A Baltimore story: Hepatitis C from epidemic to cure

Hepatitis C is a serious issue that affects more than 900 clients at Health Care for the Homeless in Baltimore. With the advent of new and more effective treatment for Hepatitis C, the opportunity to cure this disease has become a realistic option for people experiencing homelessness. The Centers for Disease Control and Prevention recognizes that increased demand and availability of a cure creates a critical need to expand access to high quality treatment services. Prior to 2015, Maryland Medicaid restricted the dissemination of Hepatitis C treatments to those physicians who specialized in Gastroenterology or Infectious Disease. Baltimore City was chosen as a pilot site, and in coordination with Johns Hopkins University Division of Infectious Diseases, three providers from HCH Baltimore began a training program with other FQHCs around the city using a standardized, evidence-based curriculum. At HCH Baltimore, we recognized that in order to effectively provide quality services for our patients, it was crucial for us to develop a cohesive interdisciplinary care team approach that involves PCPs, nurses, medical assistants, and pharmacists. After establishing our system, we started on-site treatment in May of 2015, and have thus far been able to treat and cure 25 patients within six months, with a goal of treating 100 patients within one year. This seminar will focus on our training, the lessons we have learned through the process of building an effective interdisciplinary system, and our "best practices" to help serve patients and balancing the challenges of rigorous prior authorizations, idiosyncratic insurance hurdles, and assuring patient adherence with nurses, pharmacists, and CMAs. While specific aspects of our Hepatitis C program are site-specific, our screening and care coordination model is applicable to other infectious and chronic disease states. Additionally, our approach to capturing and reporting data related to Hepatitis C is applicable to any health center that initiates a new program. The policy implications of Baltimore's experience are enormous, and range from improved public health to the shifting roles of PCPs to expanding care coordination within an evolving health home.