of consumer healthcare decision-making.

Consumers are taking more ownership in their health than ever before, said Ryan Olohan, national industry director for health care at Google, during a presentation at the Health Innovation Summit, co-hosted by CVS Health in partnership with Drug Store News and Mack Elevation.

“They’ve got more information and data at their fingertips, and they are using the information to become more discerning, more educated and more demanding,” he said during his presentation in June. One-in-20 Google searches is related to healthcare information, and a large majority (86%) of consumers go online when experiencing new symptoms, Olohan said.

Consumers increasingly are unwilling to sit back and passively allow their doctors to make treatment decisions, he said. Nearly half (48%) of consumers said they wanted to partner with their doctors on treatment decisions in 2015, up from 44% in 2012 and 40% in 2008. “The trend is that consumers more and more want to have a two-way relationship with their doctor,” he said, noting that 84% of consumers conduct an online search following a doctor’s appointment.

As an example of the volume of research being conducted online, Olohan cited the activity around rheumatoid arthritis, which was the subject of 16 million Google searches in 2016, a more than 10% increase over the preceding year. An additional 230,000 searches took place on YouTube, where there are 135,000 videos related to rheumatoid arthritis and more than 1,500 related channels.

Healthcare-related search also is increasingly localized, especially for consumers who have immediate health needs. The number of searches containing the phrase “hospital near me,” “pharmacy near me,” “doctor near me,” “clinic near me” or “dentist near me” have been steadily increasing since they first began showing up on Google just a few years ago. “This is a new consumer behavior that up until 2013 never existed before,” Olohan said.

Localized searches also drive retail purchases, according to Google research. Three-in-4 people who conduct a local mobile search visit the store within 24 hours, and more than 25% of those searches result in a store purchase.

Time of day also is a factor in consumers’ online search behavior, Olohan said. For example, Google searches for the term “infant formula” peaked at around 3 a.m. to 4 a.m. every night in one recent week, according to Google Trends. Parents are looking for information about why their babies are waking up crying in the middle of the night, and that presents an opportunity for marketers to target solutions to these potential customers, he said.

Meanwhile, Google and its sister companies under the Alphabet umbrella are making significant advances in other areas of health care, as well. These include such disruptive technologies as contact lenses that contain a microchip that measures the glucose level in a diabetic patient’s tears, and a clinical-grade, wearable health sensor.


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Which area of the industry do you think Amazon’s entry would shake up the most?