Doctor in lab coat smiling holding clipboard

“Care1st Health Plan Arizona started this program to address two complementary issues: the prevalence of hepatitis C in Arizona, particularly among vulnerable populations, and the shortcomings of the existing fee-for-service model in treating this population,”

Arizona ranks among the lower half of states when it comes to hepatitis C.

Approximately 90,000 individuals are living with hepatitis C in Arizona, making it one of the state’s most commonly reported infectious diseases.

So, Care1st Health Plan Arizona signed an agreement with Maricopa Integrated Health System (MIHS) to launch the Hepatitis C Center of Excellence program, which will treat Medicaid members in Maricopa County.

Through the partnership, Care1st Health Plan Arizona will collaborate with MIHS hepatologists at Maricopa Medical Center to evaluate and treat 100 members by administering antiviral medication targeted at the hepatitis C virus. The medication, which is taken daily for approximately 12 weeks, is covered by Care1st Health Plan Arizona and is available to Medicaid members at no cost.

“Care1st Health Plan Arizona started this program to address two complementary issues: the prevalence of hepatitis C in Arizona, particularly among vulnerable populations, and the shortcomings of the existing fee-for-service model in treating this population,” Chief Medical Officer Dr. Satya Sarma said.

“That’s why Care1st Health Plan Arizona’s bundled payment model used as part of our Hepatitis C Center of Excellence is exciting, because it creates an opportunity for providers that doesn’t exist in fee-for-service models. Instead of focusing on the volume of revenue-generating services they render, providers can innovate their clinical workflow, flexing to the needs of their patient.

“At the same time, the provider is accountable for delivering quality outcomes for their patients, because the full bundled payment is dependent on achieving a cure as demonstrated by eradication of the virus.”

Participating members will also work with MIHS navigators and community health workers to ensure program compliance and to help connect them to needed social and human services such as food, housing, transportation and more.

Under the value-based contract, participating MIHS providers receive bundled payments to help drive quality health outcomes. Bundled payments are identified as one of the more advanced levels of compensation in value-based contract payment structures under the Centers for Medicare and Medicaid Services’ (CMS) Learning Action Network (LAN). These payments help contain costs and promote better health outcomes while allowing for innovation at the clinical practice level.

“There is now a cure for hepatitis C; however, it is an expensive treatment, and the cost of treatment failure is high. Creating efficiencies in provider workflow, so as to address all elements impacting adherence to treatment, is important,” Sarma said.

“Social determinants of health such as food, housing and transportation, which can impact a patient’s ability to adhere to treatment, are not routinely addressed in provider settings today. Therefore, we needed a payment model that allows physicians flexibility in how they treat patients while driving efficiency.”

The partnership between Care1st Health Plan and MISH came from physicians who discussed the issues and gave clinical expertise to input their ideas for the plan.

“This medication will be taken daily for approximately 8-12 weeks, and there is follow-up after the medication course is completed to ensure the medication has been taken and that the treatment was successful,” Sarma said.

“The patients will continue to be followed at our Hepatitis C Center of Excellence, and we expect to evaluate our results at the end of the one-year program period in order to assess whether to continue and/or expand the program.”

By providing services like food, housing and transportation, Care1st and MIHS are assisting Medicaid members in Maricopa County to have a better chance of complying with and benefiting from their treatment.

“Overall, our goal is to offer our members living with hepatitis C in Arizona access to higher quality care all while finding greater efficiencies in the system,” Sarma said.

“By offering a holistic approach that addresses social and economic barriers to care and challenges with medication adherence, all while providing an innovative payment model that encourages and incentivizes physicians, we hope to help our members achieve better health outcomes and overall wellbeing.”