When pharmacist Brooke N. Stevens, PharmD, BCPS, AAHIVP, generously stepped up to review this year’s POSITIVELY AWARE hepatitis drug and treatment guide, she mentioned her work with Project ECHO.
Dr. Stevens is a clinical HIV/HCV pharmacist for Indiana University Health, in Indianapolis. The Project ECHO program—Extension for Community Healthcare Outcomes—teams up specialists such as Dr. Stevens, from larger towns and cities, with health care providers in smaller towns, offering the expertise needed to help serve patients.
“One of the big things that a lot of these providers have learned—in the hep C ECHO specifically—is checking for fibrosis, to be sure they have all their T’s crossed and I’s dotted, whether the patient has cirrhosis or not,” said Dr. Stevens. “That question comes up a lot, and the providers are able to give various examples of what to expect in lab values and what kind of tests to order. Not all of these primary care providers have the same access to tests that the hepatology team has.”
The specialists also help their colleagues with the information they need to work with insurance companies and the bureaucratic maze of paperwork and rules involved. This is especially helpful for smaller clinics that have fewer staff—and less time for chasing down the right insurance forms, authorization codes, and other requirements.
“Providers will tell us ‘I’ve spent two hours on the phone and I can’t even figure out how to get a PA [prior authorization] form.’ [An insurance company can refuse to make payment if prior authorization for care was not given.] So we’ve been able to give them specific numbers for contacts at the insurance companies and we’ve been able to give them specific forms. I think that has taken a lot of time off the process for them, especially considering that a lot of the primary care teams don’t have social workers, pharmacists, and pharmacy technicians working on their team. They’re trying to see patients and do all of this other work at the same time—that’s a lot to take on for them.
“Ultimately, that wastes a lot of the provider’s time and it also delays therapy for the patient,” Dr. Stevens said. “We’ve dealt with all insurance companies and know the different quirks, and we’ve been able to give the other providers a lot of that information. So hopefully that makes it smoother for everyone, including the patients.”
Thanks to Project ECHO, patients can stay with the provider they prefer, rather than being forced to travel far to see a specialist. In rural areas, a trip to a specialist can take hours.
“Especially in the smaller towns in Indiana, it’s been really good. The patients don’t have to travel three hours to get to an expert. This has really expanded options for patients,” Dr. Stevens said.
She often wonders what patients think about delays as providers struggle with insurance companies. “They probably don’t understand how complex that whole process is. We really are trying to get you medicine!”
Project ECHO is based on a hub-and-spokes model. At the “hub” are experts and specialists, comprising the “spokes” are primary care providers. In a video conference where everyone can see one another, a total of one or two cases are presented by the spokes of patients under their care. (No private or personal patient information is given.) These providers also discuss whatever issues have come up in their work and learn from one another. The hub of specialists then also provide clarification on the issues and make recommendations. There is also a 15-minute presentation on a particular topic.
“It’s mostly case-based learning rather than a lecture-like environment, and everyone learns from the cases,” said Dr. Stevens.
Hubs may be made up of a particular specialty, such as LGBTQ health, substance use disorder, or hepatitis C. Dr. Stevens serves on a hepatitis C hub.
Project ECHO is available across the U.S. and even around the world. Providers can learn more and register at echo.unm.edu/join-the-movement/join-an-echo.
Special thanks to Dr. Brooke N. Stevens for reviewing the 2019 POSITIVELY AWARE Hepatitis Drug Guide. Dr. Stevens is an HIV clinical pharmacist at the LifeCare Clinic at Methodist Hospital and The Ryan White Center for Pediatric Infectious Disease and Global Health at Riley Hospital for Children, both at Indiana University Health (IU Health) in Indianapolis. In addition, she works closely with providers at the Digestive and Liver Disorders Clinic at University Hospital and other smaller clinics to assist with obtaining and educating on hepatitis C treatment. She currently serves as a clinical preceptor (training pharmacy students) at IU Health, and is on the clinical faculty of the Midwest AIDS Training and Education Center. She serves on the “hub team” for the HCV Project ECHO (Extension for Community Healthcare Outcomes) at the Richard M. Fairbanks School of Public Health (RMFSPH). Dr. Stevens graduated from Butler University with her Doctor of Pharmacy in 2014. After pharmacy school, she did a two-year residency at IU Health, with her second year specializing in infectious disease. She is credentialed as a Board Certified Pharmacotherapy Specialist through the Board of Pharmacy Specialties as well as an HIV Specialist through the American Academy of HIV Medicine.