A look inside CVS Caremark's strategy for improving health equity

When the CVS Caremark team geared up to take on health disparities, it quickly realized that any initiative would require a significant basis in data to succeed.

That entailed both gathering more data and building the tools necessary to track and analyze them. 

For example, Joel Helle, vice president of physician services at CVS Specialty, told Fierce Healthcare that Caremark has not historically gathered race and ethnicity data, but now asks payers and plans sponsors for that information to more accurately target where disparities are occurring.

"It's real race and ethnicity data, and we know who those patients are," he said. "That's the future, in my mind, of what everybody needs to do."

In addition, the company built a proprietary tool that combs data from 17 different indexes to identify where disparities exist, he said. That tool, he said, puts "red dots" on the map to highlight risks, and the Caremark team can then use its internal data to further drill down to challenges in specific communities.

With the data in place, CVS is tackling equity at multiple levels of the company. About a year ago, CVS Health hired its first chief health equity officer, Joneigh Khaldun, M.D., to drive strategy around equity and health disparities at the enterprise level.

In addition, different segments within the company are taking on the issue through their unique positions in the market. Helle and his team spearhead that work within the Caremark pharmacy benefit manager arm, and the PBM has established a four-pronged approach to addressing disparities:

  1. Awareness and educational resources
  2. Testing and screening
  3. Access to health services
  4. Treatment optimization interventions

These principles are applied to each of the health equity initiatives that the company rolls out. For instance, two initial disease states of focus at Caremark are HIV and sickle cell anemia, both of which disproportionately impact communities of color.

Halle said that while there is plenty that Caremark can do to educate populations at risk for sickle cell about testing and preventive care, the team also had to apply that thinking internally and learn more about the unique challenges facing this population.

For one, sickle cell patients are predominantly Black and may face discrimination in seeking care. The team learned from national experts on the disease that they recommend patients visiting an emergency department dress nicely to avoid being removed by security, as they may be mistaken for drug addicts.

Helle said it was critical to find educational opportunities for the staff so they can identify disparities like this: "How do we make sure they have enough education around those disease states to make sure they’re managing them appropriately?" he asked.

In another initiative, CVS joined up with drugmaker Gilead Sciences to make no-cost HIV testing available in MinuteClinics across five geographies in recognition of National HIV Testing Day in late June. The project identified five communities that are "priority jurisdictions" for the Department of Health and Human Services' Ending the HIV Epidemic in the U.S. program for the free testing.

Encouraging people at risk to get tested is even more critical as COVID-19 drove down use of preventive care services, Helle said.

"During COVID, there was almost no HIV testing going on," he said.

Helle emphasized that Caremark's work around equity so far is merely a starting point, and the industry can expect to see more to come from both the PBM and CVS Health broadly.

"I think you’ll start to see us being more vocal about it externally," Helle said.