CVS ‘con­fi­dent’ it will re­place rev­enue lost from tobacco sales

Modern Healthcare - - Q & A -

Since 2008, Dr. Troyen Bren­nan has served as ex­ec­u­tive vice pres­i­dent and chief med­i­cal of­fi­cer at CVS Health Corp.

Pre­vi­ously known as CVS Caremark Corp., the phar­macy chain op­er­ates 7,800 stores and nearly 1,000 walk-in clin­ics in 31 states un­der the Minute-Clinic brand. He over­sees the com­pany’s clin­i­cal and med­i­cal af­fairs strate­gies. Be­fore join­ing CVS, Bren­nan was CMO at in­sur­ance gi­ant Aetna and pre­vi­ously was CEO of Brigham and Women’s Physi­cians Or­ga­ni­za­tion in Bos­ton. He earned his med­i­cal de­gree, law de­gree and a mas­ter’s in public health from Yale as well as a mas­ter’s de­gree from Ox­ford Uni­ver­sity, where he was a Rhodes Scholar. Mod­ern Health­care re­porter Bob Her­man re­cently talked with Bren­nan about CVS’ de­ci­sion to drop the sale of tobacco prod­ucts at its stores, the grow­ing role of re­tail clin­ics and the chain’s mission to help pa­tients man­age med­i­ca­tions and their costs. This is an edited tran­script.

Mod­ern Health­care: CVS stopped sell­ing cig­a­rettes, cigars and other tobacco prod­ucts last Oc­to­ber. What are the re­sults so far, and what has the re­ac­tion been?

Dr. Troyen Bren­nan: It has gone well, and the re­ac­tion has been pos­i­tive. We saw our fu­ture in the in­dus­try and re­al­ized the sale of tobacco prod­ucts was an­ti­thet­i­cal to health­care. We guessed that the cost would be about $2 bil­lion in lost rev­enue, but we hoped to make that up in the long term by de­vel­op­ing more prod­ucts that em­pha­size peo­ple’s health. We also changed our name to CVS Health, which seems to have res­onated with the public. Over­all rev­enue is up as a re­sult. We haven’t re­placed the loss in our re­tail stores as­so­ci­ated with tobacco, but we’re con­fi­dent we will.

MH: Do you see other ma­jor phar­macy com­pa­nies fol­low­ing suit?

Bren­nan: Un­for­tu­nately, no, we don’t see other re­tail­ers fol­low­ing suit, even though we’ve de­vel­oped ev­i­dence that demon­strates that when you elim­i­nate tobacco sales from re­tail phar­ma­cies, over­all rates of smok­ing de­crease—at least that’s what we have found in Bos­ton and San Fran­cisco.

MH: Can you talk a lit­tle bit more about the prod­ucts you hope will make up for the lost rev­enue?

Bren­nan: We’re very in­ter­ested in try­ing to add more prod­ucts that con­trib­ute to peo­ple’s health. We have be­gun to make some changes over­all in the types of food we of­fer, and we’ll con­tinue to do that, as well as look­ing to prod­ucts that em­pha­size health as well as beauty.

MH: What do you think is ac­tu­ally the big­gest public health cri­sis right now?

Bren­nan: We still have to count tobacco as the big­gest public health prob­lem in the coun­try— one that is solv­able by get­ting peo­ple to stop smok­ing. The next one is the prob­lem we have with weight. Obe­sity rates are way too high and are as­so­ci­ated with very high rates of other dis­eases like di­a­betes, hy­per­ten­sion and coro­nary artery dis­ease. So, when we think about a well­ness ap­proach, we’re fo­cus­ing on those is­sues.

MH: You’ve writ­ten a lot about pa­tient-safety top­ics and over­all health­care qual­ity. What are your cur­rent views of the pa­tient-safety move­ment and the legal av­enues pa­tients have to deal with med­i­cal er­rors?

Bren­nan: The pa­tient-safety move­ment is vi­brant and de­vel­op­ing a lot of good pro­grams in hos­pi­tals and health­care in­sti­tu­tions. As a re­sult, there have been a lot of good out­comes for pa­tients. Re­gard­ing li­a­bil­ity, that’s not as sub­stan­tial an is­sue as it was 15 or 20 years ago. I think peo­ple are less con­cerned about is­sues as­so­ci­ated with mal­prac­tice some­how in­ter­fer­ing with pa­tient safety.

MH: What are your thoughts on Congress’ move to re­peal the sus­tain­able growth-rate for­mula? Is the move­ment to­ward pay­ing physi­cians for value in­stead of vol­ume some­thing that is ac­tu­ally go­ing to take hold?

Bren­nan: Get­ting rid of the SGR, if we were just go­ing to be putting in fixes in ev­ery 18 months to two years, makes good sense, fo­cus­ing on real pol­icy around how physi­cians are paid. I think it’s just part of what the ad­min­is­tra­tion and the fed­eral gov­ern­ment are do­ing over­all, em­pha­siz­ing

“We’ll con­tinue to work on ways we can pro­vide care for pa­tients who are quite sick at home.”

pay­ment for bet­ter out­comes and im­prove­ment in pop­u­la­tion man­age­ment.

MH: CVS re­cently cre­ated a few more part­ner­ships and clin­i­cal af­fil­i­a­tions with health sys­tems. What are the ba­sics of th­ese part­ner­ships?

Bren­nan: A lot of them are based on our phar­macy and re­tail clinic out­reach. We are com­mit­ted to get­ting to about 1,500 Min­uteClin­ics by 2017 and are on pace to do that. The clin­ics are pro­vid­ing good care for peo­ple who have acute and short-term ill­nesses, but we also see them slowly mov­ing into chronic care. But we see chronic care as com­ple­men­tary pri­mary care, where we’re work­ing di­rectly with pri­mary-care providers.

MH: How do those part­ner­ships in­cor­po­rate pre­scrip­tions and elec­tronic health records? Bren­nan: We’re not the med­i­cal home, but we work closely with the med­i­cal home. To do that, we have to be able to share elec­tronic health records, and that’s the point of a lot of our af­fil­i­a­tions with in­te­grated de­liv­ery sys­tems. We’re reach­ing out to them and say­ing, “We can work with you. We can help pro­vide bet­ter phar­macy care through our phar­ma­cies. We can col­lab­o­rate for the kinds of com­ple­men­tary pri­mary care that Min­uteClin­ics can pro­vide, and as a re­sult pro­vide bet­ter care for all of your pa­tients.”

We have over 50 of those af­fil­i­a­tions now, and we’ll con­tinue to add to that num­ber over time.

MH: What are some other ar­eas CVS plans to in­vest in?

Bren­nan: Our other big move is that we have de­vel­oped a large phar­macy drug pro­gram un­der Medi­care, the so-called PDPs, and we’ll con­tinue to grow that pro­gram so that peo­ple who are on tra­di­tional Medi­care are able to ac­cess the drug ben­e­fit. We’ve also added home in­fu­sion. Co­ram is the largest home-in­fu­sion com­pany in the coun­try, and we own that now. We’ll con­tinue to work on ways we can pro­vide care for pa­tients who are quite sick at home and need that ser­vice.

We’ll also be mak­ing a lot of changes in the ways we help pa­tients im­prove med­i­ca­tion ad­her­ence. About 50% of pa­tients with chronic ill­ness aren’t tak­ing their med­i­ca­tions six to eight months af­ter their doc­tor started to pre­scribe them. We are in a good spot there, be­cause we can im­prove qual­ity and re­duce cost by just mak­ing sure pa­tients take their med­i­ca­tions.

MH: One of the prom­i­nent is­sues in phar­macy in­volves some of the high-cost spe­cialty drugs. We’ve seen this with hep­ati­tis C and So­valdi. How is CVS work­ing to help man­age th­ese costs?

Bren­nan: That’s what a phar­macy ben­e­fit man­age­ment com­pany does, and that’s re­ally half of what we do here at CVS— to take ad­van­tage of com­pe­ti­tion be­tween phar­ma­ceu­ti­cal com­pa­nies and try to re­duce costs to the great­est ex­tent pos­si­ble. We also try to make sure that peo­ple on med­i­ca­tions are us­ing them ac­cord­ing to ev­i­dence-based guide­lines. We put into place uti­liza­tion-man­age­ment ap­proaches that en­sure the pa­tients who need the drugs are get­ting the drugs, es­pe­cially the very ex­pen­sive drugs, but that we’re not hav­ing pa­tients un­nec­es­sar­ily use very ex­pen­sive med­i­ca­tions.

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