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A Cost Reimbursement Model for Hepatitis C Treatment Care Coordination

Behrends, Czarina N., PhD, MPH; Eggman, Ashley A., MS; Gutkind, Sarah, MSPH; Bresnahan, Marie P., MPH; Fluegge, Kyle, PhD, MPH; Laraque, Fabienne, MD, MPH; Litwin, Alain H., MD, MPH; Meissner, Paul, MSPH; Shukla, Shuchin J., MD; Perumalswami, Ponni V., MD; Weiss, Jeffrey, PhD, MS; Wyatt, Brooke E., MPH; Schackman, Bruce R., PhD

Journal of Public Health Management and Practice: May/June 2019 - Volume 25 - Issue 3 - p 253–261
doi: 10.1097/PHH.0000000000000806
Research Reports: Research Full Report

Objective: To estimate the cost of delivering a hepatitis C virus care coordination program at 2 New York City health care provider organizations and describe a potential payment model for these currently nonreimbursed services.

Design: An economic evaluation of a hepatitis C care coordination program was conducted using micro-costing methods compared with macro-costing methods. A potential payment model was calculated for 3 phases: enrollment to treatment initiation, treatment initiation to treatment completion, and a bonus payment for laboratory evidence of successful treatment outcome (sustained viral response).

Setting: Two New York City health care provider organizations.

Participants: Care coordinators and peer educators delivering care coordination services were interviewed about time spent on service provision. De-identified individual-level data on study participant utilization of services were also used.

Intervention: Project INSPIRE is an innovative hepatitis C care coordination program developed by the New York City Department of Health and Mental Hygiene.

Main Outcome Measures: Average cost per participant per episode of care for 2 provider organizations and a proposed payment model.

Results: The average cost per participant at 1 provider organization was $787 ($522 nonoverhead cost, $264 overhead) per episode of care (5.6 months) and $656 ($429 nonoverhead cost, $227 overhead, 5.7 months) at the other one. The first organization had a lower macro-costing estimate ($561 vs $787) whereas the other one had a higher macro-costing estimate ($775 vs $656). In the 3-phased payment model, phase 1 reimbursement would vary between the provider organizations from approximately $280 to $400, but reimbursement for both organizations would be approximately $220 for phase 2 and approximately $185 for phase 3.

Conclusions: The cost of this 5.6-month care coordination intervention was less than $800 including overhead or less than $95 per month. A 3-phase payment model is proposed and requires further evaluation for implementation feasibility. Project INSPIRE's HCV care coordination program provides good value for a cost of less than $95 per participant per month. The payment model provides an incentive for successful cure of hepatitis C with a bonus payment; using the bonus payment to support HCV tele-mentoring expands HCV treatment capacity and empowers more primary care providers to treat their own patients with HCV.

Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York (Drs Behrends and Schackman and Mss Eggman and Gutkind); New York City Department of Health & Mental Hygiene, Queens, New York (Ms Bresnahan and Drs Fluegge and Laraque); Albert Einstein College of Medicine, Bronx, New York (Drs Litwin and Shukla and Mr Meissner); Montefiore Medical Center, Bronx, New York (Drs Litwin and Shukla); Icahn School of Medicine at Mount Sinai, New York, New York (Drs Perumalswami and Weiss); and Mount Sinai Hospital, New York, New York (Dr Perumalswami and Ms Wyatt).

Correspondence: Czarina N. Behrends, PhD, MPH, Weill Cornell Medical College, Department of Healthcare Policy and Research, 425 East 61st St, Ste #301, New York, NY 10065 (

The authors acknowledge the important contributions of the Project INSPIRE administrative staff, HCV champions, clinical providers, care coordinators, and peer navigators who provided patient support and crucial information for this study. The authors especially want to highlight the contributions of Andrew Huang, program coordinator, and Nicolette Gantt, grant administrator of the NYC Department of Health and Mental Hygiene, who provided significant support and data for this study.

The project described was supported by grant number 1C1CMS331330-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

Alain Litwin has received grant support from and has been an advisory board member for Merck and Gilead Sciences. Jeffrey Weiss has received grant support from and served as a consultant to Gilead Sciences. The remaining authors have no conflicts to disclose.

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