BACKGROUND
HCV is a liver infection caused by a blood borne virus, which can spread through contamination of blood and body fluids. The disease is highly infectious, and most people don’t have any symptoms. HCV can lead to life threatening health conditions and it’s important to treat the virus early before cancer of the liver develops. The diagnosis is done through a blood test. Cost-effective medications are available, and this disease is curable. At the end of treatment, a blood test that detects no virus is known as sustained virological response (SVR) and is used to determine if the virus has cleared.
HCV remains a global concern despite efforts by the World Health Organization (WHO) and numerous healthcare organizations and civil groups. It’s estimated that 71 million people worldwide remain untreated even though treatments are readily available and cost effective. The WHO has issued a target date to eliminate HCV by 2030. New Mexico Department of Health (NMDOH) issued a 2022 publication EndHepC-NM, urging all healthcare organizations and New Mexicans to work together to end the disease by 2030. To help standardize and catalyze treatment decisions, the New Mexico Health and Human Services released a Hepatitis C
Uniform Checklist Form.
CHALLENGE
NM has one of the highest HCV prevalence and death rates in the country. It’s estimated there are over 45,000 New Mexicans who live with the disease, many not knowing they have it. HCV is a notifiable disease, which means healthcare providers must report patient positive test results to NMDOH. NM has many rural areas where people don’t have access to care and these areas have much higher average annual rates.
Often, when patients present to clinics, they can’t remember when and where their last blood work was done and may not have other health information. The clinicians must reorder the labs and patients must make another trip to a lab for a blood draw. Theclinicians wait weeks for the results to get prior authorization for medication. The inability to treat patients quickly and correctly is a hinderance to ending the disease.
Finally, all NM practitioners participating in NM Medicaid (Centennial Care) must manually complete the Uniform HCV checklist to obtain drug prior authorization. The checklist contains valuable information; however, completing it is cumbersome and time consuming due to identifying, aggregating, and aligning the patient’s most recent lab results with the checklist. In addition, these patient checklists are not stored on any centralized healthcare platform that providers can access.
SOLUTION
In August 2021, Syncronys, New Mexico’s Health Information Exchange, engaged RG to help streamline the diagnosis and treatment at the point of care and provide insights on the disease.
The RG team considered three different factors:
• The clinical lab guides most medical decisions. How can RG leverage lab results to provide value and more patient centered care?
• Patients receive care from multiple providers and facilities, and they may change insurance plans. There is little patient longitudinal history because there is no interoperability among providers.
• Effective care coordination relies on real time standardization of healthcare data. What type of data is needed to connect all healthcare providers and payers so there are less patients lost to follow up?
RG created an HCV Summary Tool that summarizes a patient’s HCV prognosis to enable effective clinical decisions and align their status with the Uniform HCV checklist. The HCV Tool resides within the Syncronys platform and gives clinicians the information they need to provide more efficient and informed care. If the patient has HCV, the lab results can be used to streamline screening, diagnosis, and treatment. Calculations necessary to understand the patient’s risk such as the AST to Platelet Ratio Index (APRI) and Fibrosis-4 Index are also available. By logging into the Syncronys portal and searching for a patient, the HCV Tool is displayed with up-to-date information. Clinicians can now make appropriate medical decisions at the point of care, and it eases their
workflow when they aggregate all the patient’s laboratory results necessary for treating HCV.
PRELIMINARY RESULTS
Patient Data
In August 2021, when the HCV Summary Tool went live, there was an initial spike of 11,000 patients that were identified as having HCV. As of February 2022, the number of patients with HCV has leveled off with slight increases from month to month. A single causative factor has not been identified, but it can be anything from change in insurance providers, seasonality or patients not seeking care because of COVID. Patients that achieved SVR from July 2021 to February 2022 have fluctuated anywhere from 54 to 90. Overall, there was a decrease in total patients with HCV, however, this data does not correlate with the number of patients that are achieving SVR. The data is preliminary, RG will need more time and data to analyze and provide insights on patient care.
HCV Summary Tool Usage
The number of clinicians using the HCV Summary Tool for the last twelve months had an overall increase of over 500 percent, starting with 8 clinicians in October 2021 and an overall average of 44 clinicians per month. The number of times these clinicians accessed the tool had exponential growth, from 12 clicks in October 2021 to an average of 192 clicks per month.
CONCLUSION
RG’s patent pending, peer reviewed HCV Summary Tool integrates with labs across the state. The online summary document can integrate with other healthcare providers and provide interoperability between systems. RG is playing a role in eliminating HCV by 2030 by innovatively addressing the disease through targeted intervention.