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NEW YORK — Winning with ability and agility in the age of healthcare retail-ization. That’s what it is all about for CVS Caremark, and that was a central theme of Wednesday’s timely Analyst Day meeting in New York City, held just weeks before the New Year when health reform will begin to significantly alter the healthcare landscape.
Gathering at the Mandarin Oriental Hotel in New York City, analysts heard from key members of the executive team who outlined the company’s strategies to drive long-term enterprise growth through its vast pool of assets and its nimbleness in responding to the evolving health care landscape.
“I think today’s meeting is particularly timely given all that is happening in the healthcare industry as we enter 2014. As we are all acutely aware, the industry is undergoing its most transformative shift in decades and CVS Caremark is extremely well positioned to thrive in this changing healthcare landscape,” president and CEO Larry Merlo told analysts.
During the meeting, which was also webcast, Merlo took to the stage to provide a 30,000-foot view of the changing healthcare landscape and the company’s ability and agility to respond to these changes.
“Our ability is defined by the fact that we have brought together an unmatched breadth of assets and expertise to drive innovation. And that innovation has delivered results for our clients, our customers and for our shareholders,” said Merlo. “Our agility is rooted in the fact that, while we are laying out a clear direction and a long-term strategy, the marketplace is undergoing significant change. And we have the ability and nimbleness to respond to those changes while continuing to deliver strong results.”
It is this unique combination of ability and agility that positions the pharmacy innovation company to capitalize on the opportunities created by such changes within healthcare as coverage expansion and payor mix, the retailization of healthcare, a greater focus on cost and quality, and evolving pharmacy economics. And its integrated business model is proving successful in enhancing access to care, lowering costs and improving health outcomes.
As 2014 draws near, CVS Caremark has set its sights on driving enterprise growth.
By 2018, more than 30 million Americans will gain insurance and many more will face changes in their coverage. Employer-sponsored coverage is expected to remain relatively flat, with Medicare, Medicaid and individual purchased coverage facing rapid growth. The growth in these areas spells a rise in the importance of government, payors and health plans.
“When you look at government payors, our advantage comes from our strong positions in both the Medicare and Medicaid businesses across both our retail and PBM channels,” Merlo told analysts. “We made investments in building these businesses and you can see our significant share in these markets. Our ability to gain share of pharmacy spend across the enterprise from lives in our PDP and managed Medicaid business is a significant advantage over our standalone competitors. And we are especially well positioned to participate in coverage expansion through Medicaid as the leading PBM in the managed Medicaid market, along with our strong retail footprint in the majority of states that are expanding the Medicaid population.”
As it relates to health plans, the company is confident in its ability to grow market share through its existing PBM relationships. Today, there are more than 80 health plan clients representing about half of its PBM lives.
“The truly unique aspect of our model is the ability to support health plans through our assets across the enterprise, whether or not we’re the PBM,” Merlo added. “And our consumer expertise in this new business-to-consumer world of healthcare is being welcomed by health plans across the country.”
Private payor CareFirst, for example, is a new CVS Caremark client starting January 2014. CareFirst has developed a primary care medical home model that is focused on improving quality and lowering costs. The physician is measured on more than 20 quality and efficiency metrics and is given annual spending targets for their patient group. To further improve care and cost improvements, CareFirst is leveraging CVS Caremark’s capabilities.
“We have the ability to support the primary care physicians by improving quality and lowering overall health care costs for their patients through the work our enterprise assets can deliver,” said Jon Roberts, president of CVS Caremark Pharmacy Services, during his presentation. “We are in the process of integrating our technology platform, along with our retail pharmacies, mail, specialty pharmacies and MinuteClinic into CareFirst’s [iCentric network].”
Retailization of health care
“With the implementation of the Affordable Care Act and continued growth in Medicare we are seeing a rapid increase in the number of consumers choosing their own health plans,” Merlo told analysts.
In fact, in 2014 it is estimated that 2% to 3% of lives will be on the exchanges and this is projected to grow to 5% to 8% by 2016. By 2020, it is estimated that about 20% of consumers will be direct choosers of their health care purchasing. Meanwhile, many individuals will have more benefit design choices through employers.
This rise in consumers choosing their own health plans will mean a greater demand for transparency and value in the healthcare marketplace. And both consumers and plan sponsors will increasingly turn to tighter pharmacy management tools to help save money.
Enter the retailization of health care.
This is an area, in which CVS Caremark executives — with its decades of retail experience in a business-to-consumer environment, its channel-agnostic offerings (i.e. Maintenance Choice, Pharmacy Advisor and Specialty Connect), a growing footprint of conveniently located and low-cost MinuteClinic locations, and new digital capabilities that enable it to personlize the relationship with consumers — are quite confident in the company's ability to compete aggressively.
In touching upon the retailization of healthcare in his remarks, Roberts said, “The growth of private exchanges and the emergence of public exchanges will put the decision of plan choice directly into the hands of the consumer. … This increased consumer involvement will push payors and providers to provide more personalized and cost-effective solutons.”
Added Roberts, “CVS has a much deeper understanding of the consumer and what drives consumer behavior than anyone else in the PBM industry. Our unique model with more than 7,600 CVS drug stores along with our MinuteClinics puts us in contact with millions of healthcare consumers every year. … This consumer contact combined with our research partnerships with leading academic institutions arms us with unique, unmatched insights to design our marketing and member engagement strategies.”
Another trend playing out within the U.S. healthcare system is a much greater focus on cost and quality in the payor and provider communities as the shift toward an outcomes-based payment system continues. Meanwhile, narrow provider networks are gaining traction and payors are increasingly focused on controlling specialty trend.
So as the needs of payors and providers change and risk-sharing increases, CVS Caremark’s business model enables it to support payor and provider goals. Furthermore, the company’s success in improving adherence rates is not going unnoticed.
“With a 400 basis point improvement over the past four years, our adherence rates are almost nine full percentage points above the competition,” said Merlo, giving credit to its technology investments and unique clinical programs like Pharmacy Advisor.
It should also be noted that the company is expanding its presence in the infusion market through the previously announced acquisition of Coram, which even further broadens the capabilities that CVS Caremark can bring to its payor customers.
In addition, incoming president of CVS/pharmacy Helena Foulkes Andy Sussman, SVP and associate chief medical officer and president of MinuteClinic, also shared insight on their respective businesses.
Driving retail growth through personalization
Speaking to analysts about how the company is driving growth through personalization and leveraging the front end of its stores to capitalize on the changing health care landscape was Foulkes.
As reported by Drug Store News, Foulkes will assume the role of president of CVS/pharmacy on Jan. 1. She succeeds Mark Cosby, who is stepping down on Dec. 31.
Foulkes has been with the company for more than 20 years and, over the years, has held increasingly large and impactful roles in the company’s retail business, including merchandising, marketing and store operations. Her industry track record includes taking on the massive challenge of building what has become one of the most successful loyalty programs in all of retailing, ExtraCare.
“Personalization is core to our retail strategy. We have a number of initiatives underway and all of them designed to help us connect directly with individual consumers to deliver a personalized experience,” said Foulkes, who was quick to point its ExtraCare loyalty program, which is the engine behind all of its personalization efforts.
To stay on the leading edge, the company is further investing in ExtraCare and remains focused on identifying top customers and the share of wallet opportunity they represent.
According to Foulkes, 40% of front store shoppers represent 87% of ExtraCare front-end sales. She acknowledged that rivals may have a similar ratio but CVS/pharmacy has one major advantage. Knowledge.
“Our real advantage is that we know exactly who those 40% are yet, even with them, we have significant upside. As an example, we know that our top customers spend only 30% of their total beauty spend at CVS. We have them in our stores so there’s a great opportunity to capture more of their share of wallet,” said Foulkes.
To further illustrate the opportunities for conversion, there are roughly 50 categories within CVS stores and yet nearly one-quarter of its shoppers shop only one or two categories. Clearly, the opportunity to convert more shoppers is tremendous.
“We are providing customers with conversion offers that encourage her to shop in categories she hasn’t shopped before. The coupons she receives will also drive greater share of wallet in those categories she does shop,” Foulkes added. Year-to-date the company has delivered 2.5 billion targeted offers to drive profitable growth.
The company’s store clustering initiative also remains a key focus. To date, the company has 560 Urban cluster stores in place. These stores are designed around the fact that they are in a dense trade area with limited competition, and are much like a general store with expanded grocery and on-the-go foods.
Meanwhile, the company began piloting in 2013 its Suburban cluster stores. These stores integrate pharmacy and MinuteClinic, with an elevated health and beauty assortment. During the fourth quarter, the company completed roughly 60 of these stores.
“It’s too early to talk about results but we’ll evaluate and learn what worked and what didn’t and adjust as needed,” said Foulkes. “The key takeaway regarding our cluster strategy is that we are continually evolving based on early wins and other key learnings that we incorporate into our ongoing reset and remodel program.”
Foulkes also pointed to enhancing the experience of the circular through its new myWeekly Ad digital circular, growing store brands and bolstering its digital offering as ways the company is working to drive growth.
Transforming primary care
With a primary care physician shortage that is expected to reach 45,000 in 2020 and nearly half of patients indicating that they do not have a primary care physician, the role of MinuteClinic is becoming increasingly vital.
“We continue to integrate MinuteClinic with other sources of care and these include patient-centered medical home practices and Accountable Care Organizations,” said Sussman. “We now have affiliations with 30 major health systems — a foundation for our enterprise strategy to differentiate CVS Caremark for providers.”
For 2013, MinuteClinic is expected to enjoy better than expected revenue growth, reaching about $240 million. For 2014, revenue is estimated to reach about $300 million.
One key growth driver is the expanded footprint. In the last three years, the company has added more than 350 MinuteClinics, including 160 new clinics in 2013. The company now operates about 800 clinics — more than half of all retail clinics within the United States. By 2017, it expects to have about 1,500 clinic locations.
MinuteClinic is clearly not looking to replace primary care physicians but, with a physician shortage, its collaborative approach and broadening capabilities makes the clinic operator an important support to primary care practices.
In addition to expanding its geographic footprint and non-acute services — which now account for 18% of total volume — the company is also looking to increase access via such technology as telehealth.
Via a pilot in Southern California, the company employs high-definition video and audio equipment.
“Our model differs from some other providers in our use of connected, peripheral device cameras. These transmit physical exam findings such as images of the ear, throat and skin. Along with heart and lung sounds provided by a digital stethoscope,” said Sussman. “We anticipate applications that will include establishment of telehealth sites at Caremark employer locations. We also plan remote physician consultations for MinuteClinic patients, further expanding our scope of services.”
Going forward, the company will look to provide this telehealth care to homes and on mobile devices.