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WOONSOCKET, R.I. — No one in 1997 would have predicted that Josh Flum would become one of the most important pharmacy executives in the country. That year he graduated from Yale Law School and started on a journey that took him from the U.S. Court of Appeals for the Third Circuit, where he served as a law clerk, to Miller, Cassidy, Larocca & Lewin, a prestigious Washington legal firm, the Boston Consulting Group and, eventually, CVS Caremark Corp., where he is now senior vice president of retail pharmacy.
“At the Boston Consulting Group I was fortunate to be assigned to a case working with CVS/pharmacy,” says Flum. “Once I was at CVS, I had an immediate affinity for the pharmacy business and its potential as well as for the quality and passion of the entire organization, from senior leadership through to the store-level colleagues.”
Impressed with Flum’s work, CVS Caremark management asked him to join the company’s pharmacy operations team. In relatively quick succession, he served in a number of capacities, including leading the pharmacy technology group and the enterprise delivery team in charge of such programs as Pharmacy Advisor. In 2011 he assumed his current role as head of the company’s newly created Retail Pharmacy Division.
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Josh Flum: "We plan to utilize our pharmacy staff to assure that our customers are aware of the health care options that are available to them under health reform." |
“It is a testament to the company that they recognized that someone with a non-traditional background could effectively lead such a critical component of the business,” notes Flum, whose appointment came during a time of unprecedented change in community pharmacy. Now his task is to help CVS Caremark — and the entire profession — carve out an expanded role in the nation’s rapidly evolving health care system.
“CVS Caremark’s purpose is to help people on their path to better health,” he says, “and we are accomplishing this by reinventing pharmacy. This starts with the belief that a pharmacy is much more than a place to get your prescriptions filled. It’s also a place where patients should expect caring, expert guidance; new solutions to reduce health care costs; and more convenient access to pharmacists.”
The company is arguably better equipped than any of its rivals to make that vision a reality. The merger that brought CVS, the second-largest drug chain in the United States, together with Caremark, which at the time was the No. 3 pharmacy benefits manager and has since moved up to the second spot, in 2007 left the new entity with a unique range of capabilities.
“As a pharmacy innovation company, CVS Caremark is well positioned to advance the retail practice model to meet the current and future needs of patients, payers and prescribers,” asserts Flum. “Since CVS/pharmacy and Caremark merged, we have leveraged our unmatched assets to pioneer industry-leading solutions for improving access, cost and quality for patients and payers.”
He cites Maintenance Choice, which gives plan members the option of obtaining 90-day prescriptions at retail for the same cost as mail order, and Pharmacy Advisor, a program that aims to improve medication adherence and identify gaps in care for people with chronic conditions, as examples of the kind of new approaches the company is bringing to the marketplace.
“Our Maintenance Choice pharmacy benefit is an example of a plan design that has improved access for patients while significantly reducing overall costs for payers,” Flum says. “The deep clinical expertise of our PBM team, coupled with the advanced consumer insights of our retail organization, helped catalyze the development of our retail suite of clinical programs, which help ensure patients start and stay on appropriate therapies.
“Through the Pharmacy Advisor program, our pharmacists have one-on-one consultations with patients. With chronic disease accounting for 84% of all health care spending, Pharmacy Advisor is helping to reduce costs and improve outcomes. For instance, by ensuring diabetic patients are on the right medication and stay on that medication, the program is helping to reduce a diabetic patient’s cost of care by $3,700 annually.”
In addition to diabetes, Pharmacy Advisor covers nine other chronic conditions, including depression, asthma, chronic obstructive pulmonary disease and osteoporosis.
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"Over time, our pharmacy teams have taken on greater responsibility for influencing patient outcomes,” CVS’ Flum says.
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Implementation of major provisions of the Affordable Care Act (ACA), which is expected to eventually add as many as 30 million individuals to the ranks of the insured, should give CVS Caremark greater scope to innovate. Beginning with the start of the open enrollment period on October 1, the first order of business will be to help people navigate through the system.
“CVS Caremark can play a unique role in helping to inform and educate patients about new insurance options under the Affordable Care Act,” says Flum. “We understand that increased access to care will help people on their path to better health. We plan to utilize our pharmacy staff to assure that our customers are aware of the health care options that are available to them under health reform and the steps they need to take to enroll quickly and easily.
“We expect to partner with both government entities and private sector outreach groups as health reform is rolled out. We are also working actively with health plans to support their outreach and enrollment activities as coverage is expanded.”
One aspect of CVS Caremark’s business that will benefit from health care reform is MinuteClinic, which currently operates some 650 in-store clinics in 25 states.
“The rapid growth of MinuteClinic, in both number of clinics and patient visits, is a testament to how our clinics are helping to solve the unmet health care access needs that exist in the community today,” Flum notes. “As a provider with Joint Commission certification and patient satisfaction far exceeding typical health care organizations, MinuteClinic brings an additional level of health care credibility to CVS as it takes steps to deepen its reputation as an important provider in the community.
“We are very excited by the opportunities that the ACA brings to both our clinics and CVS Caremark, as other provider organizations and insurance companies look for high-quality, low-cost options for improving population health management.”
He adds that MinuteClinic and its nurse practitioners are increasingly viewed as helping address pressing problems by serving as an alternative to emergency rooms, providing an expansion of general primary care services, and offering a convenient access point for chronic care screening, monitoring and, eventually, treatment.
Health care reform will accelerate the changes already under way in pharmacy practice. With primary care physicians in short supply, CVS Caremark pharmacists will be called upon to deliver a wider variety of services and interact more closely with other health care providers.
“Over time, our pharmacy teams have taken on greater responsibility for influencing patient outcomes,” says Flum. “Whether it be their expanded role in the delivery of pharmacycentric services to promote adherence, or the access provided to the community by having 20,000 certified CVS pharmacist immunizers readily available to administer a variety of preventative vaccinations, or as educators who help their patients navigate their pharmacy benefit design to ensure cost-effective management of their condition, CVS pharmacists have become a valuable asset within the community for helping to improve access, quality and cost of care.”
In coming years that transformation will continue to gather momentum.
“In the near future, the role of our pharmacists will further expand as they become an integral part of the broader health care delivery system,” he notes. “The value derived through pharmacist engagement and intervention has become accepted across all stakeholders within the health care continuum.
“Areas of future growth and opportunities include pharmacist involvement in reducing unnecessary hospital readmissions by supporting quality interactions during transitions of care, helping health plans achieve CMS [Centers for Medicare and Medicaid Services] Star Rating performance criteria, and supporting emerging health care delivery models like accountable care organizations [ACOs] meet their patient outcome goals through patient-centered medical neighborhood models for coordinating pharmacy care.”
Flum says that CVS Caremark is committed to giving its pharmacy teams the tools and resources they need to deliver outstanding pharmacy care to their patients.
“Technology is a key enabler inside of the pharmacy today, and clearly it is one of the most important driving forces behind our efforts to create efficiencies, provide high-quality patient care and deliver outstanding clinical outcomes,” Flum explains. “Investments in pharmacy automation, e-prescribing integration, patient safety and quality checks, as well as technology-enabled work-flow processes, allow our teams to manage their daily process as efficiently as possible with the highest degree of quality.
“Technology is also a fundamental enabler of our industry-leading patient care model. For example, our adherence programs are driven by a suite of predictive clinical algorithms that identify not only the patients that would benefit most from an intervention but also the most appropriate point in their course of therapy that this intervention should occur. By identifying these interactions, integrating them directly into our pharmacy work flow and equipping our pharmacy teams with the information necessary to engage with their patients, technology empowers our pharmacy teams.”
In addition to improving patient outcomes, investments in enhancing the patient care model increase CVS Caremark’s chances of flourishing in the new health care paradigm.
“We are well positioned to play a meaningful role in the emergence of risk-based health care models,” says Flum. “By focusing on how we find solutions for the needs of our traditional retail patients, as well as our existing and emerging enterprise customers (payers, prescribers and health systems), we will be an effective partner in helping all constituents achieve the common objectives of access to care, reduction in costs and improved outcomes.
“There are a number of areas in which we intend to create a positive impact on at-risk health care models. Our enterprise assets and innovative offerings will allow us to support emerging Medicare ACOs with the management of patient medication benefits and improve utilization trends. We will also partner with health systems to improve patient access to primary care services through MinuteClinic.
“Additionally, we will leverage our presence in the communities we serve to ensure patients have successful transitions in care after hospital stays, and we will collaborate directly with payers and providers to achieve optimal adherence. By focusing on these common opportunities, we will help our customers be successful in a risk-based environment.”
