Monthly Update
 March 2014
 
  
CCC Board of Directors Meeting Dates:

 All Board meetings will be held at 2:00pm at 1111 E. Cesar Chavez St., Austin, TX 78702 and can be changed or added as needed.

  • April 8, 2014 
  • May 13, 2014 
  • June 10, 2014 
  • July 8, 2014 
  • August 12, 2014 
  • September 9, 2014 
  • October 14, 2014  
All meetings of the Board of Managers of Central Health and the Board of the CCC are open to the public. 

 

One of two monthly meetings of the BOM of Central Health is streamed live. Audio of Central Health Board meetings is available on www.CentralHealth.net 

 

  * The BOM of Central Health must approve budgets of the CCC in an open meeting.

:: 512-978-8164

Contact: Mark Hernandez
A Note from the CMO 
 
Mark Hernandez, MD
Chief Medical Officer

 

March concludes the second quarter of the CCC Fiscal Year -- a good time to reflect on the important work underway for the CCC.  By now, you're probably familiar with one or more of the workgroups that are collaboratively working to guide system development and/or establish care standards to help achieve the CCC vision of delivering high-quality, cost effective, person-centered care.  The robust discussions within these workgroups around evidence-based practices and innovative approaches to health care delivery have been instrumental in the development of care standards for the CCC provider network.

 

These care standards are reflected in clinical guidelines and protocols for the treatment of specific health conditions. 

 

  • Clinical Guidelines provide guidance to the healthcare team in the diagnosis, management and treatment of a specific disorder or disease state.  They are designed to support the decision-making processes in patient care and are based on a systematic review of clinical evidence - the main source for evidence-based care.
  • Clinical Protocols are more specific than guidelines and provide a comprehensive set of criteria and steps for the management of a single clinical condition or aspects of organization.

CCC workgroups in specific clinical areas (diabetes mellitus, behavioral health, chronic liver disease, women's health, pulmonary diseases, hypertension, and heart failure) recently completed rapid design sessions to develop the content for each clinical protocol using scientific evidence. These clinical protocols will facilitate the review of health outcomes and support performance improvement efforts around quality of care, risk reduction, and cost efficiency.  The approval of the proposed clinical protocols is underway.  We'll share more information as it becomes available. 

 

On behalf of the CCC, I want to thank all of you for your invaluable input on best practices and innovative approaches to health care. 

 

                    - Mark

Transforming Care - Implementing CCC 1115 Medicaid Waiver Projects

 

The 1115 Medicaid Waiver allows for funding of Delivery System Reform Incentive Program (DSRIP) projects that increase access to health care services, increase the quality and cost-effectiveness of care, and enhance the health of the patients and families served.  The Community Care Collaboration (CCC) DSRIP projects include fifteen approved 4-year projects (the Comprehensive Patient Navigation Project was recently approved!) and 1 proposed 3-year project.  

 

Last month we spotlighted two of CCC's approved four year projects -- Expansion of Pulmonology Services and Expansion of Dental Services.  This month we spotlight another DSRIP service expansion project - Gastroenterology (or gastrointestinal) Services, the branch of medicine dealing with the structure, functions, and diseases of the stomach, intestines, and associated organs. 

Transforming Care - Expanding Access to Gastroenterology (GI) Services

   

The approved CCC Expansion of Gastroenterology Services DSRIP project helps to address current unmet and anticipated future needs for GI services by expanding these services in community-based clinics that serve the CCC population. Additional clinic sessions with GI providers at patients' primary care medical homes are expected to 1) reduce wait times for care, 2) minimize the need to travel to a separate clinic for these services, and 3) increase adherence to appointment schedules and treatment plans.  Over the course of the waiver, this service expansion will  provide over 1,500 patient encounters.

 

One focus of the GI Expansion project is to treat and cure Hepatitis C (Hep C) with just-released antiviral drugs. These new drug regimens have proved to cure Hepatitis C at much higher rates than previous drug regimens. The first phase of the project is the implementation of a new Hepatitis C clinic for CCC patients at CommUnityCare's North Central Health Center. The clinic is staffed by a care team led by Dr. Imtiaz Alam, a contracted Gastroenterologist and Hepatologist, and a CommUnityCare Mid-level Practitioner, LVN, 2 Medical Assistants, and a Registered Respiratory Therapist. In its first week of operation, the Hep C clinic saw 38 patients. In this DSRIP project year, hundreds of Hep C patients are expected to be served.   

 

This new clinic addresses a significant unmet need for Hep C treatment services.  Prior to the implementation of the North Central clinic, GI specialty services for the CCC population were primarily offered through the specialty clinic located at University Medical Center Brackenridge (UMCB) in downtown Austin.  The wait times for GI appointments at the UMCB specialty clinic average 121 days, or approximately four months. Patients needing to see a GI for liver concerns, including Hepatitis C infection, often wait nearly a year for care.

  

Without expanded services, the access issue will only get worse.  According to projections from the Texas State Data Center, Travis County's population is expected to grow by another 7% during the waiver period.  In addition to increasing need due to population growth, demand for GI services will be fueled by changes to guidelines from the Centers for Disease Control and Prevention (CDC) that recommend that all people born during 1945-1965 be tested for Hepatitis C. Hepatitis C infection is a growing concern for low-income Travis County residents. According to analysis of the safety net patient population in Region 7 and surrounding counties, Hepatitis C related visits increased approximately 16% between 2009 and 2010.

 

In addition to the expansion of services, this CCC DSRIP project implements the standardized care guidelines and protocols recently adopted by the Chronic Liver Disease Protocol Workgroup (see article below). 

 

The next phases of the CCC GI Expansion Project will include the expansion of the Hepatitis C clinic with extended hours and additional clinic locations, including the new Southeast Health and Wellness Center, and the implementation of other community-based GI services for the CCC population. 

Leader Spotlight   
 

Imtiaz Alam, MD, is the lead physician for the new CCC Hepatitis C clinic at CommUnityCare NorthCentral.  

 

Dr. Imtiaz Alam received his medical degree from University of Dundee in Scotland. He completed his residency at Hahnemann University Hospital in Philadelphia, Pennsylvania, and his gastroenterology and hepatology fellowship at the University of California, San Francisco. While in San Francisco, Dr. Alam was an National Institutes of Health (NIH) research fellow. His area of basic science research was complications of chronic liver diseases. 

 

From 1996-1998, Dr. Alam was an Assistant Professor of Medicine at Texas A & M College of Medicine. In 1998, Dr. Alam started the Austin Hepatitis Center, where he is currently the medical director. Dr. Alam is also Chief of Gastroenterology and Hepatology at University Medical Center at Brackenridge in Austin, Texas and a Clinical Assistant Professor of Medicine at University of Texas, Southwestern.

 

In 2007 Dr. Alam helped begin the gastric neurostimulator program in Austin and developed the Seton Gastroparesis Center.

 

Dr. Alam maintains one of the largest private practices in the United States devoted to liver diseases and gastroparesis. Dr. Alam is board certified in Internal Medicine and Gastroenterology. Dr. Alam is currently a principal investigator for many Phase 1 to Phase 3 drug trials. He has written and published numerous articles for peer reviewed journals. 

Transforming Care - Establishing Care Standards across the CCC

  

To help achieve the CCC's vision to create a healthcare delivery system that is a national model for providing high quality, cost-effective, person-centered care and improving health outcomes, CCC Clinical Protocol Workgroups are working to identify best practices within their designated specialty areas and agree upon standards of care to be implemented across the CCC contracted provider network.  These standards of care are being documented through clinical guidelines and protocols.

  

As discussed above, protocol Workgroups have been developed for each of the following areas - diabetes mellitus, behavioral health, chronic liver disease, women's health, pulmonary diseases, hypertension, and heart failure.  The Chronic Liver Disease Workgroup has adopted a Clinical Guideline and developed an associated Protocol for the treatment of individuals with Hepatitis C.

  

Hepatitis C is an infectious disease caused by the Hepatitis C virus.  It is transmitted through blood-to-blood contact.  If untreated, long-term consequences of Hepatitis C can include cirrhosis, liver cancer, or liver failure.  Unlike many other diseases, however, Hepatitis C can be cured with treatment.

  

The adopted CCC Hepatitis C Guidelines and Protocol address standards for screening, testing, referral to care, treatment, and related education to help improve health outcomes for these individuals and decrease the spread of the disease.

  

Screening and Testing.  Of the estimated 2.7 million to 3.9 million persons (1999 to 2008 National Health and Nutrition Examination Survey data) chronically infected with HCV in the United States, 45% to 85% are unaware that they are infected. Identificationof individuals with active infection is the first step toward improving health outcomes among persons with HCV infection and preventingtransmission.

 

1.      HCV testing is recommended at least once for persons  born between 1945 and 1965.

  

The Center for Disease Control and Prevention currently recommends that all persons born between 1945 and 1965 be tested for HCV status regardless of risk-factors. This is due to their finding that just testing based on risk factors alone for this group failed to identify more than 50% of HCV infections in part due to patient underreporting of their risk and provider limitations in ascertaining risk-factor information. Individuals in this age cohort account for nearly three-fourths of all HCV infections, reflecting a higher incidence of HCV infections in the 1970s and 1980s.

  

2.      Other persons with the risk factors identified below should be tested for HCV infection.

  

  

Risk Behaviors

Risk Exposures

Other Medical Conditions

Injection Drug Use

Long-Term Hemodialysis

HIV Infection

Intranasal Illicit Drug Use

Needle sticks or other exposure to HCV-infected blood

Unexplained chronic liver disease and chronic hepatitis including elevated alanine aminotransferase levels

  

Birth to an infected mother

  

  

Recipients of transfusions or organ transplants

  

  

 

Referrals to CCC Hepatitis C Clinic.  The new CCC Hepatitis C clinic will phase in opening for referrals.  For the clinic's first 90 or so days of operation,  the schedule will be open for individuals who have previously been diagnosed with Hepatitis C but who have been waiting to be seen at the UMCB Specialty Clinic.  Further, priority will be given to individuals who have cirrhosis and do not have any contraindications for treatment.  After the initial few months of clinic operation, referrals will be accepted for newly diagnosed patients in the age cohort of individuals born between 1945 and 1965 or those with the other identified risk factors or medical conditions.

 

Treatment.   The CCC will follow the new standard of care for Hepatitis C, which is a once-daily, two-pill regimen.  For the majority of patients who are Interferon ineligible, the new medications, Sovaldi and Olysio, are taken once per day for approximately 12-weeks.  A COSMOS randomized drug study reported on at the annual American Association for the Study of Liver Diseases (AASLD) in 2013 demonstrated a 90-100% cure rate for patients with HVC and with fewer side effects than older medications.  While the new medications are expensive, they will be available to many in the CCC population through a patient assistance program.

The protocol identifies the specific treatment regimen to be followed for any specific individual based on a number of factors such as patient genotype, whether or not the patient has been in treatment before and how he/she responded, and whether or not the patient already has cirrhosis of the liver.

 

Education.  In addition to receiving therapy, HCV-infected persons should be educated about how to prevent further damage to their liver and the precautions needed to avoid exposing others to their blood.
Southeast Health and Wellness Center

 

Work has begun to transform the former Veterans Administration Austin Outpatient Clinic, located at 2901 Montopolis Drive, into the new Southeast Health & Wellness Center. Community leaders and organizations in the Montopolis and Dove Springs neighborhoods have worked with Central Health to plan the renovation of the 70,000 square foot facility.  

 

Phase I, scheduled to open in October of this year, will offer primary medical and dental care, specialty care, behavioral health care, radiology and laboratory service, a pharmacy, and a community meeting space. Phase II of the project, expected to open in 2015, will potentially include health screenings, eligibility and enrollment services for health care coverage programs, and exercise classes, among other services to promote wellness and prevention. 

 

Once completed, the new Southeast Health and Wellness Center will exemplify the CCC's vision for the future of care delivery in Central Texas.