Finding new ways to address hepatitis C
Posted: April 22, 2019 | Word Count: 561
According to the Centers for Disease Control and Prevention, viral hepatitis is a silent epidemic that affects more than 5 million people in the United States. Additionally, more than half of those living with hepatitis do not know they have the virus, putting them at risk for life-threatening liver disease and cancer and, potentially and unknowingly, transmitting the virus to others.
The hepatitis virus comes in five types, including A, B, C, D and E, all of which attack the liver. According to the World Health Organization, more than half of the hepatitis population (60 percent) in the U.S. develops chronic hepatitis C, a lifelong infection which can lead to liver damage, cirrhosis, liver cancer and even death. Hepatitis C disproportionately affects those on Medicaid, with the Pew Charitable Trusts estimating anywhere from 700,000 to 1 million Medicaid patients are infected with the virus.
“New medications for the treatment of hepatitis C are 95 percent effective, but their success is highly dependent on the patient’s compliance with the treatment protocol, which can be a challenge for our nation’s most vulnerable populations,” said Kelly Munson, executive vice president, Medicaid, WellCare Health Plans, Inc. “Physicians need to treat the whole patient, which includes not only their clinical needs, but also their social needs.”
To examine a new model of treating hepatitis C — while acknowledging that social and cultural elements are critical factors in treatment — WellCare, through Care1st Health Plan Arizona and in partnership with Maricopa Integrated Health System (MIHS), has launched the Hepatitis C Center of Excellence Program. The program will treat Medicaid members in Arizona with hepatitis C and is estimated to be the first Medicaid plan in the United States to offer bundled payments as part of a value-based agreement for the infectious liver disease. Bundled payments are a departure from the traditional fee-for-service model, as they provide a lump sum to the treating physician, allowing that doctor to customize a treatment protocol that fits the needs of each patient.
All patients enrolled in the program will have access to case managers, as well as WellCare’s Community Connections Help Line, to tap into local social support resources.
According to WellCare, there are three critical factors of bundled payments that are particularly beneficial for the treatment for hepatitis C in the Medicaid population:
- Success is dependent on a cure. Due to new medicines for hepatitis C, doctors can achieve a cure for most patients who comply with the treatment protocol. As such, bundled payments mean that a doctor can find the right mix of medical and social support to lead each patient to the most successful outcome, without concern about reimbursements.
- Bundled payments create efficiencies. Within a bundled payment system, the doctor can refer to testing — everything from blood work and ultrasounds — at a facility most convenient for the patient. For those with limited access to transportation, accessibility to appointments is a critical factor in compliance.
- Go beyond healthcare. It’s difficult to prioritize hepatitis C treatment when you have other social challenges, like housing, food and transportation. Under a bundled arrangement, doctors are incentivized to connect patients with social supports to achieve the best outcomes.
If you are in need of assistance, call WellCare’s Community Connections Help Line at 1-866-775-2192, where someone is available from 9 a.m. to 6 p.m. (local time) Monday-Friday.