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. In this third and final post on HCV we highlight the role of telemedicine in helping provide holistic, coordinated care to HCV patients.

Community Health Center, Inc. (CHC) has 13 service delivery sites in Connecticut, but its single Hepatitis C treatment provider could at best see patients at two or three.  How could the organization extend holistic, coordinated HCV care and treatment to all of its patients within its primary care patient centered medical home?  In 2012, CHC became the first health center to replicate the Project ECHO™ (Extension for Community Healthcare Outcomes) model, which was pioneered by the University of New Mexico and has been traditionally implemented by academic institutions.

The CHC HCV ECHO™ program allows primary care providers and teams to gain skills and knowledge to diagnose and treat HCV within their own primary care settings. Using state of the art technology, a multidisciplinary panel of experts with front line clinical expertise hosts virtual sessions for primary care teams that want to incorporate HCV diagnosis and treatment into their daily practice. Regularly scheduled sessions are comprised of brief instruction on a relevant HCV related topic and discussions of actual patient cases. Initially established to prepare CHC’s own primary care providers and teams to manage HCV so that their patients could be cared for in a medical home familiar and comfortable to them, CHC’s HCV ECHO™ is now open to providers from health centers around the country.

An important feature of CHC’s HCV ECHO™ is its emphasis on team-based care. Daren Anderson, MD, VP/Chief Quality Officer at CHC points out that this is particularly important for managing patients with HCV, as many have co-morbid (co-occurring) health conditions, such as addiction and other behavioral health diagnoses that require a team approach.  In fact, says Dr. Anderson, it is the primary care provider and the behavioral health provider who share the responsibility of presenting patient cases during the ECHO™ sessions.  Recommendations from the panel of experts regarding specific patient cases involve various members of the primary care team and emphasize collaboration and integration across the organization.

As primary care providers and teams become skilled in caring for complex, co-morbid patients with HCV, Dr. Anderson stresses that it is critical that the delivery systems that surround them are supportive and not limiting. In tandem with its HCV ECHO™ program, CHC runs a Quality Improvement Coaching ECHO™, which teaches the science of quality improvement and how to engage with and redesign systems of care.  Clinical expertise and an efficient delivery system must go hand in hand.

In addition to HCV, CHC runs ECHO™ programs for Chronic Pain, HIV, and Buprenorphine Management Therapy.  To learn more about these programs, please visit http://quality.chc1.com/ECHO.

For more information and resources on HCV, visit http://www.nachc.com/hepatitisc.cfm.