Strengthening LAI Prep Care with EHR Optimization at Callen-Lorde Community Health Center

Summary

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Podcast Summary: Strengthening LAI Prep Care with EHR Optimization at Callen-Lorde Community Health Center

Becker’s Healthcare Podcast | December 12, 2025
Host: Lucas Voss (Becker’s Healthcare)
Guest: Steven Sugimara, Director of the LAI Program at Callen-Lorde Community Health Center

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Episode Overview

This episode delves into how Callen-Lorde Community Health Center is leveraging Electronic Health Records (EHR) to tackle the complex operational challenges of delivering Long-Acting Injectable PrEP (LAI PrEP) care to vulnerable and underserved LGBTQ+ communities. Guest Steven Sugimara shares actionable insights on insurance navigation, workflow optimization, multidisciplinary collaboration, and the transformative impact on patient access and outcomes.

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Key Discussion Points & Insights

1. Introduction to Steven Sugimara and Callen-Lorde’s Mission

• Background: Steven Sugimara outlines his public health experience focusing on sexual minority and vulnerable populations, and his current efforts directing the LAI program at Callen-Lorde (00:43).
• Mission: “We provide welcoming and supportive health care for the LGBTQ community all across New York City, regardless of their ability to pay.” — Steven Sugimara (00:53)
• Approach: Passion for improving outcomes for underserved populations through data innovation and community partnerships.

2. Major Barriers to LAI PrEP Access

Steven describes a web of challenges in delivering LAI PrEP care, specifically for populations facing economic and insurance instability (01:38–03:33):

• Reimbursement Complexity:

  • Different insurance plans with varied prior authorization requirements
  • Inconsistent policies between pharmacy and medical benefits
  • “Plans appear to resist...with hurdles like prior authorization.” (02:26)

• Credentialing & Scheduling:

  • PCP alignment required by insurers
  • Coverage gaps for underinsured patients—especially those frequently losing coverage due to job loss
  • High reliance on Medicaid, with monthly verification needs (02:55)

• High Denial Rates:

  • “We’re seeing denial rates well beyond what we typically see for other procedures or injections.” (03:25)
  • Payers delay approvals, risking the clinic having to cover the cost

3. Workflow Streamlining via EHR Optimization

To address operational complexity, Steven describes a systematic approach to improvement (03:53–05:35):

• LAI Optimization Workgroup:

  • Cross-functional group with clinical, leadership, billing, scheduling, and IT representation
  • Regular meetings to identify bottlenecks and standardize care processes

• Standardized Templates & Documentation:

  • Moved from using multiple cumbersome Excel spreadsheets to a unified EHR template
  • Template includes:
    • Initial LAI PrEP prescription
    • Integrated insurance verification
    • Internal referral system
    • Clinical checklist for eligibility and patient education

• Impact:

  • “Following this optimization, we saw a 150% increase in weekly LAI appointments—doubling the number of patients initiated on LAI PrEP and persisting.” (05:28)
  • Drastically reduced time from referral to LAI initiation: “...from months to about 14 days.” (05:32)

4. Game-Changing EHR Tools: Electronic Prior Authorization & Medication Records

Steven highlights powerful EHR features that made staff jobs easier and expedited patient care (06:04–06:42):

• Electronic Prior Authorizations:

  • Real-time processing and data auto-population reduce staff workload and patient wait times
  • “This has significantly decreased staff burden while improving patient experience as patients wait less time to be initiated on LAI.” (06:20)

• Medication Administration Record (MAR) Integration:

  • Enables providers to instantly check for drug-drug interactions as part of the LAI screening process

5. The Human & Collaborative Element

The success of the LAI PrEP program depends on seamless teamwork (07:18–08:03):

• Multidisciplinary Coordination:

  • Frequent team huddles (“twice weekly to review all upcoming LAI appointments”)
  • Proactive identification and resolution of potential care or coverage barriers

• Quotes:

  • “Collaboration transforms a program from a set of siloed services to a well-coordinated comprehensive prevention system.” (07:38)
  • Results: improved access, higher patient satisfaction, stronger adherence, and measurable community health impact

6. The Big Picture: EHR Optimization as a Model for Innovation & Equity

Steven closes with a broader perspective on technology as a driver of public health (08:24–09:05):

• Not Just Tech for Tech’s Sake:

  • “Leveraging electronic health records isn’t about technology for its own sake. It’s about making sure people who could benefit from long acting PrEP don’t fall through the cracks.” (08:26)

• Model for Prevention & Equity:

  • EHR-driven coordination can serve as a template for equitable access to preventive care in other domains
  • Emphasizes need for continuous teamwork between all stakeholders, including data and clinical teams, pharmacists, and community organizations

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Notable Quotes & Timestamps

• “Plans appear to resist this with hurdles like prior authorization.” — Steven Sugimara (02:26)
• “We’re seeing denial rates well beyond what we typically see for other procedures or injections.” — Steven Sugimara (03:25)
• “Following this optimization, we saw a 150% increase in weekly LAI appointments... doubling the number of patients initiated on LAI PrEP.” — Steven Sugimara (05:28)
• “This has significantly decreased staff burden while improving patient experience as patients wait less time to be initiated on LAI.” — Steven Sugimara (06:20)
• “Collaboration transforms a program from a set of siloed services to a well-coordinated comprehensive prevention system.” — Steven Sugimara (07:38)
• “EHR-based coordination for long acting PrEP can serve as a model for how we use data and integration to close gaps and access across many preventive services.” — Steven Sugimara (08:35)

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Important Segments & Timestamps

• Introductions & Background: (00:32–01:38)
• Key Challenges in LAI PrEP Care Delivery: (01:38–03:33)
• Steps to Optimize Workflows via EHR: (03:53–05:35)
• EHR Tools Driving Impact: (06:04–06:42)
• Importance of Team Collaboration: (07:18–08:03)
• Closing Reflections on Tech & Equity: (08:24–09:05)

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Tone & Language

The conversation balances pragmatic, operational details with an empathetic, community-focused outlook. Steven blends technical expertise with a passion for health equity, while Lucas prompts practical insight and context. The tone is collaborative, optimistic, and solutions-oriented.

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Takeaway

Callen-Lorde Community Health Center’s success with LAI PrEP program optimization demonstrates the transformative potential of well-designed EHR workflows, cross-departmental collaboration, and a relentless focus on patient equity. Their model showcases how technology and teamwork can de-complicate access to vital preventive health services—offering lessons for all healthcare organizations serving marginalized communities.

Transcript

[A]

Hi everyone, this is Lucas Voss with Becker's Healthcare. Thanks so much for tuning in to the Becker's Healthcare podcast series. Great to have you. We are talking about how provider organizations are leveraging EHRs and EMRs to coordinate care and navigate insurance requirements for HIV prep patients prescribed long acting injectables or LAIs. And joining me for today's discussion, very excited to have him, is Steven Sugimara and he's the director of the LAI program at Kellan Lore Community Health Center. Steven, thanks so much for being here today. It's great to you.

[B]

Thanks Lucas, for having me excited.

[A]

Absolutely. I want to start off with introductions for the audience that might not know you yet, at least to kick us off if you want to just share a little bit about yourself and your work in healthcare.

[B]

Sure. So I am a public health professional with a background working with and alongside sexual minority and vulnerable populations. As you mentioned. I'm currently the director of the Long Acting Injectors program at Calenlor Community Health center where we provide welcoming and supportive health care for the LGBTQ community all across New York City, regardless of regardless of their ability to pay. I was most recently the deputy director of an NIH funded AIDS research center at Columbia University and the New York State Psychiatric Institute. And prior to that I was engaged in HIV and emerging infectious disease surveillance in the greater Atlanta area. I also have significant experience supervising intensive HIV case management and care coordination programs in New York City, particularly those accessing care at New York Presbyterian Hospital and the former St. Vincent's Hospital. My work is always centered on advancing health equity and I'm passionate about using data innovation and community partnerships to improve outcomes for underserved populations.

[A]

And I love to have you on for this conversation specifically because of all of your experience, more than anybody, really. I think you know all of these complex operational challenges that patients on LAI Prep really face. They are complex and multifaceted. Dose timing, insurance, navigation, obviously scheduling right before optimizing your EHR workflows. What were some of the biggest pain points that you and your team encountered in coordinating care for these patients?

[B]

Yeah, so like you went through, there are a number of barriers to LAI access in practices like Callen Lorde. I would say first and foremost is reimbursement complexity. There are a number of commercial health plans, each with multiple lines of business that have different rules and policies within them. In New York State, we bill as a pharmacy or medical benefit. If medical benefit, we're able to utilize the 340B savings that support administrative and clinical burden. But plans appear to resist this with hurdles like prior authorization. There's also variation in the length of authorization across payers and lines of business. We found that LIs also exacerbate credentialing challenges. So sometimes that requires a PCP alignment or the PCB listed on the patient's insurance must match the provider they're seeing for the injection visit. One thing that we tend to keep an eye on are coverage gaps, especially in our current economic state. Many folks are underinsured or uninsured or will be expecting a job loss and losing their employer based insurance which can make adherence and persistence difficult to manage. About half the patients that we see are on Medicaid plans, so that must be checked on the 1st of every month to ensure the plans weren't terminated the day prior. And lastly, we're seeing denial rates well beyond what we typically see for other procedures or injections. And it seems that payers will attempt to run out the close to avoid the PEELS processes running the risk that we eat the cost of the injections.

[A]

Yeah, you mentioned coverage gaps there and certainly some of the other elements here that are very tied to complex workflows that are tied to very sometimes labor intensive workflows. What are some of the steps that you and your team took to streamline some of this to make workflows easier within the EHR or emr?

[B]

Right, yeah. So it became quickly evident that complex systems would slow the adoption of LAI Prep. So if we wanted our program to grow, we we needed to leverage our resources to optimize our workflows. So we created an LII optimization workgroup comprising cross departmental experts meeting weekly and ad hoc as needed. And this workgroup had representation from senior and clinical leadership as well as billing operations and scheduling and also it. So some of the immediate challenges we wanted to address included inconsistent documentation. So the templates we were using and the alerts within our electronic health record were not standardized. Only a few providers were trained to conduct our eligibility screenings at the time. And insurance verification processes took a lot of time per patient and per appointments approximately 20 to 40 minutes. So we wanted to avoid any duplicative efforts. And we were relying on about five to six separate Excel spreadsheets which became cumbersome. So we decided to optimize a pre existing template within our electronic health record. This template puts all the tools that a provider needs to complete a specific visit into a single screen which increases workflow efficacy and speed. Our template includes the initial LAI Prep prescription for insurance verification, an internal referral for tracking and a Clinical checklist which guides a provider in documenting and screening what's needed while including baseline requirements to familiarize the patient. In the process of being on LAIs. And following this optimization, we saw 150% increase in weekly LAI appointments. Well, by the time of this recording, doubling the number of patients initiated on LAI prep and persisting. Also importantly, our time from referral to LAI initiation went from months to about 14 days.

[A]

Again. So interesting because you have the direct impact on patient access and on obviously the benefits that patients have through the optimization, which is key not only from an organizational perspective, but also for your community, which is crucial. You spoke a little bit about the templates and some of the centralizations. If we dive into that more in specifics, how did tools like electronic prior authorizations or we also have enhanced medication administration records, et cetera, change your day.

[B]

To day operations then Electronic prior authorizations are really, really helpful because they can be initiated and processed directly through our ehr. Requests can be auto populated with patient and prescription data and responses occur in real time. And this has significantly decreased staff burden while improving patient existence experience as patients wait less time to be initiated on lai. We've also incorporated the medication administration record in our screening tool that I mentioned. So if a patient is interested in the latest LAI Prep product, this product has known to have some drug drug interaction. So it's critical that the provider can review the MAR in real time when making a referral.

[A]

Yeah, certainly adds to the process as well. I want to talk a little bit about the human side of things here, the human element of all of this, because it's certainly key, especially when we're optimiz and we're changing things around. Coordinating prep LAI care. Often, you know, it involves multidisciplinary teams, multiple system touchpoints as you've just outlined. Can you share how collaboration across those teams supported all of this optimization that you just highlighted and what kind of impact you've seen? You've already highlighted some of the numbers which are incredible. But what has this done for you?

[B]

Yes, coordinating an LI Prep program absolutely requires collaboration among clinical, pharmacy, nursing care coordination, outreach and administration teams. The list goes on really. Everyone plays a role in ensuring our patients move seamlessly the process from education and eligibility to initiation, adherence and retention. Currently, our broader LAI team meets twice weekly to review all upcoming LAI appointments to ensure all potential barriers to care and coverage are addressed before our patients even come in to see us. So collaboration transforms a program from a set of siloed services to a well coordinated comprehensive prevention system. This has led to improved access, higher patient satisfaction, stronger adherence and persistence and a measurable public health impact.

[A]

Really, truly a more proactive approach which then again, as we've talked about, really impacts the patients, the communities, which is crucial and a key part of these optimizations. Steven, it's so fantastic to have you on. I want to leave you with the floor here, so to speak. Anything else that we haven't touched on that you'd want to share with our listeners?

[B]

Yeah, just, you know, just overall summarize that Leveraging electronic health records isn't about technology for its own sake. It's about making sure people who could benefit from long acting prep don't fall through the cracks. When we design these systems thoughtfully, we make prevention easier, more equitable and more sustainable. And it's a really exciting moment right now for HIV prevention. EHR based coordination for long acting prep can serve as a model for how we use data and integration to close gaps and access across many preventive services. And again, none of this happens in isolation. It takes collaboration between clinicians, data teams, pharmacists and community partners. So I'd encourage anyone working in these spaces to think about how their systems can help make innovation and equity go hand in hand.

[A]

Stephen, so great to have you on. Thanks for your time and insights today.

[B]

Thank you so much.

[A]

It's great to have you. And I'd also like to thank our sponsor, Gilead Sciences. You could tune into more podcasts from Becker's Healthcare by visiting our podcast page at beckershospitalreview.

[B]

Com.