starting an hcv clinic - npaihb€¦ · 04.01.2018 · no ns5a resistance test required unless...
TRANSCRIPT
![Page 1: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/1.jpg)
DISCLOSURES
This activity is jointly provided by Northwest Portland Area Indian Health
Board and Cardea
![Page 2: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/2.jpg)
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 email If you have any questions about this CE activity, contact Michelle Daugherty at [email protected] or (206) 447-9538
![Page 3: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/3.jpg)
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
![Page 4: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/4.jpg)
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.
CONFLICT OF INTEREST
![Page 5: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/5.jpg)
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
![Page 6: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/6.jpg)
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
![Page 7: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/7.jpg)
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
![Page 8: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/8.jpg)
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.
http://www.hepatitiscentral.com/wp-content/uploads/2015/04/expenisive-hepatitis-c-medication.jpg
http://aph.org.ua/wp-content/uploads/2016/08/Bez-nazvanyya-4.png
![Page 9: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/9.jpg)
Who are we?
![Page 10: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/10.jpg)
Prior to HCV Clinic
With Insurance (Pvt./Federal)
Referred to Medical Specialists
$10,000-$15000/referral
Distance
Lost to follow-up
Without Insurance
Very Few Options
Rationing Care
Poor outcomes
![Page 11: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/11.jpg)
Inter-collaborative Approach
Patient
Primary Care
Provider
Pharmacist
Laboratory Services
Benefits Coordinator
Behavioral Health
Public Health
![Page 12: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/12.jpg)
Identifying Patients with Hepatitis C
iCare
168 patients • 25% screening rate
VGEN
155 patients
![Page 13: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/13.jpg)
EHR Documentation
Referral
Consult from PCP
Walk in
Initial Visit
PHQ-9
AUDIT-C
Education
Labs
Immunizations
Comprehensive
visit
Project ECHO
Start Medication
Authorization
Treatment
Counseling
Labs
Immunizations
End of Treatment
Labs
SVR
Patient is cured!
Counsel about re-infection
and prevention
![Page 14: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/14.jpg)
Consult Template
![Page 15: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/15.jpg)
EHR Note Templates
![Page 16: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/16.jpg)
EHR Note Templates
![Page 17: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/17.jpg)
Hepatitis C Labs Order Menu
![Page 18: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/18.jpg)
Hepatitis C Labs Order Set
![Page 19: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/19.jpg)
Patient Management Tools
iCare Panel
Consults
Excel Panel List
NICE Hep C Tool
![Page 20: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/20.jpg)
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
Hepati
tis
C P
ati
ent
Panel Lis
t
![Page 21: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/21.jpg)
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
Hepati
tis
C P
ati
ent
Panel Lis
t
![Page 22: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/22.jpg)
Managing Patients
Snapshot of stage in treatment process
drop down menus (these can be adjusted)
![Page 23: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/23.jpg)
Patient Panel
![Page 24: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/24.jpg)
Individual Patient Data
![Page 25: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/25.jpg)
Appointment Calendar
![Page 26: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/26.jpg)
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
![Page 27: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/27.jpg)
Patient Assistance Program
Gilead’s Support Path
• Harvoni®, Epclusa®
• iAssist: https://www.assistrx.com/iassist/
AbbVie Patient Assistance Foundation
•Mavyret®
![Page 28: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/28.jpg)
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.”
![Page 29: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/29.jpg)
Time Investment and Workload (Minutes)
30 • Initial Visit
30 •ECHO
30 •Prior Authorization
60 •Treatment
30 •Counseling
![Page 30: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/30.jpg)
Current Status
• Pending
8
• Project Echo
3 • Medication
Approval Pending
3
• Treatment
8
• ETR
4
• SVR “cure”
2
8 11 14 22 26 28
![Page 31: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/31.jpg)
Patients Enrolled in Clinic
Baby Boomers
36%
Non-Baby Boomers
64%
AGE DISTRIBUTION
![Page 32: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/32.jpg)
HCV Screening Rate
25.3%
27.3%
36.2%
42.1%
25.0%
27.0%
29.0%
31.0%
33.0%
35.0%
37.0%
39.0%
41.0%
43.0%
5/31/2017 6/30/2017 7/31/2017 8/31/2017 9/30/2017 10/31/2017 11/30/2017
![Page 33: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/33.jpg)
HCV Screening Rate
![Page 34: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/34.jpg)
Cost Analysis: Cumulative
$557,424
$363,240
$203,112
$62,421
$172,467 $110,046
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000
Total RetailValue
Cost of Meds toClinic
POS Revenue Total Return
IHS Source
Medicaid/Exp
PAP
$1,123,776
![Page 35: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/35.jpg)
Next Steps
Leading efforts in the Great Plains, Bemidji and
Billings Areas
Sharing experiences and resources with other service
units
![Page 36: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/36.jpg)
Next Steps
POC Testing (>14 years)
Behavioral Health
Public Health
Clinic
Pharmacy
Dental
Emergency Room
![Page 37: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/37.jpg)
Success Story
Drop minimum fibrosure
score requirements
No NS5A resistance test required
unless prescribing Zepatier®
12-months abstinence
requirements remains
ND Medicaid and Expansion
![Page 38: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/38.jpg)
Medicaid Letter – Balancing Act
STATE
CLINIC
![Page 39: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/39.jpg)
Hepatitis Listserv
Share info via text HCV
to 97779
Create a NICE Project Listserv to
continuously improve and
grow resources
Create a MAX.gov to
share resources
![Page 40: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/40.jpg)
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
![Page 41: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/41.jpg)
Recorded Webinars
http://www.npaihb.org/hcv/#clinical-resources
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
![Page 42: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/42.jpg)
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.
![Page 43: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/43.jpg)
Questions
![Page 44: Starting an HCV Clinic - NPAIHB€¦ · 04.01.2018 · No NS5A resistance test required unless prescribing Zepatier® 12-months abstinence requirements remains ND Medicaid and Expansion](https://reader036.vdocuments.mx/reader036/viewer/2022070113/605ec86599556b619d1d7fd0/html5/thumbnails/44.jpg)
Thank you
Contact Info:
701-477-6111 Ext 8426