DISCLOSURES. This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea

Transcription

1 DISCLOSURES This activity is jointly provided by Northwest Portland Area Indian Health Board and Cardea

2 DISCLOSURES COMPLETING THIS ACTIVITY Successful completion of this continuing education activity includes the following: Attending the entire CE activity; Completing the online evaluation; Submitting an online CE request. Your certificate will be sent via If you have any questions about this CE activity, contact Michelle Daugherty at or (206)

3 DISCLOSURES Faculty: Jonathan Owen, PharmD & Neelam Gazarian, PharmD CME Committee: David Couch; Kathleen Clanon, MD; Johanna Rosenthal, MPH; Pat Blackburn, MPH; Richard Fischer, MD; Sharon Adler, MD CNE Committee: David Stephens, BSN, RN; Erin Edelbrock MPA; Ginny Cassidy-Brinn MSN, ARNP; Carolyn Crisp, MPH

4 CONFLICT OF INTEREST Richard Fischer, MD is a member of an Organon speaker s bureau. Dr. Fischer does not participate in planning in which he has a conflict of interest, and he ensures that any content or speakers he suggests will be free of commercial bias. None of the other planners or presenters of this CE activity have disclosed any conflict of interest including no relevant financial relationships with any commercial companies pertaining to this CE activity.

5 Acknowledgement This presentation is funded in part by: The Indian Health Service HIV/AIDS & Hep C Program and The Secretary s Minority AIDS Initiative Fund There is no commercial support for this presentation

6 Outcomes and Objectives: Conference Objective: At the completion of this activity, the learner will be able to explain the steps that would be necessary to begin to screen for and treat patients with the Hepatitis C Virus (HCV) at their practice sites. By the end of this learning event participants will be able to: Describe tools for management of the care of HCV patients and how to implement them

7 Starting a HCV Treatment Program-Belcourt Authored and Presented by: LCDR Jonathan Owen, PharmD LT Neelam Gazarian, MS, PharmD Quentin N. Burdick Memorial Health Care Facility Indian Health Service Belcourt, ND 12/14/2017

8 Agenda Describe use of tools to manage complex care of hepatitis C patients, discuss workload capabilities. Share resources of NICE Project with participants to help manage hepatitis C clinic.

9 Who are we?

10 Prior to HCV Clinic With Insurance (Pvt./Federal) Without Insurance Referred to Medical Specialists Very Few Options $10,000-$15000/referral Rationing Care Distance Lost to follow-up Poor outcomes

11 Inter-collaborative Approach Primary Care Provider Public Health Pharmacist Patient Behavioral Health Laboratory Services Benefits Coordinator

12 Identifying Patients with Hepatitis C icare VGEN 168 patients 25% screening rate 155 patients

13 EHR Documentation Referral Initial Visit Comprehensive visit Treatment End of Treatment SVR Consult from PCP PHQ-9 AUDIT-C Project ECHO Counseling Labs Patient is cured! Walk in Education Start Medication Authorization Labs Counsel about re-infection and prevention Labs Immunizations Immunizations

14 Consult Template

15 EHR Note Templates

16 EHR Note Templates

17 Hepatitis C Labs Order Menu

18 Hepatitis C Labs Order Set

19 Patient Management Tools icare Panel Consults Excel Panel List NICE Hep C Tool

20 Hepatitis C Patient Panel List Managing Patients Excel document for patient management Created by Jessica Leston, Brigg Reilley, and David Stephens Automatically calculates APRI, FIB 4 scores Excellent for helping to prioritize patients based on liver function and viral load

21 Hepatitis C Patient Panel List Managing Patients New panel created by Nelly to help manage patients referred to the clinic Spin-off of previous panel, automatically calculates APRI, FIB 4 scores Organized by stage in the treatment processes Reminders for labs while in treatment, immunizations, notes

22 Managing Patients Snapshot of stage in treatment process drop down menus (these can be adjusted)

23 Patient Panel

24 Individual Patient Data

25 Appointment Calendar

26 Navigating Insurance/Prior Authorizations Comprehensive Visit Clinic Notes Project ECHO Recommended regimen Lab Values Chem 14, CBC, anemia panel, Vit D, AFT, HIV, Hep A & B, pregnancy Viral load and genotype Fibrosis Score: APRI, FIB4, Fibrotest Abstinence requirements Urine drug screens and/or clinical notes Compliance

27 Patient Assistance Program Gilead s Support Path Harvoni, Epclusa iassist: AbbVie Patient Assistance Foundation Mavyret

28 Patient Assistance Programs Tribal ID card Income documents Max income allowed differs by program Proof of no insurance American Indians/Alaska Natives (AI/AN): Indian Health Coverage Exemption American Indians and Alaska Natives (AI/ANs) and other people eligible for services through the Indian Health Service, tribal programs, or urban Indian programs (like the spouse or child of an eligible Indian) don't have to pay the fee for not having health coverage. This is called having an Indian health coverage exemption.

29 Time Investment and Workload (Minutes) 30 Initial Visit 30 ECHO 30 Prior Authorization 60 Treatment 30 Counseling

30 Current Status Pending 8 3 Project Echo Medication Approval Pending 3 8 Treatment ETR 4 2 SVR cure

31 Patients Enrolled in Clinic AGE DISTRIBUTION Baby Boomers 36% Non-Baby Boomers 64%

32 43.0% 41.0% HCV Screening Rate 42.1% 39.0% 37.0% 36.2% 35.0% 33.0% 31.0% 29.0% 27.0% 27.3% 25.3% 25.0% 5/31/2017 6/30/2017 7/31/2017 8/31/2017 9/30/ /31/ /30/2017

33 HCV Screening Rate

34 Cost Analysis: Cumulative $1,200,000 $1,000,000 $203,112 $800,000 $363,240 $600,000 $1,123,776 IHS Source Medicaid/Exp $400,000 PAP $200,000 $557,424 $62,421 $172,467 $110,046 $0 Total Retail Value Cost of Meds to Clinic POS Revenue Total Return

35 Next Steps Leading efforts in the Great Plains, Bemidji and Billings Areas Sharing experiences and resources with other service units

36 Next Steps Behavioral Health Emergency Room Dental POC Testing (>14 years) Public Health Clinic Pharmacy

37 Success Story ND Medicaid and Expansion Drop minimum fibrosure score requirements 12-months abstinence requirements remains No NS5A resistance test required unless prescribing Zepatier

38 Medicaid Letter Balancing Act STATE CLINIC

39 Hepatitis Listserv Share info via text HCV to Create a NICE Project Listserv to continuously improve and grow resources Create a MAX.gov to share resources

40 Patient s Story First patient enrolled in HCV clinic summer of 2017, achieved SVR mid-november I have been waiting for this for so long. I know I have made some mistakes in the past, but I had started to turn my life around. I am very thankful to them for not being judgmental and for treating me with respect. I am finally able to start a family. God bless you! - First patient to attain SVR in HCV clinic

41 Recorded Webinars How to create an icare panel How to create a quick order menu for required labs How to use the NICE patient management tool Hepatitis C clinic workflow Medicaid Letter, appointment cards

42 Special Thanks Jessica Leston, HCV/HIV/STI Clinical Programs Director for the Northwest Portland Area Indian Health Board Brigg Reilley, National HIV/AIDS Program David Stephens, BSN, RN, Case Manager for the Northwest Portland Area Indian Health Board.

43 Questions

44 Thank you Contact Info: Ext 8426