28 July 2026
In West Virginia, a patient can live just 10 miles from a healthcare service, yet still face an hour-long journey through winding mountain roads. Mobile phone coverage disappears. Internet access is unreliable. Public transport is almost non-existent. Even something as simple as calling a patient with test results can become a challenge.
For people living with hepatitis C, those realities can mean years without treatment, despite the availability of medicines that can cure the infection in as little as eight weeks.
For Dr Kyle Miller, a family physician and addiction medicine specialist serving as Director of Addiction Medicine at Community Care of West Virginia, and his team, the answer wasn’t asking patients to travel further.
It was redesigning healthcare so specialist hepatitis C care could be delivered closer to home through integrated primary care and telehealth.
Combined with recent policy reforms and support from a growing network of clinicians and researchers – including INHSU – the approach is helping reshape access to hepatitis C care across rural West Virginia.
Removing barriers before treatment even begins
Like many rural regions, West Virginia faces significant healthcare access challenges. Geography is only part of the equation.
Many communities have limited telecommunications infrastructure, poor internet connectivity and few transport options. One Community Care clinic even lands in the National Radio Quiet Zone – an area with restricted telecommunication services aimed to reduce interference for sensitive telescope equipment housed in the nearby Green Bank Observatory. For patients experiencing unstable housing, financial hardship or other social challenges, those obstacles become even greater.
Rather than expecting patients to travel to specialist services, Miller’s team developed a cross-site telehealth model that allows people to receive specialist hepatitis C care in their own community, regardless of where they live.
But the appointment doesn’t stop with hepatitis C. “You always seize the opportunity to do as much as you can at any given point,” Miller says. For patients who may struggle to access healthcare regularly, the team uses each visit to provide broader preventive care, vaccinations, counselling and follow-up planning alongside hepatitis C treatment. “We’ve really tried to make it as much of a one-stop shop as possible.”
Delivering the model required every clinic across the organisation to adapt. Nurses, peer workers, clinicians and managers redesigned workflows so patients could receive the same coordinated care regardless of which clinic they attended.
“Anytime you do something new, it prompts conversation,” Miller says. “We’ve built workflows around it internally… and now it’s gotten to a point where it’s been pretty seamless.”
The model of care has also enabled expanded capacity in treatment services for hepatitis C, with cross-site telehealth bringing not only convenience for the patient, but flexibility for the medical provider.
Rather than adhering to one provider’s rigid appointment availability – dictated by geographic proximity to the patient – instead, a network of treatment-capable providers’ schedules can be utilised.
Miller notes that Community Care recently achieved a milestone in which all the medical providers within the Addiction Medicine program have completed training on hepatitis C, fully integrating this element of care into specialised substance use disorder treatment. As such, since implementing the model in 2023, roughly 200 patients have completed treatment intake appointments, and thousands more have been screened for hepatitis C and HIV as part of Community Care’s broader primary care network.
Building the right network
While developing the model of care, Miller immersed himself in local, national and international networks working towards a common goal: eliminating hepatitis C.
Locally, mentors, including through the West Virginia Hepatitis Academic Mentoring Partnership, helped build his expertise both in hepatitis C treatment and in training clinicians to provide care, and provided the training and case-based support for the other clinicians on his team. Joining the state’s Hepatitis Elimination Technical Advisory Group (HETAG) brought together clinicians, researchers, state employees, and other stakeholders to tackle shared challenges.
Internationally, attending an INHSU Hepatitis C Intervention Symposium in Denver connected Miller with a broader network of clinicians, researchers and advocates, allowing for shared perspectives from differing health systems.
“Sometimes in medicine things move slowly and you’re timid to act,” he says. “But this is a space where I’ve felt supported from so many different angles.”
Those connections soon translated into practical action, when INHSU’s Programs and Policy Manager Olivia Dawson connected him with John Card, staff attorney at Harvard’s Center for Health Law and Policy Innovation, to develop a policy brief to advocate for the removal of prior authorisation for hepatitis C treatment.
Prior authorisation meant that before a patient could be prescribed treatment for hepatitis C, Medicaid needed to give authorisation.
“By then, the patient might have moved. They might have lost their cell phone service,” Miller says. “If you didn’t have that step, you could have been halfway through treatment.”
The good news is that – following advocacy from across the state – earlier this year, West Virginia Medicaid removed the requirement. Now, clinicians can prescribe treatment immediately rather than waiting weeks for approval.
“The policy changed before the brief we were working on was completed,” says Miller. “But it showed that success is not something that happens through one organisation or one person… It’s putting everything in motion at once.”
What’s next
While the model of care continues to evolve, Dr Miller voiced that the Community Care team – with support from the West Virginia Alliance for Creative Health Solutions – is now undertaking research to better understand why so many people in West Virginia live with hepatitis C for years before receiving treatment.
Early findings suggest practical barriers such as transport and access remain important, but so do relationships. Patients consistently value being treated in their own communities by healthcare providers they know and trust.
“Stigma also continues to play a significant role,” says Miller. “With some participants reporting they delayed treatment because they felt ashamed, judged or belittled when seeking healthcare.”
For Miller, the journey to improving hepatitis C care has never been about a single innovation. It has been about understanding local barriers, bringing the right people together and building solutions around the communities they serve.
“If someone wanted to build a similar model, I’d start by looking at the resource mapping side of things,” he says. “Where are the hurdles? Try to identify what those barriers are so you can be more targeted. And don’t be afraid to embrace technology, involve your staff from across the organisation, and have conversations to figure out a path that works.”
Involvement in the INHSU network
Since attending the INHSU Hepatitis C Intervention Symposium in Denver, Miller has continued to be involved in the INHSU network, recently joining the steering committee for the US Symposium Series.
“I didn’t know anyone in the room when I attended and met so many people who are dedicated to eliminating hepatitis C,” he says. ” Now, it feels like it really has come full circle, and I feel like I get to help make a little bit more impact too.”
