Increasing Engagement with Preventive Care via myHealthFinder @ CVS Minute Clinics |

CVS health sought improve preventive service uptake by consumers of CVS MinuteClinic by implementing the myHealthFinder digital interactive tool.

CVS Health
U.S. Department of Health and Human Services’ (HHS) Office of Disease Prevention and Health Promotion (ODPHP)

Clinical preventive services help reduce morbidity, mortality, and unnecessary healthcare costs; However, these services are largely underused. Reasons for underuse include limited health literacy, insufficient access to primary care, and inconvenience.
To address these barriers, HHS’ Office of Disease Prevention and Health Promotion developed the myHealthfinder tool, a credible source for user-friendly prevention and wellness information without a patient cost-sharing requirement. The myHealthfinder tool can be embedded and shared online.

In May 2015, CVS’s MinuteClinic partnered with the healthfinder.gov team to integrate the myHealthfinder tool into the CVS Pharmacy and MinuteClinic websites.

The patient population for the intervention included users of MinuteClinic who resided in any of the following states: AZ, CA, FL, HI, IN, MI, MO, OH, OK, RI, TN, VA, CT, GA, IL, KS, LA, MA, MD, MN, NC, NH, NJ, NV, NY, PA ,SC, TX, and the District of Columbia.
There was no patient cost-sharing requirement to use the myHealthfinder tool.

This project did not require any additional preparation or restructuring of the clinic or staff workflow.

Two digital outreach campaigns were developed:
- Web-based campaign: Web-based outreach (i.e. web-exposure) included top-of-page and bottom-of-page banners, text friendly URLs, and a myHealthfinder content tab on CVS and minuteclinic webpages. Those who visited www.CVS.com or www.minuteClinic.com were exposed to this campaign. CVS Pharmacy and MinuteClinic website access points were developed with a link that directed to the myHealthfinder tool.
Email-based campaign: Email-based outreach included an email that encouraged the use of the myHealthfinder tool and provided a direct link. The emails were sent to those who had visited MinuteClinic at least once and registered to receive email communications.

This digital intervention consisted of a web-based campaign and email-based campaign:
- The web campaign was launched on CVS Pharmacy and MinuteClinic websites in web-exposed states where website visitors could click a link and be directed to the myHealthfinder tool.
- The email campaign was an outreach email sent to those users who had registered to receive MinuteClinic emails and were in the email-exposed states. This email encouraged the use of the myHealthfinder tool and provided a direct link to the myHealthfinder tool embedded in the MinuteClinic website. This email campaign occurred only once with no follow up emails.
Exposure to each campaign was assigned at the state-level and applied to all patients residing in those states.
- States exposed to the web-based campaign (web-exposed) resided in one of 13 geographically diverse states (AZ,CA,DC,FL,HI,IN,MI,MO,O- H,OK,RI,TN,VA) which included 348 clinics.
- Those living in web-unexposed states (included 491 clinics) were not exposed to the web-based campaign. Within these web-unexposed states there were two subgroups: those both web-unexposed and email-unexposed, and those web-unexposed and email-exposed. Those residents in the latter group received the email campaign only.

The pilot study is complete. The web-based exposure occurred between May 29 and September 30 of 2015. The single email-based exposure was performed on September 26, 2015.
In the future, the researchers hope to improve timing and relevance of the outreach messages so that engaged patients will increase their use of the recommended preventive services.

Engagement with web-based campaign: Assessed by the number of clicks on content that linked to the myhealthfinder webpage (web-based clicks).
Engagement with email-based campaign: Assessed by the “open rate,” the proportion of individuals who opened the email, and the “email click-through rate,” the proportion of individuals who clicked through the email to directly access the myhealthfinder webpage within the MinuteClinic website.
Preventive service uptake: Assessed by the average number of MinuteClinic patient visits per month per clinic for each of the following preventive service outcomes: influenza vaccine, pneumococcal vaccine, hepatitis A vaccination, diabetes screening, high cholesterol screening, and tobacco-cessation counseling. The services were identified using the Current Procedure Terminology (CPT) code(s) for that service in the EHR.
- The web-based campaign was associated with a significantly greater increase in the uptake of pneumococcal vaccines among exposed clinics over a 4-month period, corresponding to a 26% increase in pneumococcal vaccine use following the campaign’s inception at MinuteClinic locations.
- Use of all other preventive services (Hepatitis A, high cholesterol screening, diabetes screening, and tobacco cessation) was non-significant between exposed and unexposed clinics.
There were no statistically significant differences in the uptake of other services at MinuteClinics attributable to the email campaign.

Consumers’ web-based clicking to the myhealthfinder tool via the CVS and MinuteClinic websites was associated with a statistically significant increase in pneumococcal vaccination rates. This is promising given the public health and economic impacts of pneumococcal disease.
This intervention was a low-cost effort utilizing a pre-existing tool and pre-existing websites.
This study could be duplicated by other retailers and potentially lead to meaningful increases in exposure to and communications about preventative services.

Study limitations:
- It was difficult to identify true changes in utilization of the influenza vaccine, as the web-based effort was launched prior to the availability of the 2015 influenza vaccine.
- Influence of the web-based and email campaigns could only be measured for preventive services delivered at MinuteClinics, as they only had data from MinuteClinics themselves. The outreach campaigns and the myhealthfinder content did not specify where patients should receive their recommended preventive services, so some may have received the services without these services being captured in this dataset.
Some patients who received communications may have already had the recommended service, so receiving the services at MinuteClinic would have been duplicative.

myHealthfinder tool: An easy-to-use prevention and wellness tool, designed by the HHS with attention to health literacy and usability principles. Based on a patient’s self-reported age, sex, and pregnancy status, the interactive tool provides personalized information for recommended preventive services.

Polinski JM, Harris LM, Shrank WH, Sussman A, Barron J. Impact of a patient engagement tool on preventive service uptake. Healthcare. 2018;6(3):162-167. doi:10.1016/j.hjdsi.2017.12.002.

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