Los Angeles County’s Covid-19 Test-to-Treat Program With Healthvana Successfully Reaches Underserved Populations by Leveraging Technology

The Los Angeles County Department of Public Health, Stanford University researchers, and Healthvana, a patient engagement technology platform, are published in the March 2023 issue of NEJM Catalyst - “Streamlining Test-to-Treat: A Novel Care Delivery Model for Oral Antiviral Access to Close the Equity Divide in Los Angeles County.” (Full study + key takeaways: https://catalyst.nejm.org/doi/full/10.1056/CAT.22.0328)

The Los Angeles County Department of Public Health and Healthvana piloted an innovative treatment-dispensing model, cost-free to patients, to address inequitable access, complex care costs, and the time-sensitive nature of Covid-19 medication prescriptions. The intervention successfully combined confidential digital delivery of test results, antiviral education, and direct access to therapeutics within hours of a positive test result.

“Thanks to this innovative approach, people living in disproportionately impacted communities were able to access free services within hours after receiving a positive test. This helped people get well and undoubtedly kept people out of the hospitals and saved lives,” said Dr. Barbara Ferrer, Ph.D., M.P.H., M.Ed., Director of the Los Angeles County Department of Public Health. “The Los Angeles County Department of Public Health is committed to addressing racial and economic inequities by bridging service gaps and this program helped us improve access to life-saving services in the midst of a deadly pandemic. I want to thank our partners at Healthvana for providing timely information about our telehealth services to residents and workers living in under-resourced communities.”

The study notes equitable public health solutions targeting underserved communities are unlikely to come from the same health care infrastructure that initially created them.

“Successful public-private partnerships like this can be replicated by local, state, and federal leaders, with the goal of reimagining how to reach at-risk populations with more streamlined solutions that leverage technologies we all use every day,” said Nirav R. Shah, MD, MPH, Senior Scholar, Clinical Excellence Research Center, Stanford University School of Medicine.

One of the key takeaways from the publication was ‘meeting people where they are’ and coupling it with the rapid roll-out and real-time iteration. That’s what will make the future of public health successful.

"The largest county in the U.S. made getting Paxlovid as easy as ordering a pizza - bringing access to populations that have traditionally not been reached," said Ramin Bastani, CEO of Healthvana. "Programs like these show the future of public health. A future where the power of technology is leveraged to reach people at the highest risk and that helps them navigate toward better health. A future where patient trust is earned - one positive interaction at a time. A future where focusing on at-risk and underserved populations is not only the right thing to do but also saves considerable money. In this case, one Covid-19 hospitalization costs about $500,000 in California (according to Becker’s Hospital Review), while the cost of each intervention in this program was relatively minuscule. That's a big win-win. Our team is grateful for the innovative leaders from the Los Angeles County Department of Public Health that enabled the program and to the researchers at Stanford University."

Program details: access to antivirals directly from a positive result, free telehealth services in over 60 languages

• For individuals who completed a free PCR test at dedicated Los Angeles County Department of Public Health testing sites, Healthvana delivered confidential test results through email and/or text messages.
• Positive patients were provided the option to “Get Treatment” via a large button on the same screen as the patient’s positive result, and residents were directed to call the Los Angeles County Department of Public Health Telehealth Call Center for a nurse or physician consultation (available in over 60 languages).
• Prescriptions were available at the patient’s choice of pharmacy or were delivered to the home by overnight mail from the Los Angeles County Department of Public Health pharmacy.

Program results: 1 in 15 patients who saw their positive test result received an antiviral prescription

• During the study period, this care model delivered over 25,000 PCR-positive test results from over 75 Los Angeles County Department of Public Health test sites and enabled patients to connect with a clinician within hours; nearly 1,500 patients received a prescription for antivirals.
• 90% of patients lived in the highest-vulnerability zip codes as identified by the Los Angeles County Department of Public Health.
• The median time between a patient receiving their result notification via Healthvana and clicking the “Get Treatment” button was 6.25 hours (375 minutes), allowing patients to quickly begin the process to receive their antiviral medication. (This is critical, as time is of the essence with Covid-19 antivirals, which must be taken within 5 days of the first symptoms.)

Study impact: lives saved, long-COVID, 100x healthcare system cost savings

• The test-to-treat program focused on providing antiviral access to high-priority communities in Los Angeles County; the poorest zip codes have a 2x risk of death: "Hospitalization and death rates are nearly double for people living in the county’s poorest neighborhoods compared to those residing in the wealthiest neighborhoods." (Los Angeles County Department of Public Health Email)
• Los Angeles County Department of Public Health’s overall program cost was considered nominal compared with the average hospitalization cost to manage a single case in California, which ranged from about $111,213 (non-complex) to $461,780 (complex). Program costs include part of the Los Angeles County Department of Public Health clinician salaries, the phone banking salaries, and the Healthvana program costs which are estimated to be less than the treatment of a single hospitalized complex case.
• The longer-term impacts of access to Paxlovid on long-Covid are still being studied; however early data suggests that not receiving antivirals could have compounding effects over time, resulting in worse long-term health outcomes for the individual and increased national healthcare costs over time.

About Healthvana

Healthvana makes healthcare better for patients. The company’s engagement platform is used to manage and communicate with patient populations, leading to better health outcomes and lower costs. Since 2015 the company has delivered over 50 million health records to patients across the U.S. Healthvana’s work has been featured everywhere from Fox News to The New York Times, and at the White House. For more information, visit www.Healthvana.com.

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