1. Project INSPIRE: a Comprehensive Care Coordination Program for HCV-Infected Patients
Marie P. Bresnahan, MPH, Mary M. Ford, MS, Payal Desai, MPH, Nicolette Gantt, Fabienne Laraque, MD, MPH
Viral Hepatitis Program, Bureau of Communicable Disease,
New York City Department of Health and Mental Hygiene
Even with new treatments patient navigation is still very important to getting patients with high needs evaluated and treatment. May not have made it into care otherwise.
Multiple services provided to patients…
Taking place in SEPs/community based programs non-traditional settings is still effective
BACKGROUND
Intervention Description
RESULTS
DISCUSSION
INSPIRE was implemented at 12 outpatient clinics, serving high need patients, with a high level of fidelity to the protocol.
Project INSPIRE has enrolled 2,204 (90% of target) participants from the target neighborhoods with the highest rates of HCV in NYC, as of end August 2016.
Care coordinators are successfully supporting participants with complex comorbid conditions and multiple risk histories to engage in and complete treatment
Among the 2,204 participants enrolled by August 30, 2016, most reached key milestones including completing a comprehensive assessment (85%), receiving an HCV medical evaluation (84%) and initiating treatment (73%)
On average, 97% of participants who initiated treatment have received alcohol counseling, health promotion, treatment readiness counseling, and medication coordination. Two-thirds (66%) of participants received their first health promotion session within 15 days.
Project INSPIRE - Innovate & Network to Stop HCV & Prevent complications via Integrating care, Responding to needs, and Engaging patients & providers
New York City (NYC) has an estimated 146,500 Hepatitis C virus (HCV) infected residents and only about 12% are estimated to have been cured. ‎HCV infection is a complex disease that is prevalent in patients with co-morbid conditions such as substance abuse, HIV, and mental illness, which makes a supported setting critical for treatment success. Project INSPIRE, a Round II Healthcare Innovation Award from the Centers for Medicaid and Medicare Services (CMS), was designed by the NYC Health Department to offer comprehensive care coordination and to develop a payment model to sustain care coordination services.
The NYC Health Department is working in partnership with:
Medical Centers: Mount Sinai Medical Center
Montefiore Medical Center
Managed Care Orgs: Healthfirst and VNSNY CHOICE
Evaluator: Weil Cornell Medical Center
The goals of Project INSPIRE are to improve HCV cure rates and patient self-sufficiency through evidence-supported care coordination services.
Figure 1. Participant Flow Chart
A large proportion of those assessed have a mental health condition (45%) and report current or former alcohol use (72%).
Over half of participants assessed report current or former injection (63%) or intranasal drug use (59%).
Note: Total % may not add up to 100 due to % of missing values
*N is of participants who have completed a medical evaluation
Figure 1 displays the components of the pre-treatment, treatment, and post-treatment phases of the program.
The majority of participants enrolled are anticipated to make it through the post-treatment phase.
Activities such as, Care Coordination Plan Review and Health Promotion Module 6 may be repeated for participants if they are unable to successfully reach a treatment phase milestone.
FUTURE EVALUATION ACTIVITIES
Conduct an enhanced patient satisfaction and collaborative practice survey.
Compare clinical outcomes to a control group using NYC surveillance, Medicaid and Medicare data.
Utilize data from cost analysis to develop payment model to sustain care coordination services for HCV care and estimate cost savings.
METHODS
Patient recruitment:
Enroll 3,200 HCV+ Medicaid or Medicare enrollees in NYC between January 2015 – February 2017
Catchment area, Upper Manhattan and the Bronx, neighborhoods with high rates of HCV
Program components:
Comprehensive assessment and care plan
Clinic-based care coordination and peer navigation
Referrals for substance abuse, alcohol services or for other medical comorbidities
Health promotion and medication adherence support
Inter-disciplinary case conferences
Weekly tele-mentoring sessions
Program Evaluation:
Monitoring and analysis of patient-level clinical data
Matching with NYC DOHMH surveillance and CMS claims data
Fidelity analysis and patient survey
Data Collection Period:
January 2015 – August 2017
Figure 3. Percent of INSPIRE Participants Receiving Key Care Coordination Services, Jan ‘15 – Aug ‘16 (N=975)
Figure 2. INSPIRE Participants, by Race/Ethnicity, Jan ‘15 – Aug ’16 (N=2204)
FUNDING STATEMENT
The project described is supported by Grant Number 1C1CMS from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented was conducted by the awardee. Preliminary findings may or may not be consistent with or confirmed by the findings of the independent evaluation contractor.
Over 95% of participants who completed treatment received an assessment, medical evaluation, alcohol counseling, treatment adherence and treatment readiness.
CONTACT INFORMATION
Marie P. Bresnahan, MPH, Program Director
Viral Hepatitis Program, NYC Department of Health and Mental Hygiene
th Street, 5-75, Queens, NY
(347)
The majority of participants are Hispanic/Latino (48%), followed by Black, Non-Hispanic (35%).