Focus on Hepatitis C: Health Centers Work to Address the Chronic Disease

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 second post on HCV we highlight the importance of patient and community relationships in providing care.

Dr. Mary Angerame, MS APRN-BC, Nurse Practitioner and Head of Hepatitis C Treatment Program at Jordan Health's Anthony L. Jordan Health Center

Dr. Mary Angerame, MS APRN-BC, Nurse Practitioner and Head of Hepatitis C Treatment Program at Jordan Health’s Anthony L. Jordan Health Center

Mary Angerame, MS APRN-BC is a nurse practitioner and head of the Hepatitis C Treatment Program at Jordan Health’s Anthony L. Jordan Health Center in Rochester, New York.  Like Caroline Teter from part one of the HCV series, she has hope and is optimistic that new treatment options will increase the number of patients with chronic HCV who are cured, will decrease the pool of virus in the community, and will lead to an eradication of HCV in 10 years.  And like Teter, Mary agrees that “it’s all in the relationships”. A key member of the center’s HCV team is a patient she treated for HCV—twice.  Now cured and able to draw on his own experiences this team member says it his calling to talk with patients, with the community, and with the staff about HCV.

As Angerame points out, “when you work with patients and provide care that is truly patient centered, you not only see them cured, you also see them move forward in their lives in other ways.”  Like the homeless patient who regularly attended the center’s peer support group for patients diagnosed with HCV.  Today he is cured and starting college.

To address the complex array of issues associated with diagnosis and treatment, the center’s HCV program provides ongoing counseling, mental health services, chemical dependency services, care coordination, healthcare planning, family services, and support groups. When patients clear the virus, there is celebrating and many happy tears.  For some patients, says Mary Angerame, completing treatment may be the first success they have ever experienced.

Relationships at the community level are important, too.  The health center provides services at three public housing locations.  When the food truck is on site with fresh fruits and vegetables, the center’s HCV program team is on site, too, to provide free HCV screening to both residents and other community members. Free screening is also offered at community health fairs.  When offered alongside screenings for hypertension, diabetes, and cholesterol, most patients say yes to an HCV screening test.  And if patients decline or are not sure they need to be tested, Mary Angerame and her team remind them that early detection for HCV is in line with early detection for breast cancer, heart disease and everything else.  Knowing is power.

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

Digital Do-Gooders in the Health Center World

Our hat is off to Central Florida’s Community Health Centers, Inc. (CHC). They were named the 2014 HIMSS (which stands for Healthcare Information and Management Systems Society) Community Health Organization Davies Award of Excellence winner. Since 1994, the Nicholas E. Davies Award has recognized excellence in the use of health information technology (HIT), specifically the use of electronic health records (EHR) to successfully improve the healthcare delivery processes and patient safety while achieving a demonstrated return on investment.

Community Health Center Winter Garden Grand Opening by Photographer Jessie Dee-0814As the recipient of the Davies Community Health Organization Award, CHC has demonstrated that their use of electronic health records and HIT has resulted in a significant, sustainable improvement of patient outcomes and a return on their investment.  This is quite an accomplishment, given that many health centers have a difficult time maintaining their EHR systems and training staff how to use it.

Nevertheless, a majority of health centers have achieved high functionality with the EHR systems. According to this NACHC Fact Sheet, between 2009 and 2013, the adoption rate at health centers more than doubled. By 2012, more health centers had installed EHR systems compared with office-based physicians (90% vs. 78%).

Community Health Centers, Inc.,  however, is a “stand out for their commitment to use health information technology to drive quality improvement,” according to Jonathan French, Director of Quality and Patient Safety at HIMSS. “CHC has developed a culture focused on quality improvement, where the EHR is a tool that enables the staff to take action that ultimately results in improved outcomes.”

“CHC is honored to receive the 2014 HIMSS Community Health Organization Davies Award in recognition of our successful application of an electronic health record to improve care outcomes and population health,” said Kim Barkman, Director of Clinical Informatics at Community Health Centers, Inc.

Mark Dickinson, Executive VP/CFO and Interim President/CEO, says that “Community Health Centers is committed to providing high quality, outcome based healthcare to our patients and to the processes necessary in achieving that goal. This award is the culmination of the hard work and dedication of the entire CHC staff toward that goal.”

Community Health Centers, Inc. will be recognized at the 2015 Annual HIMSS Conference & Exhibition, April 12th-16th in Chicago IL.  For more information on applying for the HIMSS Davies Awards of Excellence, visit the HIMSS Davies Award website.

Diabetes Prevention and Treatment

Picture1Every November we mark National Diabetes Awareness Month and are reminded of the toll the disease takes on communities and the healthcare system. Nearly 30 million children and adults in the U.S. have diabetes while another 86 million are at risk of developing the chronic disease. According to the American Diabetes Association, diabetes costs the country $245 billion annually.  It is projected that by 2050 as many as one in three American adults will have diabetes.

Diabetes is a chronic disease that causes high blood sugar levels and, if left untreated, can have a devastating effect. People with diabetes are more at risk of heart disease, stroke, blindness, kidney disease, nerve damage, and premature death. And it doesn’t stop there. A family history of the disease increases the risk for developing it.

The increase in the disease has resulted in many guidelines for managing and preventing diabetes from various organizations over the years. However, in an effort to clarify the many guidelines for diabetes care the National Institutes of Health National Diabetes Education Program (NDEP) has collaborated with more than a dozen professional organizations and federal agencies to publish Guiding Principles for the Care of People With or at Risk for Diabetes. The resource doesn’t create new guidelines, but instead it brings together “areas of agreement for diabetes care that could be clinically useful in diabetes management and prevention.”

“Guiding Principles is the result of a major collaborative effort from a varied group of experts who are committed to improving the care for people with or at risk for diabetes,” said National Institute of Diabetes and Digestive and Kidney Diseases Director Griffin P. Rodgers, M.D. “These principles represent the cornerstone of diabetes management and prevention.” The set of ten principles is now available online and includes:

  • Identifying Undiagnosed Diabetes and Prediabetes
  • Manage Prediabetes
  • Provide Self-Management Education and Support
  • Provide Individualized Nutrition Therapy
  • Encourage Regular Physical Activity
  • Control Blood Glucose
  • Reduce Cardiovascular Disease Risk
  • Detect and Monitor Microvascular Complications
  • Consider Special Populations
  • Provide Patient Centered Care

 

This Week in Healthcare: Open Enrollment Round 2

NEWSCommunity Health Centers Are Ready to Enroll More Uninsured (NACHC)

A NACHC survey revealed that Community Health Centers were ready for the open enrollment period. Nearly ninety-seven percent (97.2%) of respondents said that they felt ready.  When asked to describe how they have prepared for open enrollment, respondents described a range of activities that include training staff, sustained community outreach and health center “in reach” to existing patients.

State Health Insurance Exchanges Hope to Woo Urban Minorities (Kaiser Health News)

Connecticut and California’s exchanges were successful last year but both still lacked reach to young urban minorities so this year they dialing up their efforts to reach them.

People Auto-Enrolling into Federal Marketplace Coverage Could Overpay (CBPP)

In 34 states, people who enrolled into 2014 coverage through the Federally Facilitated Marketplace (FFM) will be automatically re-enrolled in the same plan in 2015 unless they choose a new plan. This report from the Center on Budget and Policy Priorities outlines the key factors that could impact a family’s or individual’s changes in subsidies for health coverage.

Insurance Exchanges Launch with Few Glitches (Kaiser Health News)

Kaiser Health News reported early this week that more than 100,000 Americans signed-up for coverage on Saturday—the first day of open enrollment—through the ACA’s online insurance exchanges. However, they also noted that “the enrollment process continues to face plenty of uncertainties, including the response of a confused and still uninformed public, among them 20 million uninsured who did not enroll the first year; a shorter enrollment period and premium increases that many of the 7 million people who bought coverage last year will face unless they shop around.”

California Enrolls 11,357 in First 4 Days of Obamacare Open Enrollment (Los Angeles Times)

According to the LA Times article, Covered California indicates they are ahead of last year’s enrollment pace. Comparatively, during the first enrollment period it took them 15 days to enroll 11,000 Californians.

What Makes an Obamacare Website Work? Ask Kentucky (USA Today)

While many websites had issues during the first open enrollment period Kentucky’s Kynect site was successful and continues to be. Kentucky says they kept it simple and used technology they familiar to them. “We did not put in a lot of fancy slides or other things,” said Chris Clark, technical program manager for kynect. “We kept ours very simple and straightforward.”

A Quarter of Uninsured Say They Can’t Afford to Buy Coverage (Kaiser Health News)

According to a poll, taken just days before open enrollment, 25 percent of those without coverage expected to remain uninsured due to cost. The poll also noted that 9 in 10 of the uninsured where unsure of when open enrollment began.

Living in Louisiana’s Tragic Healthcare Limbo

Louisiana’s refusal to expand Medicaid is leaving 242,000 of the most vulnerable state residents without healthcare. According to the article researches from a Harvard-CUNY study “found that because of the states’ opting out of the expansion, 7.78 million people who would have gained coverage will remain uninsured, causing up to 17,000 more avoidable deaths because sickly patients get care too late.”

Focus on Hepatitis C: Health Centers Work to Address the Chronic Disease

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.