Clinical Scorecard: Addressing Racial and Sociodemographic Inequities in Hepatitis C Management at an Urban Academic Medical Institution, 2018-2023
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection
Key Mechanisms
Treatment access disparities influenced by insurance type, prior authorization barriers, homelessness, and substance use disorder
Target Population
People with hepatitis C infection, particularly those insured by Medicaid or uninsured in urban settings
Care Setting
Urban academic medical centers and public health programs
Key Highlights
Only 26.5% of people with hepatitis C infection were treated in an urban academic medical center, with lowest treatment rates among Medicaid and uninsured populations.
Removal of prior authorization restrictions in Medicaid programs is necessary but insufficient alone to achieve equitable hepatitis C elimination.
Homelessness and substance use disorder are significant predictors of low hepatitis C treatment rates, disproportionately affecting Medicaid enrollees.
Guideline-Based Recommendations
Diagnosis
Utilize hepatitis C virus surveillance registries to identify untreated individuals.
Management
Streamline and eliminate prior authorization requirements across all insurance types to facilitate timely hepatitis C treatment initiation.
Address social determinants such as homelessness and substance use disorder within Medicaid populations to improve treatment uptake.
Monitoring & Follow-up
Track treatment initiation rates across insurance types to identify and address disparities.
Monitor healthcare utilization patterns, including inpatient and emergency department visits, among untreated patients.
Risks
Untreated hepatitis C leads to ongoing transmission, preventable liver disease, premature death, and increased healthcare utilization.
Prior authorization barriers contribute to treatment delays, loss to follow-up, and increased economic burden.
Patient & Prescribing Data
People with hepatitis C infection in urban areas, stratified by insurance type (Medicare, Medicaid, private, uninsured).
Treatment rates are highest in Medicare (55%) and private insurance (48%), lower in Medicaid (32%), and lowest in uninsured (21%); overall, 66-69% remain untreated despite policy efforts.
Clinical Best Practices
Implement linkage-to-care case management programs to improve treatment engagement.
Advocate for policy changes removing prior authorization requirements across all insurance programs.
Integrate social support services addressing housing instability and substance use disorders within hepatitis C treatment programs.
