The hepatitis C virus (HCV) is America’s deadliest infectious disease. It affects five million people in the U.S., a vast majority of whom are socio-economically disadvantaged. People living in poverty have nine times greater risk of contracting HCV;[i] between one-fourth and one-half of the homeless population has HCV.[ii] Left untreated, the disease develops into a chronic condition that can cause liver damage, cirrhosis, cancer, and death. Patients with HCV also risk infecting others — often those living in similarly precarious circumstances.
The Medicaid program bears much of the costs of HCV, spending on average almost $2,500 each month to care for members with the disease.[iii] Medicaid beneficiaries with HCV have three times higher inpatient admission rates, longer hospital stays, and more than twice as many emergency department visits than Medicaid members who do not have HCV.
There are medications that can, in almost all cases, cure HCV. The difficulty is making sure the vulnerable populations it affects most have access to these highly-effective drugs and the supports necessary to stay adherent to their treatment plan. The instability and challenges these patients face on a daily basis often prevent them from receiving the care they need.
“Patients who don’t have stable housing, may not have access to food or transportation, and are also often dealing with substance use disorder and mental illness, have a very hard time making it to doctor visits, getting necessary tests, and regularly taking medication,” said Kelly Munson, executive vice president of Medicaid for WellCare Health Plans. “Caring for these patients requires more than treating their disease; we must also help address their basic needs so they have a far better chance of complying with and benefiting from their treatment.”
To promote a more holistic approach to HCV patient care, WellCare is conducting a program that uses a value-based system and ties bundled physician payments to patient outcomes, rather than the typical fee-for-service structure. This allows health practitioners the flexibility to address some of the socioeconomic barriers to treatment by providing HCV patients with case managers who connect them with local services that can assist with basic needs such as food, housing, childcare and transportation.
The program also empowers physicians to determine the best place for HCV patients to be examined and tested, even if providers are out-of-network. This can help coordinate care and reduce multiple trips to different facilities that may create additional obstacles for patients.
There are drugs that can cure patients with HCV, but achieving this health outcome takes more than just medical care. Approaches such as WellCare’s — that address both the clinical and social needs of patients within and beyond the walls of the physician’s office — are necessary for breaking down the barriers preventing successful treatment. Learn more.