Public Health Emergency - Leading a Nation Prepared
This document includes promising practices and recommendations from Intermountain Healthcare’s success in proactively risk stratifying patients who would benefit from COVID-19 monoclonal antibody treatments. These findings provide inspiration and information to those working to build treatment awareness and increase monoclonal antibody utilization in a health system setting. The information below can supplement individual plans and provide context to playbooks and planning discussions with leadership.
When the U.S. Food and Drug Administration first issued an emergency use authorization for monoclonal antibody treatments, there was a high demand for these treatments, but infusion availability was scarce.
Intermountain Healthcare used a risk-adapted strategy to identify COVID-19 patients who were likely to benefit from monoclonal antibody treatment. With this risk-adapted approach, Intermountain Healthcare was able to prioritize high-risk patients and decrease the risk of being hospitalized with severe illness. As of June 2021, Intermountain Healthcare
screened and contacted 11,000 COVID-19 positive patients, of which 1,300 were infused within 62 hours of being tested for COVID-19. Intermountain Healthcare was able to achieve a 4% hospitalization rate of high-risk patients, reflecting a more than 50% relative risk reduction in many patients.
Like many health systems during COVID-19, Intermountain Healthcare was responsible for both ongoing care delivery and implementing public health measures including the use of monoclonal antibody treatments for COVID-19.
Uniquely, Intermountain Healthcare applied an equity lens to their risk-adapted strategy
by including data about geographic location, race, ethnicity, and gender. This type of equity strategy is now explicitly endorsed in the FDA Emergency Authorization Act document for Casirivimab/Imdevimab. This approach ensured that high-risk patients who are more likely to benefit from monoclonal antibody treatments were identified and had equitable access to treatment.
The following section provides key recommendations based on Intermountain Healthcare’s experience.
Creative Redeployment of Personnel Provided the Manpower to Connect
Patients with Treatment
redeployed under-utilized personnel to an internal monoclonal antibody “MAb Squad.” The MAb Squad
screened the list of positive test results daily to identify eligible patients and quickly connect them with treatment. This bypassed the need for a referral; therefore, the MAb Squad provided a connection to care for patients without a primary care provider.
Including Race and Ethnicity in Risk Models Enhances Care Equity
When co-developing the Utah COVID-19 Risk Score , Intermountain Healthcare included race, ethnicity, and gender in the risk modeling to ensure that those individuals who were comprising a larger portion of hospitalized patients would be identified for monoclonal antibody treatment.
Collaboration Among Infusion Sites Increased Infusion Capacity
Across the Region
Infusion availability is a limiting factor in monoclonal antibody treatment due to the need to separate COVID-19 positive patients. Intermountain Healthcare convened representatives from infusion centers, urgent cares (e.g., InstaCare Clinics in Utah) and emergency departments to establish a network of infusion sites who agreed to shift schedules, expand hours, and open additional sites. Of the available 27 sites, 10 were added with the goal to
increase geographic equity so that no patient had to drive more than 59 minutes to receive a monoclonal antibody treatment.
Intermountain is focused on sustainability moving forward. The “MAb Squad” has received continued support from their administration after its initial successes. With decreasing community transmission, Intermountain Healthcare will consider the program successful when providers are able to assess eligibility and fit monoclonal antibody treatments into a conventional prescribing framework.
Intermountain Healthcare hopes to start patients on the path to monoclonal antibody treatments earlier in their symptom course. They are moving towards a point-of-care delivery model which involves scaling up monoclonal antibody infusion availability in emergency departments and urgent cares, as well as preparing to deliver monoclonal antibodies in the home with their home care program.
Healthcare professionals involved in the monoclonal antibody treatment program at Intermountain Healthcare reported that their involvement was one of the most satisfying endeavors in their healthcare career. Health systems considering similar programs may find that this work generates a high sense of satisfaction and engagement among providers.
The recommendations in these promising practices document provide a foundation for other health systems using existing resources and risk prediction models to connect patients to monoclonal antibody treatment.
1. While co-developing the Utah COVID-19 Risk Score, Intermountain Healthcare sent a letter to the Office of Civil Rights citing the National Quality Forum Work Group 2014 recommendations  to account for race and ethnicity in risk models. Intermountain Healthcare recognized that this was important when the goal of the risk model is to improve equitable access to a treatment and avoid systematic disadvantage to populations that are at higher risk.
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