Tackling the Hep A Outbreak

Cases of hepatitis A virus in Florida have risen drastically this year, prompting the Florida Surgeon General to declare a public health emergency.

According to the CDC, “Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by the hepatitis A virus (HAV).”

Experts say the issue of making information about this disease should be addressed, as well as the vaccine readily available-and, if it is understood what hepatitis A is, then the impact and implications for healthcare executives should be clear.

The current hepatitis A outbreak in the United States, which has resulted in more than 23,000 cases, 14,079 hospitalizations (60% of cases) and more than 230 deaths since being identified in 2016, poses several population health and operational challenges to healthcare providers and executives, according to Joy Stephenson-Laws, managing partner, Stephenson, Acquisto & Colman.

“From a population health perspective, healthcare providers need to be prepared to interact with the communities they serve and provide three key services to combat the current outbreak and take tangible steps to prevent the next one (HAV outbreaks tend to be cyclical),” says Stephenson-Laws. 

Related article: The First Hep C Value-Based Bundled Payment Plan

Given their responsibility and mission to protect the health of their local communities, the first thing providers need to be doing is educating community members on the importance of being vaccinated against HAV if they don’t already have immunity from having had and recovered from the disease, according to Stephenson-Laws.

“This is especially true if they are in a higher-risk group for contracting the virus,” she says.  “There is much providers can do in this area, including PSAs in local media; presentations at health workshops both at the facility and in such locals as senior centers and churches; including information in community health newsletters; and offering educational materials in waiting areas.”

CDC offers consumer education materials ranging from posters to patient education leaflets that healthcare providers and other related professionals can use. 

Providers can also offer “vaccination clinics” to complement the consumer education program. 

“While administering vaccines in a provider setting would not necessarily be as efficient or cost-effective as doing so in other venues, for example at a local pharmacy or a stand-alone health clinic, providers can reduce the overhead by having specific hours for vaccination in a lower-maintenance area of the facility and by recruiting medical and nursing students as well as lab technicians to administer them,” she says. “For reimbursement, it is worth noting that Medicare, VA insurance, many Medicaid programs, and private insurance cover most or all of the cost of the vaccine. In fact, private insurers are required by law to cover the cost of vaccinations-including HAV-with no copays.”

Providers may also want to consider developing, either alone or with public health officials and the healthcare community in general, comprehensive plans for conducting larger scale HAV immunization programs.

“These could include working with local medical and nursing schools, pharmacies, community centers, and schools to educate and vaccinate,” Stephenson-Laws says. “In addition to HAV vaccinations, providers could also consider other prevention methods to increase the effectiveness of the program. This type of endeavor necessarily implies significant investment of human and financial resources. But depending on the number of high-risk groups in the community, it could provide an attractive return-on-investment from a population health standpoint. To give you an idea of how important this type of investment is for a community, the World Health Organization’s theme for this year’s World Hepatis Day was ‘Invest in Eliminating Hepatitis.’”

The third service is offering medically-necessary treatment. Since HAV self resolves in the vast majority of cases, this usually focuses on easing symptoms and managing any underlying health problems, says Stephenson-Laws.

“That said, hospitalization would be necessary if a patient with HAV goes into acute liver failure,” she says. “Unfortunately, for providers and the community alike, it is providing this medically necessary treatment that can pose the greatest operational and financial challenge to providers. This is because of the higher probability that at-risk groups who contract HAV will be under-insured or uninsured and may use the ED as the point-of-entry for treatment for HAV symptoms once they have symptoms or for post-exposure prophylaxis if they are aware of this protocol. 

While more research needs to be done, there is some evidence that patients being treated for HAV and who are covered by private health insurance plan have much higher healthcare and utilization and expenditures than non-HAV patients.  One study suggests that the average cost per patient to be around $12,000 for an infected patient versus a little over $5,000 for a noninfected patient.  This same study also showed that over a 12-month period, HAV patients had more ED visits and averaged higher use of outpatient services than non-infected patients. 

Clearly, prevention is the key to help protect a healthcare executive provider’s balance sheet and operational efficiencies while protecting community health.