VA Overhauls Approach to Care for Veterans With Hepatitis C : Page 3 of 3

July 26, 2016

SCAN/ECHO has been highly successful, according to Dr Ross. Wait times for treatment decreased by 75%, and cure rates for patients treated through this program are equivalent to the rates for patients treated by specialists.

Dr Aronsohn, who leads the ECHO-Chicago Hepatitis C management team, pointed out that programs like this are going to be essential moving forward because of the high rates of HCV infection—both among veterans and among the general population. “It’s just not feasible that they’re all going to get in to see specialists and be managed by specialists,” he said. “That care is going to have to be shifted to the primary care setting.”

Even with improved efforts to connect veterans with the care they require, many veterans with HCV have conditions that may limit the ability to be treated effectively, such as substance use that impairs adherence, serious mental illness, documented non-adherence to medical appointments or treatment, unstable/uncontrolled medical comorbidities, or a lack of engagement in care, Dr Ross pointed out. Still others choose to decline treatment.

The VA is taking steps to increase the availability of treating providers and outreach staff and is scaling up efforts to reach out to patients who fall into these categories so that they, too, can benefit from treatment when appropriate.


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Lessons To Be Learned

According to Dr Ross, the success of the VA, in large part, has been due to the utilization of interdisciplinary clinical teams that integrate treatment, aggressive case management, mental health support, and clinical pharmacy expertise.

The use of a population health cascade of care model to determine which patients have been tested, diagnosed, linked to care, evaluated, treated, or cured, allows targeted interventions to improve access and quality at each stage of the cascade. In addition, electronic registries and dashboards allow near real-time reporting and analysis on various access and quality measures.

Bringing care to the patient through SCAN/ECHO and other telehealth initiatives improves access, and evidence-based standards with flexibility for clinical judgment enhance outcomes. Last, but certainly not least, Dr Ross added, the thorough integration of clinical pharmacists at all levels is critical for ensuring appropriate therapy.

So what can other health care systems potentially learn from the VA’s large-scale approach to expanding HCV treatment to all veterans? 

“There are huge disparities in our country as far as access to these medications, so the VA is a really nice model,” Dr Aronsohn said, noting that the VA is accomplishing what the medical community, patient advocates, and patients have hoped would take place across the country and around the world. “Whatever way they’ve been able to do this to make [the expanded coverage] happen is something that other systems should really pay a lot of attention to,” he added.

At the same time, Dr Aronsohn acknowledges the challenges for systems outside the VA. The cost benefits associated with HCV tend to pay off over the course of years, he explained, because savings are achieved through the prevention of the complications that arise during the end stages of liver disease. But patients tend to change payers and insurance policies fairly often, so why would a payer want to spend $100,000 for a beneficiary’s treatment when that same individual could very well be covered by someone else in 5 years? 

“The VA is a little bit of a different population: because people tend to stay in the VA for a longer period of time, they are actually able to realize the cost benefits down the road with this population.”