Latest / Becker’s Healthcare Podcast / Strengthening LAI Prep Care with EHR Optimization at Callen-Lorde Community Health Center

Transcript

Strengthening LAI Prep Care with EHR Optimization at Callen-Lorde Community Health Center · Becker’s Healthcare Podcast

• 0:00
  Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  Healthcare. Thanks so much for tuning in to
• 0:04
  the Becker's Healthcare podcast series. Great to have
• 0:07
  you.
• 0:08
  We're talking about how provider organizations are leveraging
• 0:11
  EHRs and EMRs to coordinate care
• 0:14
  and navigate insurance requirements for HIV prep patients
• 0:18
  prescribed long acting injectables or LAIs.
• 0:22
  And joining me for today's discussion, very excited
• 0:24
  to have him, is Steven Sugimaran. He's the
• 0:26
  director of the LAI program at Callen Lorde
• 0:28
  Community Health Center. Steven, Steven, thanks so much
• 0:30
  for being here today. It's great to have
• 0:31
  you.
• 0:32
  Thanks, Lucas, for having me. Excited. Absolutely. I
• 0:35
  wanna start off with introductions for the audience
• 0:37
  that might not know you yet at least.
• 0:38
  To kick us off, if you wanted to
• 0:40
  share a little bit about yourself and your
• 0:42
  work in health care.
• 0:44
  Sure. So I am a public health professional
• 0:47
  with a background working with and alongside sexual
• 0:49
  minority and vulnerable populations.
• 0:51
  As you mentioned, I'm currently the director of
• 0:54
  the long acting injectables program at Callen Lorde
• 0:56
  Community Health Center, where we provide welcoming and
• 0:59
  supportive health care for the LGBTQ plus community
• 1:02
  all across New York City regardless of their
• 1:04
  ability to pay. I was most recently the
• 1:06
  deputy director
• 1:07
  of an NIH funded AIDS research center at
• 1:10
  Columbia University and the New York State Psychiatric
• 1:12
  Institute.
• 1:13
  And prior to that, I was engaged in
• 1:14
  HIV and emerging infectious disease surveillance in the
• 1:17
  greater Atlanta area.
• 1:18
  I also have significant experience supervising intensive HIV
• 1:22
  case management and care coordination programs in New
• 1:24
  York City, particularly those accessing care at New
• 1:26
  York Presbyterian Hospital and the former St. Vincent's
• 1:29
  Hospital.
• 1:30
  My work has always centered on advancing health
• 1:32
  equity, and I'm passionate about using data innovation
• 1:35
  and community partnerships to improve outcomes for underserved
• 1:37
  populations.
• 1:38
  And I love to have you on for
• 1:40
  this conversation specifically because of all of your
• 1:43
  experience. More than anybody, really, I think you
• 1:46
  know all of these complex operational challenges,
• 1:49
  that
• 1:50
  patients on LAI prep really face. They are
• 1:54
  complex and multifaceted
• 1:56
  dose timing,
• 1:57
  insurance navigation,
• 1:58
  obviously, scheduling. Right?
• 2:01
  Before optimizing
• 2:03
  your EHR workflows,
• 2:05
  what were some of the biggest pain points
• 2:07
  that you and your team encountered
• 2:10
  in coordinating care for these patients?
• 2:13
  Yeah. So like you went through, there are
• 2:15
  a number of barriers to LA access in
• 2:17
  practices like Helen Lord. I would say first
• 2:20
  and foremost is reimbursement complexity.
• 2:22
  Mhmm. There are a number of commercial health
• 2:24
  plans, each with multiple lines of business that
• 2:26
  have different rules and policies within them. In
• 2:29
  New York state, we bill as a pharmacy
• 2:30
  or medical benefit. If medical benefit, we're able
• 2:33
  to utilize a $3.40 b savings that support
• 2:35
  administrative and clinical burden,
• 2:37
  but plans appear to resist this with hurdles
• 2:39
  like prior authorization.
• 2:41
  There's also variation in the length of authorization
• 2:43
  across payers and lines of business.
• 2:45
  We found that LAIs also exacerbate credentialing challenges.
• 2:48
  So sometimes that requires a PCP alignment, or
• 2:51
  the PCP listed on the patient's insurance must
• 2:54
  match the provider they're seeing for the injection
• 2:56
  visit.
• 2:57
  One thing that we tend to keep an
• 2:58
  eye on are coverage gaps, especially in our
• 3:01
  current economic state. Many folks are under insured
• 3:04
  or uninsured
• 3:05
  or will be expecting a job loss, and
• 3:07
  losing their employer based insurance, which can make
• 3:09
  adherence and persistence difficult to manage.
• 3:12
  About half the patients that we see are
• 3:13
  on Medicaid plans, so that must be checked
• 3:15
  on the first of every month to ensure
• 3:17
  the plans weren't terminated
• 3:19
  the day prior.
• 3:20
  And lastly, we're seeing denial rates well beyond
• 3:23
  what we typically see for other procedures or
• 3:25
  injections. And it seems that payers will attempt
• 3:27
  to run out the clock to avoid the
• 3:29
  pills processes,
• 3:30
  running the risk that we eat the cost
• 3:31
  of the injections.
• 3:33
  Yeah. You mentioned coverage gaps there and certainly
• 3:35
  some of the other elements here that are
• 3:37
  very tied to complex
• 3:39
  workflows, that are tied to very, sometimes labor
• 3:43
  intensive workflows.
• 3:44
  What are some of the steps that you
• 3:46
  and your team took to streamline some of
• 3:48
  this to make workflows easier within
• 3:50
  the EHR or EMR?
• 3:53
  Right. Yeah. So it became quickly evident that
• 3:55
  complex systems would slow the adoption of LAI
• 3:57
  prep. So if we wanted our program to
• 3:59
  grow, we we we needed to leverage our
• 4:01
  resources to optimize our workflows.
• 4:04
  So we created an LAI optimization work group
• 4:06
  comprising cross departmental experts meeting weekly and ad
• 4:09
  hoc as needed. And this work group had
• 4:11
  representation from senior and clinical leadership, as well
• 4:14
  as billing, operations and scheduling, and also IT.
• 4:17
  So some of the immediate challenges we wanted
• 4:19
  to address included
• 4:21
  inconsistent documentation. So the templates we were using
• 4:24
  and the alerts within our electronic health record
• 4:26
  were not standardized.
• 4:28
  Only a few providers were trained to conduct
• 4:30
  our eligibility screenings at the time, and insurance
• 4:32
  verification processes took a lot of time per
• 4:35
  patient and per appointment, approximately twenty to forty
• 4:37
  minutes. So we wanted to avoid any duplicative
• 4:40
  efforts,
• 4:42
  and we were relying on about five to
• 4:45
  six separate Excel spreadsheets, which became cumbersome.
• 4:48
  So we decided to optimize a preexisting template
• 4:51
  within our electronic health record,
• 4:54
  and this template puts all the tools that
• 4:56
  a provider needs to complete a specific visit
• 4:58
  into a single screen, which increases workflow efficacy
• 5:01
  and speed.
• 5:02
  So our template includes the initial LAI prep
• 5:05
  prescription for insurance verification,
• 5:08
  an internal referral for tracking, and a clinical
• 5:10
  checklist, which guides a provider in documenting and
• 5:13
  screening what's needed while including baseline requirements to
• 5:15
  familiarize the patient in the process of being
• 5:17
  on LAIs.
• 5:18
  And following this optimization, we saw a 150%
• 5:21
  increase in weekly LAI appointments, while by the
• 5:24
  time of this recording, doubling the number of
• 5:26
  patients initiated on LAI prep and persisting.
• 5:29
  Also importantly, our time from referral to LAI
• 5:31
  initiation went from months to about fourteen days.
• 5:35
  Again, so interesting because you have the direct
• 5:38
  impact on patient access
• 5:40
  and on, obviously, the benefits that patients have
• 5:43
  through the optimization, which is key not only
• 5:45
  from an organizational perspective, but also for your
• 5:48
  community, which is crucial.
• 5:50
  You spoke a little bit about the templates
• 5:52
  and some of the centralizations.
• 5:54
  If we dive into that more in specifics,
• 5:57
  how did tools like electronic prior authorizations
• 6:00
  or we also have enhanced medication administration records,
• 6:02
  etcetera,
• 6:04
  change your day to day operations then?
• 6:07
  Electronic prior authorizations are really, really helpful because
• 6:10
  they can be initiated and processed directly through
• 6:12
  our EHR.
• 6:13
  Requests can be auto populated with patient and
• 6:15
  prescription data, and responses patients wait less time
• 6:18
  to be initiated on LAI. We've also incorporated
• 6:20
  the medication administration record in our screening tool
• 6:23
  that I mentioned. So if a patient is
• 6:26
  interested in the latest LAI prep product, this
• 6:29
  product is So if a patient is interested
• 6:31
  in the latest LAI prep product,
• 6:33
  this product is has known to have some
• 6:35
  drug drug interaction, so it's critical that the
• 6:37
  provider can review the MAR MAR in real
• 6:39
  time when making a referral.
• 6:42
  Yeah. Certainly adds to the process as well.
• 6:44
  I wanna talk a little bit about the
• 6:46
  the human side of things here. The human
• 6:49
  element of all of this because it's certainly
• 6:51
  key, especially when we're optimizing, when we're changing
• 6:54
  things
• 6:55
  around. Coordinating prep, LAI care often, you know,
• 6:58
  it involves multidisciplinary
• 7:00
  teams, multiple system touch points as you've just
• 7:03
  outlined.
• 7:04
  Can you share how collaboration across those teams
• 7:08
  supported all of this optimization that you just
• 7:10
  highlighted and and what kind of impact you've
• 7:12
  seen? You've you've already highlighted some of the
• 7:14
  numbers, which are incredible, but what has this
• 7:16
  done for you?
• 7:18
  Yes. Coordinating an LII prep program absolutely requires
• 7:21
  collaboration among
• 7:23
  clinical pharmacy, nursing, care coordination, outreach,
• 7:27
  and administration teams. The list goes on, really.
• 7:30
  Everyone plays a role in ensuring our patients
• 7:32
  move seamlessly through process from education and eligibility
• 7:35
  to initiation, adherence, and retention.
• 7:38
  Currently,
• 7:38
  broader LAI team meets twice weekly to review
• 7:41
  all upcoming LAI appointments to ensure all potential
• 7:44
  barriers to care and coverage are addressed before
• 7:46
  our patients even come in to see us.
• 7:48
  So collaboration transforms a program from a set
• 7:51
  of siloed services to a well coordinated
• 7:54
  comprehensive prevention system.
• 7:55
  This has led to improved access, higher patient
• 7:58
  satisfaction, stronger adherence and persistence, and a measurable
• 8:01
  public health impact.
• 8:03
  Really, truly a more proactive approach, which then,
• 8:06
  again, as we've talked about, really impacts,
• 8:09
  the patients, the communities, which is crucial and
• 8:12
  a key part of these optimizations. Steven, it's
• 8:15
  so fantastic to have you on. I wanna
• 8:17
  leave you with the floor here, so to
• 8:19
  speak. Anything else that we haven't touched on
• 8:21
  that that you'd wanna share with our listeners?
• 8:24
  Yeah. Just, you know, just overall summarize
• 8:26
  that leveraging electronic health records isn't about technology
• 8:29
  for its own sake. It's about making sure
• 8:31
  people who could benefit from long acting PrEP
• 8:34
  don't fall through the cracks.
• 8:35
  When we design these systems thoughtfully, we make
• 8:38
  prevention easier, more equitable, and more sustainable.
• 8:41
  And it's a really exciting moment right now
• 8:43
  for HIV prevention.
• 8:44
  EHR based coordination for long acting prep can
• 8:47
  serve as a model for how we use
• 8:48
  data and and integration to close gaps and
• 8:50
  access across many preventive services.
• 8:53
  And, again, none of this happens in isolation.
• 8:55
  It takes collaboration between clinicians, the data teams,
• 8:57
  pharmacists, and community partners. So I'd encourage anyone
• 9:00
  working in these spaces to think about how
• 9:02
  their systems can help make innovation and equity
• 9:04
  go hand in hand.
• 9:05
  Steven, so great to have you on. Thanks
• 9:07
  for your time and insights today. Thank you
• 9:09
  so much. It's great to have you, and
• 9:11
  I'd also like to thank our sponsor, Gilead
• 9:13
  Sciences. You could tune in to more podcasts
• 9:15
  from Becker's Healthcare by visiting our podcast page
• 9:17
  at beckershospitalreview.com.