How CVS Health Is Rethinking Health Care Delivery

Steve Odland: Welcome to C-Suite Perspectives, a signature series by The Conference Board. I'm Steve Odland from The Conference Board and the host of this podcast series, and today, we're going to talk about CVS Health and how they're transforming access to primary care, tackling chronic disease management, and mental health services, especially for older adults and underserved populations. 

Joining me today is Dr. Sree Chaguturu, the executive vice president and president of health care delivery at CVS Health. That includes MinuteClinic, Oak Street Health, and Signify Health. Sree. Welcome to the program. 

Sree Chaguturu: Steve. It's a pleasure to be here. Thank you so much. 

Steve Odland: Everybody who's listening to this is a health care consumer. In some ways, we're all experts, but in most ways, we're not expert at all. How do you view, from a CVS Health perspective, the most pressing barriers that are facing millions of Americans today? 

Sree Chaguturu: It is a huge problem for our country. And so let me just step back a little bit and not talk about just what does CVS Health's perspective, but just what do we all, as Americans, have to think about in access to American health care? And so I am a physician, practicing physician, but also have the opportunity to lead three businesses at CVS Health delivering health care for Americans across the country. 

And when we look at the issues, we see it around cost, quality, access, experience, equity. We call this a "quintuple aim." And if we just look at something like access, we have over a hundred million Americans who face barriers to accessing primary care, and what we see is that not everyone is achieving the quality outcomes we want on even the basics. Are people getting the chronic disease management and the preventative services that they need? And I could go on and on for each one of those areas of the quintuple aim, but we have a lot of issues across each one of those areas. Again, it's cost, quality, access, experience, and equity. 

And let me just end with cost. What we see is that $1 in $5 in the American economy is spent on health care. We aren't getting great outcomes for that. If we look just at older adults, affordability is a major concern. One in five seniors spend over $2,000 annually out of pocket, and because of that, they skip care due to cost. So we have a lot of work to do as a society to make sure that we improve the outcomes in American health care.  

Steve Odland: And these problems that you've outlined—cost, quality, access, experience—have been with us for quite some time. I mean, decades and decades. And there have been lots of different policy attempts to try to address these issues. And there have been some improvements, but we still have a long way to go. What are the key things that we need to do differently?  

Sree Chaguturu: Well, what happens when people can't access care? And I think we all know this. It happens to all of us individually when it'svery difficult to get into your health care provider, but these consequences ripple outward. What we see is that individuals face delayed diagnoses, poor chronic disease management, higher hospitalization rates. As employers, we see productivity loss. We see higher health care benefit spend. And then the public health infrastructure starts to bear the burden, as there's more avoidable ER visits and deteriorating health of our populations. 

So what we need to do is think through, on a systems level, what are new ways to finance health care? And there's a lot of really interesting things that are happening there. This concept of value-based care, which potentially we can get into, but there's also new care models that we need, which is how do you actually move away from that notion of a "one doctor, one patient" to team-based care, or reimagine the way that people access care using omnichannel, virtual. So, financing and delivery of health care are the areas, Steve, that we need to continue to push on to address that quintuple aim that we talked about earlier.  

Steve Odland: This notion of team-based care seems to be critically important, and we've gone back and forth as a country on this: The country doctor or the family doctor who does it all to then specialists and HMOs, which is more of a team based. And now we seem to have, kind of this pendulum swung back a little bit. 

But when you look at particularly the older populations, as you say, which is where most of the spending is, it's towards the end of life rather than the middle, You tend to get lots of different interacting illnesses or diseases. And so that interactive team-based management seems to be really important for quality.  

Sree Chaguturu: Yeah, Steve, I guess if I were to step back for a minute, we have, as a health care industry, historically thought of primary care as one model, doctor-patient relationship. But what's really been exciting over the last 20 years is that we've realized that primary care actually needs to quote-unquote subspecialize, the way that we've subspecialized in lots of other areas of health care. 

So what do I mean by that? We know that seniors, as you mentioned, Steve, are complex chronic patients with multiple conditions, multiple medications. They need to coordinate across multiple different specialists. One doctor, one patient doesn't work, and that's where team-based care really makes sense, where you have a team that's a physician, a nurse practitioner, a pharmacist, a social worker, a financial specialist that all work together to create a care plan that helps figure out, "What do we need to do for the next six months to make sure that you stay out of the hospital and stay healthy?" 

Now, you can't do that team-based care with the traditional health care financing model. It requires us to think creatively, and that's where value-based care has come in. And where value-based care, what that is, is ultimately insurance companies and providers, health care providers, coming together to take accountability for health care outcomes, costs, and quality. If you can reduce the total cost of care using these much more expensive models, delivering care, then you can share in those savings. 

And there's also additional bonus upsides. We don't want to incentivize just on managing care because we don't want that to be by withholding care. We want to make sure that you also achieve quality outcomes, and that's where managing to a cost target, improving quality outcomes is the crux of value-based care. And we see that really taking hold in Medicare Advantage, where Medicare Advantage insurance plans are partnering with providers. And that's what we do in Oak Street Health, providing that team-based care. 

Now, we also see that that model doesn't necessarily work for somebody who's younger and healthier. What they want is convenient care in their community that can be accessed when they need it, whether it's in person and easy to get to in the community, or virtually online. And that's where what we have done at CVS Health is think differently about primary care access. 

And with MinuteClinic, the model that most people know is that it provides acute care services. But 85% of Americans are within 10 miles of a CVS Health retail location. We have 850 MinuteClinic locations around the country. What we've quietly been doing, Steve, has been expanding the types of services that we're providing in our MinuteClinic beyond just acute care services to preventative and chronic disease management, providing the full suite of primary care services in our MinuteClinic. 

And as you can imagine, that model really solves a very different problem in health care, which is convenient cost, efficient access to health care. And so that's what I mean by specialization, is that we're seeing that you can't use one model for all patient populations. We're seeing these different models, and we're excited at CVS Health of having something that works for seniors and having one that works for busy families. 

Steve Odland: Yeah. And CVS has really been a leader with the MinuteClinics, and have made an incredible investment in that, not only the bricks and mortar, but also the systems, the processes, the people, the skillsets. That has taken a lot of time and attention and investment. 

But you're right. I mean, it really does cover a broad age group. I mean, after you get through birth and into childhood, you take it from there all the way up, I would think, almost to seniors, in terms of most of the band of care that's necessary. 

Sree Chaguturu: We talk about that, as clinicians, as cradle to grave, and we want to, as a health care system, to be there along that continuum. And so, if you think about MinuteClinic providing care for largely under the age of 65, and then Oak Street Health is a model for over the age of 65. We are there as a company across the spectrum of ages and conditions.  

Steve Odland: Yeah, really terrific. Now, you also have virtual and home care models, which are relatively new. I think a lot of people in the country began to experience this during COVID when there was a broad introduction of virtual health care, but talk about your innovations there. 

Sree Chaguturu: So Steve, that's a great question. With virtual care and home care, we think about them as part of an omnichannel experience in accessing health care in a way that is much more convenient for the patient and much more centric to what people need. 

And so with virtual care, what we saw during the pandemic is an explosion of interest in accessing virtual care. What we've seen is that there has been a lot of uptake in acute services being provided by virtual care, as well as mental health services, but it also helps support people with mobility issues or with transportation issues. And it offers flexibility, privacy, and continuity. And so virtual care continues to expand. 

With MinuteClinic, what we have is both virtual care that is direct to consumer, where across 50 states, MinuteClinic is available 24/7 in providing acute care through virtual services. But we've also launched, in partnership with Aetna, virtual primary care. And with virtual primary care, we offer employers a virtual primary care-first experience, with the ability to see in person when needed in one of our clinics. And that combination of virtual and physical has been incredibly compelling to employers, but more importantly, to their employees in getting access. 

Steve Odland: It also is a great tool to provide services to rural customers, which are really hard to get to.  

Sree Chaguturu: That's exactly right. So we know that we have a provider shortage in this country. So the absolute number of providers of physicians is not sufficient for the amount of care we need to deliver, but we also see that there's a geographic distribution issue, and virtual care helps us to fill in those gaps. 

Steve Odland: Yeah. And it helps to drive down costs, too, doesn't it? Because you don't need quite as many physical facilities and it's far more efficient. You think of these issues that you outlined at the beginning, cost, quality, access, and experiences being discreet issues that all need to be addressed individually. But they are colinear, meaning, the access piece helps with quality. The chronic disease management helps with cost. All of it is a better experience. And this is how you're trying to, at CVS, attack this through this multifaceted approach.  

Sree Chaguturu: That's right. And we didn't even get into home. I'd love to talk about the home as an access point, as well. But if just to round out virtual here, what we see is exactly what you've just said. It is both an entry point—virtual is an entry point into the health care system when you need acute services, but it also helps supplement the care that you would be receiving on a chronic basis. 

So, it's an opportunity to follow up with your provider and your care team to make sure that you're staying on your path to better health. So virtual has been incredibly powerful in providing omnichannel access and keeping patients healthy.  

Steve Odland: So go ahead and get into the home element of it. That's new, as well, relatively. 

Sree Chaguturu: So the home, what we know is that patients are increasingly looking at, and especially seniors, are looking at home as an access point for health care, in addition to in-clinic and virtual. So those three areas is what we conceive of as omnichannel access to health care: virtual home and clinic. 

So a third business, Steve—at the top of the conversation you talked about Signify Health. We recently brought Signify Health into the CVS Health family. What Signify Health does is provide in-home health evaluations. Over 3 million home visits that CVS Health is providing over the course of the year where we go into seniors' homes and spend one hour with that patient, helping to understand what are their chronic conditions, and then help them understand what is the next best step to take in their care journey. 

And so why is this important? One, it is very hard to get a one-hour, in-depth review of your clinical conditions. And so to have that conversation, it helps patients get engaged in their health care journey. Two, it is an important part of helping health plans and providers to get that information. And then it is part of the financing mechanism, what we call risk adjustment. 

But three, Steve, the most important thing is when you identify risk, you have to manage the risk and help people get better.So a big part of what Signify Health does is help patients get connected to the next step. And so half a million referrals have been made over the past year for patients to get additional services. Let's take an example. We identify a patient with diabetes, and they have uncontrolled blood sugars. We then are able to make a follow-up appointment with their primary care physician or their endocrinologist, have them come into a MinuteClinic or make sure that we can help them get their medications in a more cost-efficient, timely manner or delivered to their home so that they can stay in their path to better health. 

So it's been really exciting with Signify Health to show the power of the home and helping patients get healthier.  

Steve Odland: We're talking about innovations in health care at CVS Health. We're going to take a short break and be right back. 

Welcome back to C-Suite Perspectives. I'm your host, Steve Odland, from The Conference Board, and I'm joined today by Dr. Sree Chaguturu, the executive vice president and president of health care delivery at CVS Health. 

So, Sree, we were talking about all the different physical kinds of approaches, but, if you think about one of the key crises in America, it's mental health. And the literature says it's been exacerbated by COVID for a lot of different reasons, and gosh, we could talk all day about that, but addressing these mental health issues is critical. It's critical for employers. It's obviously critical for families and individuals, but it's also critical that the health care system deal with this in a cost-effective and a quality manner. 

Talk about your views on that.  

Sree Chaguturu: Definitely. This is an incredible crisis in our country, and we need to be able to make sure that everyone has access to behavioral health care, and it should be as easy to access that as physical health care. And this is all part of having wholeperson health. And solet's talk about how we're addressing this within MinuteClinic. 

And so, again, as we talked about MinuteClinic, the typical consumer, the typical patient has an incredibly busy lifestyle. It's usually a mother who has two young children, and it'svery hard for them to find the time, but also the privacy, to be able to get the mental health services that they need. And so what we have done is develop a national program, and in 49 states, we now offer talk therapy and expanded virtual behavioral health services with licensed clinical social workers. And they're able to help with mild to moderate depression and anxiety and provide that comprehensive support for individuals ages 13 and older. 

But Steve, here, the point is what we were having a conversation earlier is, the value of virtual, is the ability to allow us to have providers who can provide private and convenient ser access to mental health services for a busy mother or father or for children. 

And then on the opposite end of the spectrum is Oak Street Health. And as we talked about Oak Street Health, this is a primary care model for seniors. And in that team-based care model, what we have done is integrated mental health providers into the team-based care model. Soyou'll be seeing your primary care physician, but then also a mental health provider. And that combination in the team allows us to make sure that the mind and the body are integrated. 

What we have seen is that there is a score for managing and identifying how intense is your depression. We call it the PHQ-9 score. And for patients who are engaged in this comprehensive model, what we saw is that 55% of our engaged patients drop almost five points, on a scale of 14, in the first six weeks of engagement. So that's a lot of numbers, Steve, but basically, by having this integrated mental health-physical health model in the clinics, we have seen a substantial drop in depression. 

And what we also see is that there's about a 10–14% decrease in total cost of care, as well. And that's because we know that if you're able to better manage your mental health, you're also able to better manage your physical health, and that these things need to be delivered together. 

Steve Odland: And how do you destigmatize addressing mental health? Because this has just been historical, and nobody's ever wanted to admit that they're struggling with anything, and particularly to employers or within an employer plan. I mean, it used to be that, that if you accessed mental health services within the employer plan, it caused a red flag. Now that's not the case anymore, with HIPAA and other controls, but there's still stigma to this.  

Sree Chaguturu: First and foremost, I think talking about, and the importance of whole body, whole person health is important. Our providers talk about the importance of caring for your mind, and that's an important part of caring for your body. I think we're in a very different space now, post-pandemic. I think during the pandemic, we saw such an increase in mental health needs that there's a much more honest conversation around the need for providing mental health services. 

But I think these two models that I just described are a really important part of addressing the stigma. One is, in the MinuteClinic model, is the ability to access it virtually. And in the Oak Street Health model, it's about the fact that your mental health provider is side by side by your primary care team. You don't need to go to another location, but they're right there in the clinic. Just breaking down the barriers, making it easier to access health care services, mental health services, is a big part of addressing the stigma of mental health. Are we done? No, we're not. We need to continue to talk about the importance of caring for your mind as well as your body. But these new care models, I think, may go a long way in addressing the stigma for mental health services. 

Steve Odland: Yeah, we've talked about many facets to this, to health care and all of the integrated means that CVS is taking. But a big component of carrying this forward is the digital revolution, the integration of all the tools, including AI. Talk about what CVS is doing with that.  

Sree Chaguturu: So, Steve, it's a great question on how are we using digital and artificial intelligence in improving health care outcomes? And so the way that I think and we think across CVS Health is that digital allows us to increase engagement into the health care ecosystem. And with increased engagement comes increased trust and better opportunity to stay on your path to better health and achieve the health outcomes that you want. 

And so an example of how we use digital, our CVS Health app. And in your CVS Health app, if you go into it—if you haven't downloaded it, I encourage you to do so. And in that, obviously, you can engage with your pharmacy and get your medications and schedule that delivery in a way that's convenient to you. But we also have access to education and resources, as well as the ability to connect to providers virtually through MinuteClinic. 

And we also have the ability to push messages out, and we do that, as we understand who you are and what your needs are, tailored messages that speak to you.So if you're a convenience-focused patient and consumer, we'll talk about the times that we're open. And if you're a cost-conscious consumer of health care, we'll talk about how accessing health care is cheap or no cost to you, based on your insurance benefits. So digital allows us to engage more frequently. 

And Steve, I would just give an example of that. Over 95% of our patients that are engaged in specialty pharmacy at CVS Health are engaged digitally. And that really helps us to make sure that patients who are getting some of the most complex medications to treat chronic conditions are getting that engagement digitally. 

So just to round out, digital helps with engagement. It then ultimately leads to improved care plan adherence, real-time data exchanges, seamless referrals, and it's just incredibly exciting about what we're doing on the digital side. 

I think the other area that you talked about is artificial intelligence, and it's incredibly exciting about what the opportunity is for artificial intelligence. And we have to also take that in a measured manner. And so, if you wind the clock back a couple of years, there was something called clinical decision support, which is almost like an early version of artificial intelligence. And it was this set of data and analytics that would pop up in the electronic medical record to help providers, physicians to make decisions on, "Is this the right next step for care?" 

When clinical decision support was rolled out, there was a lot of concern among physicians that this was ceding the ability of physicians to actually provide care to computers and to algorithms. And if you go to any physician's office today, everyone has clinical decision support, and you can't imagine providing care without clinical decision support there. Artificial intelligence is just the next step. It is going to make us as clinicians better in delivering care. 

And it's going to be in a couple of ways. One is going to be in helping us to identify what might be potential conditions or diagnoses, and that improving diagnostic capabilities is important. Another is, how do I make sure that once I've got that diagnosis, that I'm choosing the right treatment path? And that is just the next version of clinical decision support. But we also see in some other ways, which is, when you leave that doctor's office, how can we use AI to keep people engaged , reaching out to them on a consistent basis through chatbots and through digital enhanced by AI to make sure that they understand what was discussed and how do you stay on therapy. 

Another way that we're using artificial intelligence is to reduce the burden that providers have in delivering health care. So there is a technology that we use right now in our clinics called ambient artificial intelligence. And so if I'm seeing a patient, historically, I'd have to be furiously typing down in a keyboard or writing on a pad of paper. My head is down, not looking to the patient who I'm interviewing or taking care of. With ambient AI, we have the ability to have our cellphones listen to the conversation, so that I'm focused on the patient who's in front of me. And then at the end of that visit, you have a full note that's completely written out, that summarizes the conversation. 

And it allows the provider, the physician to have a much more personal relationship, not spending time typing on the computer, but that it allows you to have that more human connection and to pay attention to the details and the nuances of the patient's issues. So AI is not just improving how we diagnose and treat, but it's also improving the way that we interact and connect with our patients. And so I'm really excited about where we're headed with artificial intelligence.  

Steve Odland: Now, just wrapping up then, we've talked a lot about demographics, age-based and geographic based. We haven't talked about equity in access. Talk about what CVS Health is doing to try to improve equity and access.  

Sree Chaguturu: Yeah. The way that I think about equity is that when we, as physicians, or if you're on the health insurance side, we're looking to make sure that everyone has the opportunity to achieve the health outcomes that they want. And when you start to break down the data, you see geographic differences. You see racial or ethnic differences. You see economic differences. 

So the rural-urban divide is an example. We talked about earlier that it's easier to access health care if you're an urban setting versus in a rural setting. And by using data and analytics, we have the opportunity to understand where are there barriers, and then how do we need to then basically target and create programs that address those specific barriers to health care access. And it really is about flexible engagement channels, listening and adapting and empowering. 

So we have been using new data analytics that then help us to understand what are the disparities that we see in populations, and then having very targeted initiatives. And so we've taken a real focus to hearts and minds, and so cardiovascular health and mental health, and then understanding what are the drivers of disparities in achieving high blood pressure management, managing your depression. And then, using that data and analytics to have specific community partnerships or the use of new workers to help address those disparities. 

So, it's been very exciting. The way that I think about health equity work is that it's population health work, using data and analytics and targeted interventions to make sure that we improve the health outcomes of the populations that we're serving.  

Steve Odland: Dr. Sree Chaguturu, thanks for being with us today.  

Sree Chaguturu: Thank you. It's really a pleasure. 

Steve Odland: And thanks to all of you for listening to C-Suite Perspectives. I'm Steve Odland, and the series has been brought to you by The Conference Board.