Keywords: Hepatitis C, Incentives
A financial incentive program to improve appointment attendance at a safety-net hospital-based primary care HCV treatment program.
Kristen Lee MD
Meg Krasne MPH
Boston Medical Center, Boston MA
The BMC Primary Care HCV Treatment Program was established in 2015 in an effort to address the specific needs of HCV patients so that they can receive timely treatment and support
The program consists of the following:
-13 primary care HCV providers (physicians, nurse practitioners, and residents, 4 of whom see the majority of the patients) internally trained to treat HCV. This training includes completion of online modules provided by the American Association for the Study of Liver Disease or by University of Washington and shadowing a HCV specialist for 1 clinic session.
-A social worker: follows patients longitudinally and addresses patients’ psychosocial issues by providing education and counseling for HCV, exploring barriers to successful completion of treatment (housing, transportation issues, food insecurity), and connecting patients to behavioral health or addiction specialists if needed
-A clinical pharmacist: provides medication teaching to patients and safety monitoring while on treatment
-A pharmacy liaison: works to obtain prior authorization for HCV medication.
Project Research & Planning
Daily Workflow Steps
The typical hepatitis C clinic workflow:
The financial incentive pilot workflow:
The key outcome was clinic attendance rate (# appointments attended/total # appointments schedules) for HCV provider visits in the BMC Primary Care HCV Treatment Program.
98 patients were scheduled for visits during this intervention.
Data analysis showed that patient attendance increased from 61% in April-June 2016 to 73% in April-June 2017 with the incentive, (78% if only counting patients informed of the incentive by the social worker in the analysis).
Mass Health: a health insurance program for Massachusetts residents that are eligible for Medicaid and Childrens Health Insurance Program (CHIP).
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