1. 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

2. Disclosures Advisory Boards: BMS, Gilead Grant Funding: Gilead

3. 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

4. CDC HCV Cascade 29% 84% 93% 70% 96% 89%

5. FOCUS HCV CASCADE

6. 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

7. 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

8. 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

9. 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