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How CVS Health® and Aetna® are transforming cancer care

Color portrait of Mark Pabst By Mark Pabst

For people who have recently received a cancer diagnosis, nothing is more important than getting timely treatment and personalized support. CVS Health and Aetna are pioneering new ways to provide the support people need during their oncology journey. Here’s how they helped one Aetna member, Kamila K.

Until last year Kamila hadn’t really interacted much with the American health care system. Though she has lived in the United States for two decades, the 53-year-old Silicon Valley tech professional always enjoyed robust health. As a result, she never made extensive use of the health insurance she receives through work. 

Then, in August 2019, the Aetna member found a lump in her breast during a self-exam. The discovery launched her on a journey where she would learn the good, the bad and the ugly of cancer care in the United States. She would also find out how important the new, connected care solutions offered by CVS Health and Aetna can be for oncology patients like herself.

Accentuate the positive, eliminate the negative

The good news for Kamila and other oncology patients is that advances in early detection and treatment have greatly improved survival in recent years.i  But along with these advances have come the problems of fragmented care and increasingly complex treatments, not all of which are proven effective.

Kamila felt this disconnect almost immediately during her cancer journey. The day after discovering the lump she was in her doctor’s office, but she ended up waiting over two weeks to get her diagnosis. Her cancer spread to her lymph node under her arm, but she didn’t feel a sense of urgency on the part of her doctors to begin treatment.

“I could feel the lump under my arm grow bigger and I was really struggling to stay calm,” said Kamila. “It was hard to focus because I was so worried.”

Solutions that cut through common barriers to deliver timely, effective oncology care

Kamila felt she wasn’t receiving the level of attention she wanted, so she used Aetna’s “Best Doctor” service to find a new oncologist in her area. She credits the decision with reducing her wait time for treatment. It was also the beginning of her experience with CVS Health and Aetna’s Transform Oncology Care (TOC) program.

A joint team of experts across CVS Health and Aetna established TOC in 2019 to address the many issues facing oncology patients. The program simplifies the treatment process for health care providers and allows them to deliver high-quality, evidence-based care that supports patients throughout the treatment journey, including prevention and screening, diagnosis, treatment, survivorship and supportive care.

The result is a new way of delivering cancer care that brings greater organization to treatment and improves health outcomes for patients like Kamila.    

At the same time, Aetna is providing frontline physicians like the ones who treated Kamila with CVS Caremark’s Novologix® platform. A best-in-class clinical decision-support tool that employs data-driven diagnostics and simplifies the approval process for treatment, Novologix helps physicians get treatment started faster for patients by preapproving medications and ensuring only the most effective, proven clinical therapies can be used. For Kamila, who worried about delays in getting her treatment started, her new oncologist’s use of Novologix not only sped up the start of her treatment but also helped reduce the emotional stress she was feeling.

Supporting patients and coordinating care while controlling costs

With Aetna, cancer patients are also assigned an oncology-specific nurse care manager who proactively reaches out to the patient and assists with scheduling all necessary tests, procedures and procurement of medicines. For Kamila this meant someone who could not only make sure her care was being coordinated among her physicians, but also direct her to the type of behavioral health support she needed throughout her cancer journey.

Margie Schmelzer, Kamila’s nurse care manager, helped save money, time and likely improved Kamila’s health by streamlining her care. Margie reached out to Kamila even before she began chemotherapy and came up with strategies that helped Kamila reduce her anxiety and also let her know what to expect from treatment.

Margie also helped organize care. At one point administrators told Kamila she needed two separate surgeries, meaning two distinct surgery dates, two recovery periods and two chances for potential complications. However, her nurse care manager intervened with hospital administrators and was able to combine the procedures into a single surgery date, saving money and reducing the risk of complications. Kamila was grateful to know she had someone in her corner.

“Margie called me at first just to see how I was doing, but she started automatically helping,” said Kamila. “She was such a great advocate. She got me a lot of things I could never have gotten on my own.”

And nurse care managers don’t just advocate for their patients. They also serve as educators. For example, when the COVID-19 pandemic burst onto the scene earlier this year, cancer patients like Kamila were able to reach out to their nurse care managers to ask about best practices and behaviors to reduce their risk of contracting the disease.

Already showing positive results

CVS Health and Aetna’s efforts are already improving outcomes for patients. For example, projections show improved oncology patient management can help reduce the number of patients seeking emergency care or requiring hospitalization by 10-15 percent.ii

Better care management can also help patients like Kamila feel less alone and more in control. Perhaps Kamila put it best when she said, “I want to thank Aetna for Margie. She’s been such a great support. To know that there’s someone out there who can follow up on things when I’m completely down helps tremendously.”

i https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21565

ii CVS Health – Analytics and Behavior Change. 2018 Oncology analysis – pathways and care management potential savings, 2019

About the author

Mark Pabst has worked as a writer and researcher in the health care field for almost two decades. When not writing about health he tries to stay healthy through activities like hiking, climbing and paddling in the far flung corners of his native state of California. However, despite his best efforts he still has a few unhealthy habits he can’t shake, most notably a weakness for jelly donuts.

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