Dan Knecht, CVS Health, on delivering customer-centric healthcare
Subscribe for your weekly fix of health tech stories, wherever you get your news: Substack, Twitter, Apple, or Spotify.
In this episode, we chatted with Dan Knecht, M.D., M.B.A., Vice President of Clinical Product at CVS Health. Prior to this, Dan served as Vice President of Health Strategy and Innovation for Medical Affairs at Aetna, a CVS Health company. Dan joined Aetna in 2016, prior to the CVS Health and Aetna merger, leading a series of enterprise-wide strategic clinical initiatives. His professional interests include a focus on reducing opioid overuse and addiction, addressing chronic disease with evidence-based approaches that close gaps in care, and leveraging data analytics to help people achieve better health. Dan graduated with honors from Dartmouth College and received a joint M.D./ M.B.A. from Weill Cornell Medical College and Johnson Graduate School of Management, where he was a recipient of the Lee Family Scholarship. He also is an associate clinical professor at Mount Sinai West in New York City where he still sees patients.
What we discussed:
● The CVS Health-Aetna merger in 2018 has enabled the joint company to create more customer-centric care by marrying advanced data analytics across Aetna’s ~21 million members with care management and better access to healthcare for consumers via CVS Health’s extensive retail presence.
● CVS Health balances localized care with national scale by developing products and services that address the needs of specific patient segments while continuously improving clinical product design through broad data analytic capabilities and a robust feedback cycle from providers and patients nationwide.
● CVS Health continues to invest in digital offerings and homecare services to meet the patient wherever they are in their health care journey. CVS Health is also expanding its virtual care, chronic care and behavioral health services in the wake of the COVID-19 pandemic, to meet consumers where they are and support them for every meaningful moment of health throughout their lifetime.
● COVID-19 has spurred CMS to expand its definition of healthcare, resulting in reimbursement for a broader range of services, including transportation, nutrition, and telemedicine. These changes will likely persist and benefit patients’ health in the long run.
Start to 10:32: Opportunities to unlock the last mile of patient care through the CVS Health-Aetna merger
● Combining CVS Health’s local footprint with Aetna’s national coverage: Aetna’s overall mandate is to improve people’s health, starting with its ~21 million members. The CVS Health integration has helped Aetna overcome the challenge of meeting members in the final mile of care delivery through CVS’ ~10,000 pharmacies and ~1,000 minute clinics. Approximately ~85% of Americans live within 10 miles of a CVS Pharmacy, enabling the company to provide accessible care within communities all over the U.S.
● Focusing on the customer: CVS Health is dedicated to become the leading consumer-centric healthcare company through its use of data analytics. focus on improving population health, and development of personalized clinical care solutions for consumers.
● Utilizing enterprise assets to innovate clinical products and services: Designing clinical products requires pulling assets from across the enterprise, which has led to innovations in products and services. The combination of CVS Health and Aetna has cultivated new services, in particular in treating chronic conditions. In one example, data analytics is used to identify Aetna members living close to a CVS HealthHUB™ who require ongoing treatment for diabetes and help close any gaps in care. Pharmacists connect with members by phone to share what their next best action would be to close the known gap. If immediate service is required, the HealthHUB care concierge can help direct the patient to be treated in the in-store Minute Clinic or at another nearby provider.
● CVS pharmacists are enabled to practice at the top of their licenses: Pharmacists are tasked to identify care gaps for patients when patients come into brick-and-mortar CVS Pharmacy locations to pick up prescriptions. Including pharmacists on the care team has enabled patients to receive more touchpoints along their care journey, allowing CVS Health and Aetna to more proactively outreach to members.
“One of the challenges is the final mile of healthcare and healthcare delivery. So what’s really exciting about bringing these two companies together is that it’s estimated about 85% of Americans live around at most 10 miles away from a CVS. These are retail health clinics that provide accessible care in the community. Bringing together the local presence and the trust of a CVS with the national footprint of a payer like Aetna, is a really powerful combination.”
10:32 to 22:05: Cross-functional Clinical Product team focused on meeting patients where they are
● Tailoring care based on patient segmentation: The Clinical Product team focuses on specific chronic conditions such as diabetes and hypertension as well as patient segments, such as Medicare recipients. The Clinical Product team also focused on patients who are largely maintaining their health, including those seeking nutrition or maternity solutions. Tapping into Aetna’s large member base helps the company build a comprehensive understanding of various segments of the patient population.
● Products and services improve through ongoing feedback: End users can provide ongoing feedback and dialogue to enhance the user experience. CVS Health also takes into consideration insights from pharmacists in CVS pharmacies to understand how well programs are working and whether these interventions are responsive to the needs in the patient population.
● Balancing localized healthcare with national scale: The team uses applied analytics to better understand user-specific data, and incorporates these insights to inform individualized patient care. The company’s broad analytical capabilities help enable targeted, localized care.
● Rise of digital: CVS Health aims to meet people wherever they are in their health journeys, and digital health enables this mission. Digital has pushed the thinking on ways to engage with patients, from interactions through apps on phones to engaging individuals at home. However, while COVID-19 has accelerated the adoption of virtual care and telemedicine, there are some limitations to telemedicine. These limitations, including the fact that certain examinations must be administered physically, mean in-person care will not be fully replaced.
● Build vs. buy in designing clinical products: Building capabilities that are core to the business and buying when a unique capability exists externally to the business as well as considering speed-to-market and whether the acquisition target has a “secret sauce” that cannot be easily developed are all considerations as CVS Health looks to the future. Relationships with other companies to supplement existing capabilities is another key strategy. For example, CVS Health works with Unite Us, a company that helps curate social determinants of health in communities for its customers.
● Gaps and opportunities in clinical product at CVS Health: COVID-19 has accelerated market adoption of virtual care, and CVS Health is continuing to focus on making its digital capabilities more robust. CVS Health also is continually assessing how to develop and place needed clinical assets in CVS HealthHUBs to infuse more services into communities. For example, CVS Health launched a behavioral health pilot in several markets to help communities access mental health services to treat conditions such as depression and anxiety more readily.
● Threat from startups: Overall, life expectancy in the U.S. is declining. New startups entering the market with new or innovative ideas can help boost the overall health of the population. CVS Health has an exciting strategy to improve healthcare outcomes for all Americans, and welcomes the improvements new entrants may bring.
“The ability to take the vast repository of data that a health insurer like Aetna has and then apply analytics and machine learning and other advanced AI technologies to provide actionable next best steps is really powerful.”
22:05 to End: The role of CVS Health in addressing COVID-19, and COVID-19’s lasting impacts
● Impact of COVID-19 on clinical products: Regulation changes have spurred the rapid adoption of services like telemedicine. Telemedicine adoption has also seen an uptick amongst providers. Home-based care has also increased. CMS helped facilitate the rapid evolution and adoption of these services by changing policies and expanding coverage of telemedicine and hospital-at-home services. These policies will likely persist given the difficulty in retracting policies that parallel changes in consumer behavior.
● Expanding the definition of healthcare: Since the COVID-19 epidemic, CMS has expanded its view of what constitutes healthcare. This is a positive development for patients. Healthcare now includes medical care and nutrition, living in a safe community, employment, and overall social connectedness. Following from this expanded definition, CMS is reimbursing more services that were not traditionally seen as medical care (e.g. transportation, nutrition).
● CVS Health played a critical role in scaling COVID-19 testing for the country: Through its extensive retail presence, CVS Health provided millions of tests for individuals as well as employers such as airlines and manufacturing plants. More than 50% of its testing sites are located in underserved communities, helping CVS Health to play an important role in narrowing healthcare disparities nationwide. CVS Health also participated in the federal retail pharmacy program, distributing vaccines in nearly 2,000 stores in 49 states, Puerto Rico and Washington, D.C.
● Enhancing behavioral health offerings: The impacts of COVID-19 on the mental health and wellbeing for thousands of Americans has helped to destigmatize behavioral health conditions so patients feel more comfortable seeking treatment. The Guardian Angel program was developed in response to the opioid epidemic, and matches Aetna members who have had a drug overdose with trained clinicians who have decades of experience counseling people with addiction issues. These clinicians help individuals overcome their addiction through coaching, evidence-based therapies, and longitudinal support.
● Role of CVS Health in the patient care journey: CVS Health plays a critical role with providers in delivering comprehensive care to patients. Beyond leveraging their advanced analytics to inform clinical interventions and utilizing its extensive retail footprint to improve access to care, CVS Health also supplements services not offered at primary care providers. These additional services may include nutritional coaching, which impacts many chronic conditions, and screenings for other chronic conditions such as hypertension and treatments for diabetes.
Our perspective is that we’re part of a broader ecosystem of care. We help coordinate care, we can deliver care when appropriate, and we can pay for appropriate care. But I think our perspective is that we’re partnering with patients’ providers in the community to make sure we’re supporting them, and that we’re addressing gaps of care that might have fallen through the cracks. We’re trying to address some of these social determinants of health through partnerships, like Unite Us. One important callout is the role of data interoperability.
Note: this episode was recorded on March 25, 2021 and some numbers cited in the interview may have changed.
