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PROJECT INSPIRE NYC
Hep C Taskforce MeetingMay 20, 2015
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Project INSPIRE NYC – Primary Aim
To demonstrate…
1. service delivery model to reduce illness and death from chronic illnesses and their complications
2. payment structure that will reduce costs from chronic illness and their complications
…using chronic hepatitis C infection as a case study.
Better Care + Better Health = Lower Costs
Innovate and Network to Stop HCV and Prevent complications via Integrating care Responding to needs and Engaging patients & providers
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The Mount Sinai TeamProject Director: Brooke Wyatt (347) 916 - 4428
Care Coordinators:Joy Cambe (646) 844 - 2801Aaron Vanderhoff (646) 844 - 2802Samara Washington (646) 844 - 2803Ashley Pichardo (646) 844 - 2804
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Project INSPIRE NYC – Major Activities
• Identify, recruit and treat patients:• Enroll 3,200 patients
Screen 95% for depression Complete treatment for 75% of enrollees
• Achieve cure rate (SVR) 90% for non-cirrhotic 50% of cirrhotic patients
• Provide comprehensive care:• Integrate primary care with behavioral health • Use telemedicine to connect primary care with specialists• Provide care coordination, navigation, health promotion,
and medication adherence support
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HCV Care Coordination Protocol –
Key ComponentsI. Enrollment of PatientsII. Comprehensive Intake AssessmentIII. Care Coordination Plan
• Care Navigation• Health Promotion Sessions• Social Services and Other Benefits• Medication Adherence Support and Monitoring
IV. Monitoring and Review of the Patient via the Care Coordination Plan• Chart Reviews• Case Conferencing
V. Case Closure and End of Program Services
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HCV Health Promotion Manual –Key Components
I. What is Hepatitis C?II. Liver HealthIII. Hepatitis C treatment and factors to ensure
successful treatmentIV. Harm Reduction and Substance AbuseV. Healthy Living with Liver DiseaseVI. ReviewVII. Health Maintenance and Avoiding Reinfection
Care Coordination● Multidisciplinary Team
● Holistic approach to health care and HCV treatment
○ Health Promotion
○ Referrals to Social and Supportive Services
○ Accompaniment
○ Entitlements and Benefit Services
● Care Coordinator assisting with all aspects of care
○ Prior Authorization Process and Appeals
○ Pre and Post- Treatment Health Education
○ Adherence Counseling
Cascade of HCV Care (Nationwide)
Project INSPIRE - Mount Sinai
Liver Special-ties
IMA Liver Jack Martin FPA
Series1 59 19 1 46
5
15
25
35
45
55
65
# o
f En
rollm
en
ts
10
0
10
20
30
40
50
60
70
N=59
100% 100%91% 88%
35%
Nu
mb
er
Com
ple
ted
Project INSPIRE - Liver Specialties
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Care Coordination Services - LS
0%
10%
20%
30%
40%
50%
3%
41%
2% 3%
16%
2%
8%
14%11%
Fre
qu
en
cy
Initiating Treatment: 4 (7%)On treatment: 16 (27%)Pre-treatment: 39 (66%)
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Rewarding Patient Interactions• Improved Patient interactions in the clinic setting• 100% success rate with medication appeals• Patients feel invested in and apart of their care team• Substantial increase in the number of support group attendees.
We’re improving daily…• Hired an additional 2 coordinators since February• Provide CC services for Spanish speaking clients beginning June 8th
• Centralized space in June with live data entry in the clinics• Monthly Reporting and quarterly data analysis to investigate change in outcomes
Montefiore and Mount Sinai Project INSPIRE Tele-Education and Evaluation
•Weekly tele-education webinars by experts•Primary care providers•HCV related topics•Case discussions
Join us every Tuesday from 4:30 – 5:30pm.
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To refer patients to Project INSPIRE
Mount Sinai Faculty Practice Associates5 East 98th Street, 11th FloorNew York, NY 10029Telephone: 212-241-7270
Internal Medicine Associates17 East 102nd Street, 7th FlrNew York, NY 10029Telephone: 212-824-7729 Medicaid, Medicare, and Managed Care Plans are accepted.
Medical Specialty ServicesCenter for Advanced Medicine (CAM)17 East 102nd Street, 4th Flr A&BNew York, NY 10029Telephone: 212-659-8554
A referral from a current provider (MD, DO, clinical psychologist, nurse practitioner, nurse, or social worker) can be emailed to:
Project Director: Brooke WyattPhone: 347.916.4HCV (4428)
Email: [email protected]
Or make an appointment at one of our clinics:
