This three-part blog series spotlights the great work of three Community Health Centers addressing Hepatitis C. Hepatitis C is a significant public health problem in the United States. Of the approximately 3.2 million people in the US who have chronic hepatitis C (HCV), most do not know they are infected. HCV is more prevalent in patients who are seen in Community Health Centers than HIV. According to the 2013 Uniform Data System (UDS) 145,309 patients had a primary diagnosis of HCV, up from 61,294 in the prior year. Left untreated, chronic HCV can cause significant liver complications, including cirrhosis, cancer and failure. It is the leading reason for liver transplants in the United States. The first blog in this series focuses on the importance of partnerships in addressing the chronic disease.
For Erie Family Health Center in Chicago, Illinois external partnerships have been critical to their ability to care for their patients with chronic HCV. Caroline Teter, PA-C, MPH, a provider and HCV champion at the health center, describes some of these essential partnerships. Through the University of Chicago’s Extension for Community Healthcare Outcomes (ECHO) Program, Erie’s providers receive training on HCV treatment from specialists—without leaving the health center and without any direct cost. Advanced communication technologies are used during bi-weekly calls to deliver education about the latest news in HCV treatment and to discuss the health center’s active patients.
According to Teter, “the ECHO program makes treatment possible by giving providers both skills and confidence.” And, she adds, “there is comfort in knowing that expert consultation is readily available.”
Additional support for providers to screen for and treat HCV comes from the health center’s own electronic medical record (EMR)—thanks to another important partnership. The center collaborated with the International Association of Providers of AIDS Care (IAPAC) and the Alliance of Chicago, a health center controlled network, to develop and implement decision making support tools and templates for HCV screening readiness based on age and risk factors. These tools lead to more patients being screened at the point of care and facilitate tracking and follow up based on test results. Reports pulled from the EMR guide quality improvement activities to improve screening rates. Treatment modules in the EMR, also developed in partnership with IAPAC and the Alliance of Chicago, help providers track and manage the patient’s course of treatment.
Partnerships have also been vital in addressing the high costs associated with HCV screening and treatment. Patients who are uninsured and income qualify receive free lab work through an agreement the center has with an outside laboratory vendor. Erie’s patients receive specialty care at no cost at nearby Northwestern Memorial Hospital and other local hospitals as a result of relationships the center has developed over the years. Walgreens, a 340B provider in Illinois, helps the center complete the paperwork that many public and private insurers require for prior approval for HCV drug therapies. The approval process is a significant struggle—it is burdensome on staffing and a barrier to treatment for patients. Walgreens is able to manage the process electronically, freeing up staff time.
Caroline is hopeful. With partnerships in place and new treatments that are easier for providers to administer, easier for patients to tolerate, and have a higher cure rate than previous treatments, she expects that Erie Family Health Center will be able to positively impact the lives of more patients with chronic HCV. She reminds her health center colleagues that relationships make the job easier.
For more information and resources on HCV, visit http://www.nachc.com/hepatitisc.cfm.