Transcript Beyond the Walls of the Clinic: The Importance of Collaboration with

Beyond the Walls of the Clinic:
The Importance of Collaboration with
Community Organizations to Address Viral
Hepatitis
Dawn Fishbein, MD, MS
Scientific Director, Viral Hepatitis Research
MedStar Health Research Institute
November 16, 2015
Disclosures
• Advisory Boards: BMS, Gilead
• Grant Funding: Gilead
Barriers to Hepatitis C TLC
• Specific special population: HCV
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Urban, African Americans, Men, multiple co-morbidities
Large regional healthcare system
Under-insured; prior injection drug users, current non-sobriety
Baby boomers & aging population
• Testing
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CDC – 25% tested
EHR – change to new outpatient system; type of prompting
Continued Education – teaching system
ED – not testing only Primary Care
• Linkage to Care
– Primary care providers want to still refer to specialists
– Getting patients back into care
CDC HCV Cascade
29%
84%
93%
70%
96%
89%
FOCUS HCV CASCADE
Lessons Learned & Overcoming Barriers
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Grant funding: $$ speaks
Senior management buy-in: need data
Patience and steadfastness
Data Dissemination
Involvement in technology changes
Patient empowerment
– Broadening circles
– Demanding testing, linkage and treatment
• Redefine Cascade of Care and strive to flatten
Operationalizing TLC Large System
• Do not wait for perfection – get started
– Both CDC and MedStar-wide testing
– Generate Data!
• Identify like-minded collaborators
– PCP for EHR was crucial; EHR consultant
– Data Reporting
• Identify available resources
– Pharmacy – 340B pricing
– Specialty Pharmacy navigation
– Education materials
Potential Sources of Navigation
Payers
• Insurance
Care Org
• Downstream
revenue
• Decreased
admissions
Industry
• Pharma
• Testing
companies
EHR
• Automated
systems
Specialty
Pharmacies
• Educators
Patient Care
Engagement
Medical Home
• Chronic Care
Coordination
Local Govt
• HAHSTA
navigators
Peer/Pt
Navigation
• Patientcentered
• Snowball
recruitment
National Org
• Patient
education
• Community
education
Generalize Successes & Failures
• Disseminate information whenever possible
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Especially to Senior Leadership, Providers & Patients
NVHR EHR Working Group
Involve patients
Share ideas
• Become Physician Advocates
– Alliance for Patient Access
• Pair with Advocacy organizations
– HCV Access Google group
• Lobby congress