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Let's look at the hepatitis C rate within the entire state of Arizona. And if you were to look in there, it would be bright red. In my county,

so, okay, what's going on? . We're in a rural community. There's multiple other factors, social economic factors. so we have a lot of things working against us and who's focusing on this?

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Hello, everyone. I am Carla Arzola, and I am the CIO of Rocky Mountain Human Services, and welcome to one more episode of This Week Health. Today's guest is Linda Williams. Linda is an ambulatory clinical manager at Kingman Regional Medical Center, and we will be talking about a program that the organization put into Place and she's leading that focuses on addressing hepatitis C in her community.

So Linda, welcome. How you doing today? Very good. Awesome. Well, thank you. Thank you for joining us. Why don't we start with a quick intro? Why don't you tell us about yourself, tell us about the organization and tell us what's your role.

Absolutely. So I've been at care MC Kingman regional medical center for over 10 years.

Can't believe it. Time flies by my background, completing my doctor of pharmacy at the university of Michigan. I did a residency in ambulatory care pharmacy, which focuses on chronic diseases, preventative care. And during my time here, I've been able to participate in creating our disease management clinic, which I'll talk about a little bit more later.

And really, as we focus on KRMC, understanding the type of population, the community that we're in, and in understanding that really knowing what barriers we face and how we want to be able to provide answers to those issues. We are the only remaining nonprofit within our county. Something I like to say is that the area that we have to cover is huge.

It's over 10, 000 square miles. And if we think about that, that means we have to take care of patients in an area that is bigger than 9 other states. In the entire US. So, yeah, imagine that as well as we're the largest employer in our county, right? And we're rural. We're considered medically underserved, healthcare professional shortage area.

Our closest airport is two hours away. How are you going to get? Care to the patients out here in such a large space, but in a rural community but that doesn't mean we're a tiny small hospital. We're an health institution that has a main hospital of over 230 beds. We have multiple outpatient clinics service lines.

We have a community benefit program that helps out in multiple ways supporting local community organizations. So there's a lot of things going on. That's why I like being here because. There's such a giant need. If I don't step up, if our hospital, our institution does not sell, who's going to take care of our patients.

There are very little resources that we can rely on in our community.

And that's a great point because that's going to it's a perfect segue to our conversation. Right? The program that you're leading and that you put in place is specifically because you're in a remote location. Taking care of patients that they don't have the accessibility to go anywhere else or somewhere that is closed.

And so why don't we talk about that? Why hepatitis C? How did you decide to go with that specific program?

One zero. Hepatologists in our county. None crazy, right? So if there is someone with any type of liver disease, there's no specialist located. Physically within our county and the next just looking at okay population health.

What is going on? And there's a stark map if I could show you and it's by color and you've probably seen them. Let's look at the hepatitis C rate within the entire state of Arizona. And if you were to look in there, it would be bright red. In my county, and it's not just within the state we are one of the top counties in the entire United States regarding our high prevalence of hepatitis C.

So, okay, what's going on? Why do we have such a high prevalence of hepatitis C? There's probably not many people treating it. We have no liver specialists here. We're in a rural community. There's multiple other factors, social economic factors. The number of care providers IV drug use, opioid abuse, so we have a lot of things working against us and who's focusing on this?

That was really that key piece of not anyone there weren't many people that we were identifying that truly had a hepatitis C program or program focusing on this disease of the liver. And is it complicated? No, it is not complicated. Here we are. Our specialists are in another place. Our primary care providers are just completely overwhelmed by the sheer number of patients that need care compared to the number of providers here.

What's going on with this prevalence? If it is high, why isn't it going down when there's a cure? There's a easy oral medication you're taking once a day that you only need to take for two to three months, limited side effects, and after that, you're cured. What's going on? So we wanted to make sure that as we look at how we fill the gaps and really utilizing pharmacists as a underutilized profession in the care team, underutilized underutilized member of the healthcare team, how can we create something within the confines of.

The law, the confines of scope of practice. And that's what happened. We were able to put together a very novel model of our hepatitis C program. That was a mixture of the success of our disease management clinic, which is a pharmacist run clinic focusing on providing chronic disease management. Under a collaborative practice agreement, which is specific to the state of Arizona, but that doesn't mean the other states in the U.S do not have something similar. So within the state of Arizona, we're able to use this law to really have pharmacists be a provider extender By having that and being the bridge between overwhelmed primary care providers who are here, as well as utilizing a virtual model to incorporate a hepatologist, our wonderful Dr.

Richard Manch he's a liver foundation lifetime awardee, achievement awardee uh, really move forward the care in Arizona regarding hep C. He actually practiced in our community and he realized the need here. And when we asked him, Hey, what do you think about being our hepatitis C program medical director?

He was like, yes, absolutely. You know, He didn't even hesitate to think about it because of the need here.

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That's fantastic. And one of the things that we talked about before and when, when we had an opportunity to have conversation, you mentioned, this is a Pharmacy, the pharmacist in charge of the program, not necessarily providers, which I believe it's a huge undertake for you guys.

But it also speaks volumes about the fact that you guys really want to take care of your community and make sure that you have a healthy community because that has. Alternative consequences, right? If we don't do that. And so tell me about how do you start promoting the program, right? How do you enroll your patients?

How do you market the program to make sure that people, you know, create awareness and their people are coming to you to make sure that are taking care of, proactively taking care of, of the disease or getting diagnosed and getting treatment.

Absolutely. Multi step multi phase when we rolled this out.

We dabbled in it. We're like, okay, how can we do this? Really it was, there was some barriers getting the word out. And then, so part of that was bringing on Meditech professional services and working with them as a team to have an official charter. Like, okay, this is official. This looks fantastic.

And as part of that, really putting in place one, how are we going to do this? With the technology that we have with the meta tech each are that we have. How can we make it be where it's always within providers faces right in front of them. So there were multiple parts in terms of that. So let's first talk about technology and that is for our.

primary care in our institution. I'm lucky we're able to influence that. Every single PCP document that the provider opens, there's an automatically a tab that says hepatitis C screening. So there's a visual every single time they see a patient say, Hey when they click on it. Oh, Recommendations now are to screen hepatitis C universal, universally.

If you're 18 over, you've never been screened before, bam, do it. It's not risk based, it's not if they've used IV drugs before, are unlicensed tattoos, age, it is not risk based, just screen everyone 18 over. It's there, it's simple, perfect. The next one was, okay, so now we're going to document, so, If the patient is screen positive, how is the provider supposed to refer to our hepatitis C program within the disease management clinic, making sure those processes are smooth for referral are their labs are required building order sets that the provider has as well as.

Once the patient comes over to our clinic, what are we going to do for documentation? How do we make it easier to have lab order sets? And then when they've completed the program, which can take five to six months, what happens thereafter? Is it, okay, you're discharged, goodbye forever? No, it depends.

There's two different patient populations when they've been cured. They're not going to continue to have any lifestyle where they might be at risk for the future. We do have a nice wrap up to the referring provider and said, this patient has been cured. Thank you so much. And go off into the world versus.

Our other patient population that may continue a riskier lifestyle that puts my risk to get hep C again. So in order to determine who we should continue to track or not, we were able to get help to build a health, registry so that there's a reminder like, okay ding. Okay. Patient is positive for hep C.

We're going to alert. Or it pops up on our registry to say, okay, it's been a year. see if they have have received further screening or if there's anything left to do so. Multiple things on the side. So thank you for that. It really has been beneficial for that portion to remind our providers.

Now, when you're saying get the word out, 1 of those pieces is education and it's. Anytime there's a change in guidelines, just reminding everyone the providers, the institutions, hey, it is not risk based screening, go ahead and start finding these patients out there, order these universal screenings, so constant education, reaching out to our own providers, but also knowing that KMC is not the only Health care provider in the community.

And so building those relationships with our private practices and saying hey, is there any way we can help you? We know the prior authorization barriers and steps are really tough. I mean, when we have to work through a prior authorization packet. It is not surprising where our care coordinator who focuses on patient navigation, linkage to care, she's submitting documents that are 20 to 30 pages long.

There are barriers to receiving hepatitis C treatment. One of the reasons is because it can be very pricey 20, a course. So, the peers really need to make sure, does this patient qualify and really need this medication? We have our processes fine tuned. It's a health care team that involves a pharmacist.

A care coordinator, our medical director, hepatologist, all working together to ensure that there is appropriate therapy, that the patient receives all the linkage to care that they need in terms of if they have housing instability, transportation issues, health care coverage concerns, not being able to have a stable diet and that is affecting their medication, all of these things that are going on, you.

Our entire team is there to ensure the patient is through. So that's 1 educating providers. And then the next is so we've talked about ensuring there is a good workflow on the side. We've talked about how we communicate this to the providers and to talk to them about how we can. Both work together to cure this patient and to take care of the patient and limit the provider's workload.

So why don't they consider our team? And then the next piece is really reaching out to the patient, the community. Where are you going to find these patients? And there is a stigma around hepatitis C and it's like, oh no I'm not gonna get tested because I'm not at risk. And part of that is having partners with not just intro department within our institution, working with our public relations team to work on social media posts, newsletter articles even with working with Meditech.

How do we get the word out of our program? And then next is the providers, they have to have buy in. To what we are providing to the patient to also encourage the patient to take that next step to work with us. A lot of key pieces. It's always evolving. It never stops. But the 1st thing is just move forward.

Step by step even though this idea took. years, multiple years. It was always percolating. The moment I knew we were going to do this, I called our telecom engineer. I said, Hey, save me this number. I want a Hep C hotline. And when we were ready, three years later, I was able to have 928 263 HEPC.

So we have a, we have a Hep C hotline that goes directly to our care coordinator for any patient who has a question. Do I need to be screened? Or if I'm positive, Should my significant other be screened? Oh, I'm pregnant. Is that going to be a concern for my child? Anything that the patient has concerns with or questions with, we make sure that we're available.

And that's just providers, our patients. We haven't even touched on making sure you incorporate stakeholders, community organizations, we have a relationship where we have a collaborative practice agreement with the Mojave County Department of Health, Collaborative practice agreements with providers in the community. Were highly engaged with the statewide Arizona Department of Public Health. So, if you want something to be successful, if you're passionate about it, you need to put yourself out there and continue to make those relationships and partnerships.

I know. I know that you absolutely love talking about this because you're so passionate about the topic and you just said it right. You have to have the right partnerships because it's not just about having the technology, right? I believe everybody somehow somewhere. Everybody has a system. But then what do you do with that data?

So fortunate enough, you had Meditech as a partner that was able to help you out. Create this program and, you leverage the technology to be able to utilize it, to utilize the data in and put a workflow together. Then you have the right partnerships, the right stakeholders.

And then obviously put in a precedent place, right? Well, we talk about people process technology, which is a trifecta to make something successful. And it seems like you guys made it happen. And I'm sure I mean, you made it look. Like, we had all those things in place, and I'm sure there were barriers to your program.

And you can mention a few of them, which I'm sure you overcome. But I also want to hear about the outcomes, right? Because this is, I'm excited to hear what have you seen so far after these three years that you have, put the program into place?

Yeah, I mean, it's so amazing. This is where I would love to pop up some graphs for trending.

It's not just my city, it's now, okay, the adjacent city, okay, the outskirts of the county, and we'll get a call from an office. Look we've tried to refer this patient to other places or this patient's had hep C for decades and they've just fallen through the gaps. Can you help them? Do you take their insurance?

They don't have insurance. Is there anything you can do? And it's like, yes, this is perfect. We were trying to find you out there. You know, We didn't know you existed and to be able. To know that we can meet those needs and fill in those gaps and support them when they felt like both the provider and the patient felt like no one was there to be able to help them so we can be very just like so satisfied and so proud to be able to cure these patients in our community to provide this support to the providers who felt like they didn't have anyone to go to.

And then be so successful that we are able to have plans for the future. So it's not like, okay, you rolled this out. Oh, it's kind of chugging along. It's not doing well. No, we have outcomes in terms of increased screening, patient care, extending providers and slowly increasing our geographic outreach. And that goes along with submitting for grant applications, right?

And publications, poster presentations, and I'll touch on that briefly. I didn't talk about the BCA dashboard, which is the business and clinical analytics product through Meditech. It's really cool because you have this visual dashboard that tells you what's your, the breakdown of age for your patients?

How many of the patients have been screened that were positive or refer to our program? Geographically, we can see is there a pocket of hepatitis C cases or is there an area we haven't even screened? And. I bring that up because we tap into it constantly. We open it up constantly to see if there's information for publication.

So right now we have a few things in the works, a poster presentation to a national meeting And it's been very helpful. One of the things to consider is that to continue tweaking it, how you set it up in the beginning may not be what you really need after some experience. So continue to work with the team to adjust how the reporting is, what the dashboard looks like.

Yeah. So lots of great stuff. If our Hep C program continues to be successful, we hope to be able to expand out to another area of need in our community and in our county. And that's HIV treatment and care in our community.

And that was going to be my next question, right? Because you guys won the Innovators Award, and I'm sure you were thinking about what was the next thing. So thank you for sharing that information. I can't wait to hear how you started the program and then we can talk about it, right? This is how it went and this is what we're doing.

Very exciting.

All of these Gaps in care and how we really stay on top of incorporating what you had said that trifecta that also includes technology, putting everyone together so that we can continue to. Increase access to care and not just. Having regular access, but high quality care in our community.

All right. Well, so I command you for the great work that you guys are doing and your community. sure it was a huge undertake. I mean, just putting all this together, but you're working on the next 1, which is amazing. Anything else you want to share with us just to close the segment.

Yeah, absolutely. So I would say, think outside the box, right?

What is your traditional care model? Who are you able to incorporate into the health care team to improve access to care, specifically in rural communities? And how do you utilize the current resources you have, including technology? How do you utilize that and optimize that so that you can continue to be successful?

Well said, Linda. Thank you so much for your insights, for the time. Again, can't wait to hear more of what you're doing out there and have an amazing day.

Thank you so much. Take care. Take care. Bye bye.

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