Episode Overview

Title: Streamlining Long Acting Injectable PrEP Through Teamwork and Smarter Workflows
Podcast: Becker’s Healthcare Podcast
Host: Lucas Vaz, Becker's Healthcare
Guest: Dr. Stephen K. Barnett, Senior Vice President Medical Services and Chief Medical Officer, CAN Community Health
Date: December 3, 2025

This episode explores how CAN Community Health is overcoming the logistical, clinical, and administrative complexities of delivering long-acting injectable pre-exposure prophylaxis (PrEP) for HIV. Dr. Barnett shares practical lessons in optimizing EHR/EMR workflows, cross-functional teamwork, and insurance navigation to improve patient access and care continuity, informed by hard-won experience across their multi-state clinic network.

Key Discussion Points & Insights

1. Background and Importance of LAI PrEP (00:33–02:44)

• Dr. Barnett describes his healthcare journey, emphasizing a commitment to underserved populations and evolving from general practice to HIV specialty care.
  • Notable Quote:

    “In a situation like that, we had four doctors for about a population of 40,000… The HIV epidemic was in its early stages and I did have to rely on infectious disease to help me with my patients… learned about HIV, became an HIV specialist so I could care for those people in that community without specialists around.” — Dr. Stephen Barnett [01:38]

2. Initial Pain Points with Long-Acting Injectables (02:44–07:10)

• Insurance Approval: The most persistent barrier is payer coverage, lengthening initial patient onboarding by 4–6 months.
• Medication Logistics: Early workflow required patient-specific shipments, risking drug waste and financial loss if patients missed appointments.
• Scheduling Challenges: Tight dosing windows increase pressure to reschedule quickly or restart the series.
• Frequent Visits: LAI PrEP requires more frequent labs and visits than oral PrEP, creating potential cost and adherence barriers.
  • Notable Quote:

    “The challenge was when someone didn’t show up for their scheduled injection… we have maybe seven days to get them in, or that prescription, you know, potentially couldn’t be used, is sent specifically for that patient… So it’s really a lot of stress and strain for those that just didn’t come.” — Dr. Stephen Barnett [04:14]

3. Workflow Optimization with EHR/EMR (07:10–10:14)

• Team-Based Approach: Nurses, case managers, and patient experience staff coordinated effort, leveraging EMR tools.
• Action Tracking: Implementation of “actions” and structured data tracks process checkpoints, e.g., prior authorization status (“good to go”).
• Pre-scheduled Appointments: Scheduling all future injection visits in advance supports adherence.
• Multi-channel Reminders: Use of portal messages and phone calls—especially for high-risk missed appointments—minimizes no-shows and wasted medication.
  • Notable Quote:

    “We use our EMR heavily to track and assist and remind and things like that. And that’s… been a big help for us.” — Dr. Stephen Barnett [09:54]

4. The Impact of Electronic Prior Authorization (ePA) and Enhanced Medication Administration Records (10:14–13:15)

• ePA Systems: Partner manufacturer platforms enable digital benefit verification and streamline submissions.
• Process Safeguards: Despite automation, cross-checks with insurers are standard to prevent claim denials.
• Pharmacy vs. Medical Benefit Handling: Dr. Barnett details logistical differences and coordination with pharmacies and third-party tools like Cover My Meds.
  • Notable Quote:

    “We have found though insurances change and it’s hard to keep up. So we typically try to follow that up with an actual call to the payer, the insurance company and confirm it… Once we get that, we can absolutely proceed.” — Dr. Stephen Barnett [11:57]

5. The Human Element: Team Collaboration and Lessons Learned (13:15–16:29)

• Learning from Failures: Early missteps prompted the development of white papers and the formalization of cross-team processes.
• Centralization: A central team oversees authorization and coordination, supporting clinical staff across 30 clinics in six states.
• Continuous Improvement: Structured EMR data and analytics (e.g., Power BI) help identify bottlenecks and standardize best practices.
  • Notable Quote:

    “It took going through that and our hope is that, you know, others can learn from our lived experience, which was not always pretty, to be able to optimize this and not have to go through those pain points that we went through.” — Dr. Stephen Barnett [14:16]

Memorable Moments & Quotes

• On the nature of care improvement:
  “We realized over that early period is that we needed a team approach to this and we had to have the nursing team and the providers on the ground being very cognizant of the process and… following it.” — Dr. Stephen Barnett [07:40]

• On leveraging technology and human effort:
  “That communication within the EMR is kind of the mainstay of how we can do this… We actually have about 30 clinics in six states, and if each clinic is trying to master this by themselves, it’s much more complex.” — Dr. Stephen Barnett [15:41]

Timestamps for Key Segments

• 00:33–02:44: Introduction & Dr. Barnett’s background
• 03:28–07:10: Pain points before EHR workflow optimization
• 07:38–10:14: Streamlining clinical workflows and team coordination
• 10:14–13:15: Role of electronic prior authorizations and MARs
• 13:41–16:29: Importance of collaboration, process evolution, and data-driven refinement

Conclusion

This episode offers a practical roadmap for healthcare organizations seeking to implement long-acting injectable PrEP. Dr. Barnett candidly describes the obstacles faced—insurance hurdles, missed appointments, and medication handling—before revealing how multidisciplinary teamwork and smarter, technology-enabled workflows have significantly improved patient care and organizational efficiency. His message is clear: the blend of structured data, ongoing process analysis, and strong collaboration is essential to navigating the complexities of modern HIV prevention.