Connected Health: Working to connect retail, medical homes

BOSTON—With 7,500 retail locations and 75 million people receiving its pharmacy benefits, CVS Caremark is a “big and lumbering” company working to determine the best way to connect retail to the medical home, said Troyen Brennan, MD, MPH, executive vice president and chief medical officer, speaking at Partners HealthCare’s 10th Annual Connected Health Symposium.

The pharmaceutical area has been moving very fast in terms of moving data, Brennan said. “They are better at moving data a lot faster than anyone else but that’s not saying much. That’s like having the highest SAT scores in the NFL.”

Meaningful Use Stage 2 is driving new attention to connectivity, he said. The company’s MinuteClinics rely on Surescripts but each affiliate has a different agreement about how and what information to share. “It’s an arduous process because each affiliate wants information in a different way. The IT teams have big agendas. The pace is slow but we have the pipes built and have the ability to take our information and get it to them.” Despite the challenges, “we’re very bullish and building more and more clinics.”

CVS has a homegrown EMR, Brennan said, but it “is probably past due for an update.” When patients present at a MinuteClinic, the nurse practitioner accesses the MinuteClinic EMR. If the patient happens to be a Caremark member, “we have a moment of truth about their medications.”

The company has considered alternative methods for connectivity, Brennan said. They include the use of a highly prevalent EMR, reliance on health information exchanges (HIEs), the presumption that more EMRs will open their architecture to allow more data exchange and expect bidirectional workflow or enterprise HIE connectors to evolve into full format inter-enterprise connectors.

Any of these alternatives give Brennan some pause, he said, but “we need to put some bets on the table. There is no sense trying to play all of these avenues.”

One area moving quickly is neural networks, he said. This is essentially a website with a lot of quantitative analysis. “As a result, we have the ability to measure performance overall on basic pay-for-quality measures.” For example, Carefirst—a Blue Cross program in Maryland—has 2,400 doctors participating in patient-centered medical homes with a series of pay-for-quality measures in place. And, in Hawaii, doctors’ offices have hired an individual to monitor the Coveza program. “They have the doctors’ attention and are moving the needle on pay-for quality measures.”

CVS can provide these practices with information they can plug into the overall system and “get what we want messaged,” Brennan said. “This part of connectivity is looking pretty exciting. As long as we can provide doctors with comparison information, then we feel we can accomplish something regarding medication adherence.”