An Email Coaching Option Increases Participant Program Utilization and Coach Productivity

Purpose To assess impact of adding an email option to phone-based coaching on the number of coaching sessions completed. Design Retrospective analysis of a change in program design. Setting A health plan health and wellness coaching service. Subjects Six thousand six hundred twenty four individuals who scheduled at least one coaching session. Intervention Adding an email option to phone coaching May 1 to August 31, 2020. Measures Association of a participant using an email coaching option with completing 3 coaching sessions; overall number of participants completing 3 coaching sessions when email is offered; participant satisfaction rates; and, average number of participants coached per coach by month. Analysis χ2; linear and logistic regression with gender, age, and education as covariates. Results When we offered email coaching, 29.6% of eligible participants used the option, and compared with the same months the prior year, the proportion of participants completing 3 sessions during those months was higher (73% vs 67%). ( P < .0001) 96.5% of participants who used email, vs 92.0% who did not, completed 3 sessions before their employer’s benefit qualifying deadline. ( P < .0001) More than 85% who responded to the email coaching survey expressed satisfaction. On average, each coach served 43% (486 vs 340) more participants per month when we offered email coaching. ( P < .0001). Conclusion Adding email coaching to phone coaching can increase program utilization by individuals who use email, increase overall program utilization, generate high levels of participant satisfaction, and increase the number of participants served per coach.

Personal Digital Health Assistants

Personal Digital Health Assistants (PDHA) are applications that can run on virtually any computer or mobile device including a smart phone/ personal digital assistant (PDA). A PDHA acquires, stores, and analyzes health related information of an individual. It usually communicates with remote servers of a large organization which can connect it to various resources. PDHAs are an integral part of telehealth. Their utility has increased manyfold since the start of the pandemic. The systems are increasingly more complex and are involved in all aspects of care. The PDHA are usually utilized by patients or their caregivers with assistance from professionals. Many automated systems can be utilized free of charge. Some are available as part of a prepaid health plan.

Virtual Interdisciplinary Collaboration in Statewide Implementation of the MIND at Home Dementia Care Program

MIND at Home, a well-researched holistic, family-centered dementia care coordination program, provides collaborative support to community-dwelling persons living with dementia (PLWD) and their informal care partners (CP). Through comprehensive home-based assessment of 13 memory-care domains covering PLWD and CPs, individualized care plans are created, implemented, monitored, and revised over the course of the illness. Non-clinical Memory Care Coordinators (MCCs) working with an interdisciplinary team provide education and coaching to PLWD and their identified CP, and serve as a critical liaison and resource and between families, medical professional, and formal and informal community resources. This paper will describe a statewide pilot implementation of the program within a health plan across diverse sites in Texas and will present qualitative and quantitative descriptions of a key component of the program's effective translation to practice, the virtual collaborative case-based learning sessions. Health plan teams completed online interactive training modules and an intensive in-person case-based training with the Johns Hopkins team prior to program launch, and then engaged in weekly, hour-long virtual collaborative sessions that included health plan teams (site-based field teams, health plan clinical supervisory and specialty personnel [RNs, pharmacists, a geriatric psychiatrist, behavioral health specialists] and Johns Hopkins MIND program experts and geriatric psychiatrists. To date, the program has enrolled 350 health plan members, conducted 65 virtual collaborative sessions, and provided 423 CME/CEU units to team members. We will provide an overview of virtual collaborative session structure, participant contributions and discussion topics, case complexity, as well as didactic learning topics covered.

870. Coverage, Cost Sharing, and Out-of-Pocket Costs for Single-Tablet HIV Antiretroviral Regimens in Qualified Health Plans in the United States, 2018-2020

Background A key pillar of the US “Ending the HIV Epidemic” (EHE) plan is rapidly providing antiretroviral therapy (ART) to achieve viral suppression. However, access to ART is hindered by discriminatory benefit design through non-coverage, adverse tiering (including pricier cost sharing via coinsurance instead of copays), and excessive and arbitrary utilization management for ART, all of which make rapid access to HIV treatment challenging. To understand how ACA Qualified Health Plan (QHP) formularies adapt in response to new ART single tablet regimens (STRs), we analyzed QHP coverage of two first-line STRs: dolutegravir/abacavir/lamivudine (Triumeq; approved 2014) and bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy; approved 2018). Methods For all QHPs offered in the 2018-2020 ACA Marketplaces, we analyzed Biktarvy and Triumeq coverage, cost sharing, and out-of-pocket (OOP) costs at state, regional, and EHE priority jurisdiction levels. Figure 1. Qualified Health Plan Coverage of Triumeq and Biktarvy by State, 2018-2020 Results For 2018, 2019, and 2020, respectively, we identified 19,533, 17,007, and 21,547 QHPs. In 2018, 26 states had &lt; 50% of QHPs covering Biktarvy, and 9 states had 0%. Conversely, 41 states had 100% of QHPs covering Triumeq, and only 2 states had &lt; 50% (Fig. 1). Biktarvy coverage improved from 2018-2020, especially in the Midwest (27% to 88%). Improvements were driven by increased coverage with copay except in the South, where coverage with copay remained stagnant and coverage with coinsurance increased (22% to 33%) (Fig. 2). Biktarvy coverage increased in EHE jurisdictions from 74% to 90%, driven by increased coverage with coinsurance (20% to 34%) (Fig. 3). Although Biktarvy had a higher national average wholesale price than Triumeq (&4,073 vs. &3,639 per month in 2020, respectively), monthly OOP cost trends only differed regionally in the Midwest and did not differ by EHE priority jurisdiction status (Fig. 4). Figure 2. Qualified Health Plan Coverage and Cost Sharing for Triumeq and Biktarvy by Region, 2018-2020 Figure 3. Qualified Health Plan Coverage and Cost Sharing for Triumeq and Biktarvy by “Ending the HIV Epidemic” Priority Jurisdiction Status, 2018-2020 Figure 4. Monthly Out-of-Pocket Cost for Qualified Health Plan Premium and Triumeq or Biktarvy by Cost Sharing Type and (A) Region or (B) “Ending the HIV Epidemic” Priority Jurisdiction Status, 2018-2020 Conclusion STR coverage remains heterogenous across the United States. Over time, coverage of the newer STR increased, but many QHPs in EHE jurisdictions still required coinsurance. Access to newer ART regimens may be slowed by delayed QHP coverage or complex negotiations with manufacturers about formulary inclusion as ART options become more competitive, even if patients are insulated from cost differences. Disclosures Kathleen A. McManus, MD, MSCR, Gilead Sciences, Inc. (Research Grant or Support, Shareholder)