On The Cutting Edge

Since 2010, Dr. Melissa Badowski, Clinical Associate Professor, and Dr. Juliana Chan, Clinical Associate Professor, have been treating Illinois state prisoners affected by HIV and Hepatitis C with the help of modern video conferencing technology and other high-tech tools. The Illinois Department of Corrections (IDOC) Clinic with UI Health Telemedicine Clinic currently serves all of IDOC’s 26 correctional facilities, providing care to some 600 HIV patients and 100 Hepatitis C patients each year.

While an IDOC physician directs the diagnostic decisionmaking, Badowski and Chan – HIV and Hepatitis C experts, respectively – take the lead on education and medication plans, providing medication counseling, managing side effects and simplifying inmates’ regimens.

“We’re able to provide care to high-risk individuals who otherwise wouldn’t have had access to it,” Badowski says.

Those efforts have been, in a word, transformative. Prior to the Telemedicine Clinic’s debut, most Illinois prisons relied on one general practice doctor overseeing care to these vulnerable patients, a practice that often produced inefficient care and exposed other prisoners and correctional staff to health risks. With Badowski and Chan offering specialized care, however, treatment and results have endured a dramatic shift. Prior to Badowski’s arrival, for instance, 58 percent of HIV patients in the IDOC system were virologically suppressed. Today, Badowski’s work has pushed that near 100 percent.

“We’re providing high-quality subspecialty care that has improved quality of life as well as efficacy, safety and treatment,” says Badowski, adding that the Telemedicine Clinic’s efforts have also saved IDOC millions in healthcare costs each year and decreased viral load when individuals leave prison.

In the fast-rising telemedicine field, UIC’s innovative work has emerged a prominent early example of telemedicine’s potential to revolutionize care and spurred other healthcare institutions to develop similar programs.

“We’ve proven ourselves a leader in this growing field,” Badowski says, who, like Chan, regularly presents the Telemedicine Clinic’s work in professional forums.

Badowski and Chan also expose UIC students to the novel world of telemedicine. Both faculty members regularly host UIC residents in their clinics, while pharmacy students can participate in a telemedicine rotation or take an elective course in telemedicine designed to educate students on the intricacies of the still-blossoming service.

“We’re graduating students familiar with telemedicine and have many telling us that it’s proving to be a differentiator for them in the working world,” Badowski says.

Under the direction of clinical assistant professor Dr. Mat Thambi, RxCARES addresses transitions of care for high-risk medicine inpatients.

Established in 2011 to counter an unacceptably high number of discharge errors, the innovative program is designed to minimize medication errors and spur improved patient health. Once a program involving simple follow-up phone calls to patients, RxCARES has evolved into a more robust reconciliation program to ensure proper medication use during patients’ hospital stay and following their discharge.

“Transitions of care sound so easy, but can be so complicated,” Thambi says.

A six-week rotation for fourth-year Advanced Pharmacy Practice Experience students, RxCARES requires students to follow a specific medication management protocol for patients discharged from the hospital’s Internal Medicine service. The process includes creating detailed medication histories, resolving any medication list discrepancies, reviewing discharge plans and making follow-up phone calls to patients to assure medication and clinic adherence. Students also identify any potentially harmful interactions and suggest medication changes.

“Prior to RxCARES, errors just went unchecked,” says Thambi, who created the RxCARES program alongside colleague Dr. Adam Bursua.

In the 2016-2017 academic year, RxCARES served more than 450 patients, discovering some 1,000 errors and making more than 1,000 changes to patients’ pre-admission medication lists.

“We’re helping to ensure that patients are on the appropriate medications while in the hospital as well as at discharge, the latter being especially important given that patients will be taking those medications until their next doctor’s visit,” Thambi says.

Since its debut seven years ago, RxCARES has broadened its services to discharge counseling and prescription filling while also integrating automatic referrals into pharmacy-run clinics.

Thambi says the program provides valuable professional experience to students, allowing them to learn a structured approach to patient care and to better understand the pharmacist’s value in the healthcare ecosystem.

As similar efforts become more commonplace at healthcare institutions across the country, Thambi says many look to UIC for inspiration.

“Given how harmful and costly medication errors can be, I’m proud we’ve been able to be at the forefront of something that’s improving patient health while giving our students important training,” Thambi says.

Through a clinical incentive program offered by its largest commercial HMO payer, UI Health in the Internal Medicine Center pursued upwards of $700,000 in bonus earnings for hitting clinical benchmarks in diabetes and asthma. After some years of solid performance, financial earnings began sliding in 2013. That prompted UI Health leadership to bring Dr. Christine Foanio, a clinical pharmacist in Ambulatory Pharmacy Services, into the mix.

“The thinking was that a more interdisciplinary approach and the involvement of a clinical pharmacist could be particularly advantageous in managing these chronic disease states,” Foanio says.

She crafted a pragmatic program focused on direct interaction with the most vulnerable patients, including hour-long face-to-face visits, telephone calls and regular communication through a secure portal system.

“It’s difficult for physicians to manage these conditions in a brief 20-minute office visit, so we initiated more direct intervention with patients to get them the care, feedback and direction they needed in a much more targeted visit,” Foanio says.

With Foanio’s involvement sparking a jump in performance incentives, UI Health added a second clinical pharmacist, Dr. Kelly Schmidt, and extended the program to include hypertension in 2016. Today, Foanio and Schmidt oversee a pool of some 1,200 patients with diabetes, 5,000 with hypertension and another 200 with asthma, providing hands-on care that has improved patient outcomes and helped UI Health meet its partner’s incentive benchmarks. Since 2013, in fact, the overall financial yield of the quality contract has more than doubled, leaping from 28 percent to 58 percent.

“This is really one of the only programs linking pharmacy intervention to dollars earned,” Foanio says, adding that UI Health has thus far devoted incentive earnings to various patient care initiatives.

And by regularly including pharmacy students and residents in their work – students, for example, attend managed care meetings, learn how to risk-stratify patients and execute protocols that close gaps in care – Foanio and Schmidt provide trainees a unique opportunity to understand the increasingly important linkages between clinical care and finances.

“With the healthcare model trending more and more toward value-based care, this is a prime example of how the involvement of pharmacists can add significant value to patients as well as to multidisciplinary healthcare teams,” Foanio says. �