Payer care management has significant untapped potential to enhance member outcomes, reduce costs, and streamline healthcare delivery. Traditional approaches often use a one-size-fits-all strategy, overlooking the unique needs of diverse member populations. However with the advancement of digital tools and artificial intelligence, integrated care management is being redefined.
Since 2020, Welldoc and CVS HealthspireTM have collaborated to innovate care management for high-cost, complex chronic conditions, including diabetes and obesity, along with other rare conditions. By combining Welldoc’s award-winning artificial intelligence (AI)-driven digital health platform with CVS Health’s comprehensive care delivery solution, the collaboration aims to support improved health outcomes and reduce the overall cost of care.
So, what exactly does this next-generation care management model look like?
Prioritizing member-centricity
At the AHIP 2024 Consumer Experience & Digital Health Forum, Matt Wilson, Vice President of Product & Growth at CVS Health, shared the vision of the CVS Healthspire and Welldoc collaboration.
“We are hyper-focused on ensuring we have a clinical design that drives [positive health] outcomes. And the way you get those outcomes is through an enhanced member experience. You have to be member-centric.” – Matt Wilson, CVS Healthspire
“We are hyper-focused on ensuring we have a clinical design that drives [positive health] outcomes. And the way you get those outcomes is through an enhanced member experience. You have to be member-centric.” said Wilson. “You can’t over-focus on the economics of the plan. While important, that needs to be the by-product of a good member-centric experience.”
This collaboration emphasizes customizing care management through integrated data to meet member needs, deliver personalized coaching, and address critical gaps in care. The result is improved clinical outcomes, including significant HbA1c reduction, sustainable weight loss and maintenance, and enhanced medication adherence.
Maximizing scalability with high-tech, high-touch support
As the U.S. faces a potential shortage of nearly 200,000 nurses and 124,000 physicians by the 2030s*, empowering care teams to operate at the top of their license is vital.
Welldoc and CVS Healthspire’s solutions maximize scalability through a strategy that combines high-tech tools with high-touch support. Welldoc’s advanced AI engine segments members based on their engagement needs—offering a digital-first approach for lower-risk individuals while providing more integrated human clinical support for those with higher acuity.
“By using the member health, pharmacy, medical, and lab data, we understand that not every individual needs the same level of intervention. This is how you scale a program effectively,” explained Keith Reynolds, Chief Operations Officer at Welldoc.
Enhancing GLP-1 effectiveness with comprehensive support
Next-generation care management programs go beyond traditional weight-loss methods by considering individual metabolic differences and social determinants of health.
Wilson added, “When members enroll in our weight management program—especially those on GLP-1s—we equip them with tools to track their progress, helping clinicians gain insights into each member’s journey. This holistic approach addresses not just diet and exercise, but also side effects and mental health, ensuring we approach care with empathy and rigor.”
This weight management program is adaptable, offering plan sponsors the ability to align engagement strategies with the use of anti-obesity medications (AOM). This approach ensures that members receive the dietary and lifestyle support essential for maximizing the effectiveness of AOMs.
A Model for the Future of Care Management
The next-generation care model developed by CVS Healthspire and Welldoc is flexible, scalable, and member-centric. Designed to support high-cost and complex conditions, including GLP-1 support this model effectively combines digital and human engagement, adjusting dynamically to ensure members receive the appropriate support needed to meet members’ individual needs.
By combining AI-driven technology with personalized care, this collaboration ensures that members receive the right support at the right time to help meet and exceed their health goals.
For more information on how Welldoc collaborates with the health ecosystem, discover the Welldoc digital health platform.
