PROJECT INSPIRE NYC Hep C Taskforce Meeting May 20,

Project INSPIRE NYC – Primary Aim To demonstrate… 1. service delivery model to reduce illness and death from chronic illnesses and their complications 2. payment structure that will reduce costs from chronic illness and their complications …using chronic hepatitis C infection as a case study. Better Care + Better Health = Lower Costs I nnovate and N etwork to S top HCV and P revent complications via I ntegrating care R esponding to needs and E ngaging patients & providers 2

The Mount Sinai Team Project Director: Brooke Wyatt (347) Care Coordinators: Joy Cambe (646) Aaron Vanderhoff (646) Samara Washington (646) Ashley Pichardo (646)

Project INSPIRE NYC – Major Activities Identify, recruit and treat patients: Enroll 3,200 patients  Screen 95% for depression  Complete treatment for 75% of enrollees Achieve cure rate (SVR)  90% for non-cirrhotic  50% of cirrhotic patients Provide comprehensive care: Integrate primary care with behavioral health Use telemedicine to connect primary care with specialists Provide care coordination, navigation, health promotion, and medication adherence support 4

HCV Care Coordination Protocol – Key Components I. Enrollment of Patients II. Comprehensive Intake Assessment III. Care Coordination Plan Care Navigation Health Promotion Sessions Social Services and Other Benefits Medication Adherence Support and Monitoring IV. Monitoring and Review of the Patient via the Care Coordination Plan Chart Reviews Case Conferencing V. Case Closure and End of Program Services 5

HCV Health Promotion Manual – Key Components I. What is Hepatitis C? II. Liver Health III. Hepatitis C treatment and factors to ensure successful treatment IV. Harm Reduction and Substance Abuse V. Healthy Living with Liver Disease VI. Review VII. Health Maintenance and Avoiding Reinfection 6

Care Coordination ●Multidisciplinary Team ●Holistic approach to health care and HCV treatment ○Health Promotion ○Referrals to Social and Supportive Services ○Accompaniment ○Entitlements and Benefit Services ●Care Coordinator assisting with all aspects of care ○Prior Authorization Process and Appeals ○Pre and Post- Treatment Health Education ○Adherence Counseling

Cascade of HCV Care (Nationwide)

Project INSPIRE - Mount Sinai

10 Project INSPIRE - Liver Specialties

Care Coordination Services - LS 11 Initiating Treatment: 4 (7%) On treatment: 16 (27%) Pre-treatment: 39 (66%)

Rewarding Patient Interactions Improved Patient interactions in the clinic setting 100% success rate with medication appeals Patients feel invested in and apart of their care team Substantial increase in the number of support group attendees. 12 We’re improving daily… Hired an additional 2 coordinators since February Provide CC services for Spanish speaking clients beginning June 8 th Centralized space in June with live data entry in the clinics Monthly Reporting and quarterly data analysis to investigate change in outcomes

Montefiore and Mount Sinai Project INSPIRE Tele-Education and Evaluation Weekly tele-education webinars by experts Primary care providers HCV related topics Case discussions Join us every Tuesday from 4:30 – 5:30pm.

To refer patients to Project INSPIRE Mount Sinai Faculty Practice Associates 5 East 98th Street, 11th Floor New York, NY Telephone: Internal Medicine Associates 17 East 102nd Street, 7th Flr New York, NY Telephone: Medicaid, Medicare, and Managed Care Plans are accepted. Medical Specialty Services Center for Advanced Medicine (CAM) 17 East 102nd Street, 4th Flr A&B New York, NY Telephone: A referral from a current provider (MD, DO, clinical psychologist, nurse practitioner, nurse, or social worker) can be ed to: Project Director: Brooke Wyatt Phone: HCV (4428) Or make an appointment at one of our clinics: