Challenges to Hepatitis C Virus (HCV) Care via Telemedicine for Individuals on Opiate Agonist Therapy

Transcription

1 Challenges to Hepatitis C Virus (HCV) Care via Telemedicine for Individuals on Opiate Agonist Therapy Andrew Talal, MD, MPH 1 Marija Zeremski, PhD 2 Roberto Zavala, MD 3 Rositsa Dimova, PhD 1 Melissa Lin, MS 3 Steven Kritz, MD 3 Anthony Martinez, MD 1 1 University at Buffalo, Buffalo, NY; 2 Weill Cornell Medical College, New York, NY; 3 START Treatment and Recovery Centers, Brooklyn NY

2 Challenges to Establish Telemedicinebased HCV Care in Substance Users Acceptance of telemedicine-based HCV treatment approaches by A minority population of substance users. Opiate substitution treatment program (OSTP) staff. Establishment of telehealth infrastructure in the OSTP. Provision of new HCV medications (currently severely restricted due to high cost) for delivery in the OSTP. Co-administration of methadone and HCV medications Reimbursement of telemedicine-based HCV clinic visits by third party payers. Establish billing infrastructure for dissemination of payments to both hub and spoke sites.

3 Substance users: Core of HCV Epidemic Majority of HCV infections occur among substance users. Linkage to HCV care remains low since their referral offsite is largely ineffective. Recent advances in HCV treatment have dramatically improved efficacy. Objective: To create financially-sustainable, telemedicine-based approach to HCV care. Establish telemedicine-based HCV care in an OSTP where onsite primary and HIV care exist and an electronic health record (EHR).

4 Telemedicine Network Hub: SUNY Buffalo Spoke: START Treatment & Recovery Centers START: 7 clinics, ~3000 patients, 90% African- American & Hispanic, 36% women, 18% HIV+ Currently - One clinic, ~500 patients, 46% HCV+

5 HCV RNA + Entry Patient survey Onsite patient education Study flow HCV meds ordered Specialty pharmacy HCV meds delivered & dispensed Assessment of treatment eligibility

6 Telehealth Interaction Telemedicine Consultation START EHR Onsite physicianextender Facilitates patient interactions Physical examination required for medical billing Remote EHR access Real-time result review and physician documentation Presentation of results to patient during appt

7 Patient Survey and Onsite Education Of 320 patients surveyed, majority (78%) willing to pursue HCV education and treatment 1 Respondents demonstrated substantial HCVrelated knowledge. Attendance at HCV educational activities improved HCV-related knowledge. Knowledgeable patients were more likely to accept HCV treatment. 1 Zeremski, Dimova, Talal: Journal of Addiction Medicine 2014; 8:

8 OSTP Patient Telemedicine Experience Telemedicine-based HCV treatment eligibility assessed in 25 patients HCV medications delivered to OSTP OSTP patients reactions Prefer one stop shopping and co-located medical care Value access to START provider and specialist simultaneously. No concerns about loss of privacy/confidentiality or conspiracy theory vocalized.

9 Reimbursement and billing Medicaid-managed care plans have embraced concept of reimbursement for telemedicine-based services. Billing procedures Physician-extender and physician complete note in EHR Bill submitted electronically by the hub site Payment directly from payer to hub site Funds subsequently disbursed to the spoke site Third party payer interest in telemedicine-based approaches for substance users Adherence to treatment regimen and clinic visits Assessment of substance user s satisfaction with telemedicine-based medical evaluations.

10 Conclusions Telemedicine-based approaches can engage hard-toreach populations such as minority substance users. Novel application of telemedicine for delivery of HCV care to OSTP patients. Telemedicine-based treatment approaches Appear to be embraced by substance users Lead to initiation of HCV therapy Third-party payers pay! Telemedicine-based HCV care could be catalyst for OSTPs becoming medical homes for conditions requiring specialty care.