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 – 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 – 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 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 Patient Care Engagement Payers Insurance Industry Pharma Testing companies Specialty Pharmacies Educators Local Govt HAHSTA navigators National Org Patient education Community education Peer/Pt Navigation Patient- centered Snowball recruitment Medical Home Chronic Care Coordination EHR Automated systems Care Org Downstream revenue Decreased admissions

Generalize Successes & Failures Disseminate information whenever possible – 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