Treating Members with Hepatitis C in Arizona

By Kelly Munson

May is Hepatitis Awareness Month, providing 31 days to raise awareness of viral hepatitis, a silent epidemic affecting more than five million people in the United States.

According to the Centers for Disease Control and Prevention (CDC), hepatitis is most often caused by several viruses and, when untreated, can develop into a dangerous, chronic condition. In fact, more than half of the hepatitis population (60 percent) develop chronic hepatitis C, a lifelong infection that can lead to liver damage, cirrhosis, liver cancer and even death. It is disproportionately prevalent among those on Medicaid, with estimates of anywhere from 700,000 to 1 million Medicaid patients infected. This problem is particularly acute in Arizona, where approximately 90,000 individuals are living with hepatitis C, making it one of the state’s most commonly reported infectious diseases.

Barriers to Treating Hepatitis C

Treatment for hepatitis C has historically been very expensive and long – often taking up to 48 weeks to treat – with severe side effects and only a 50 percent cure rate. Today, with the advent of new antivirals, treatment averages just 12 weeks with no side effects and a 95 percent cure rate.

Treating hepatitis C, however, is highly dependent on the patient’s compliance with the treatment protocol, which oftentimes is a challenge for many individuals of lower socio-economic backgrounds. When lack of access to housing, food and transportation are patients’ main priorities, it’s understandably challenging to maintain a successful treatment regimen.

On the other side of the equation, physicians across all health plans typically have been reimbursed for services, not results. What this means is they haven’t been incentivized to treat the “whole patient,” including their medical and social needs, which are both critical factors when dealing with hepatitis C.

To address challenges on both the patient’s and the physician’s side, WellCare, through Care1st Health Plan Arizona, is offering a new program for treating those on Medicaid and living with hepatitis C.

Care1st Health Plan Arizona and Maricopa Integrated Health System (MIHS) Launch Hepatitis C Center for Excellence Program

Care1st Health Plan Arizona and MIHS have joined forces to bring Arizona members the Hepatitis C Center for Excellence program to treat the infectious liver disease under a unique value-based bundled payment arrangement. Experts at Harvard estimate this is the first time a Medicaid plan in the U.S. has offered bundled payments as part of a value-based agreement for hepatitis C treatment.

Bundled payments, in the case of hepatitis C treatment, mean that doctors’ success is dependent on a cure. As a result, it is up to that physician to find the right mix of medical and social support to help each patient. Additionally, the doctor can make his/her own decisions on where the patient goes for diagnostics – from blood work to ultrasounds – and keep a more watchful eye on that patient, ultimately leading to better compliance.

The collaborative partnership will evaluate and treat 100 members with hepatitis C by administering anti-viral medication targeted at the virus.

In addition to medical care, participants will be connected to local social supports, such as food, housing and transportation assistance.

Bundled Payments to Help Drive Quality Outcomes

According to a recent survey from Becker’s ASC Review, more than 80 percent of hospitals with experience in bundled payments report improved patient engagement, increased alignment with physicians and a decrease in administrative costs. Additionally, more than half (57 percent) of physicians state they are willing to adopt bundled payments.

During this yearlong initiative, the Care1st Health Plan Arizona and MIHS Hepatitis C Center for Excellence will allow providers to implement groundbreaking and more effective care methods than the current fee-for-service payment model. Furthermore, this collaboration and new value-based contract gives us the ability to treat the disease sooner and eliminate the spread of the disease throughout Arizona.

At WellCare, we are committed to providing quality, holistic care to our members and the communities we serve, especially in connecting vulnerable populations with the resources they need to live happy, healthy lives.

Munson_Kelly.jpg Kelly Munson is the executive vice president of Medicaid at WellCare Health Plans.

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