Disease Management and Medicaid Waiver Services for HIV/AIDS Patients. Conclusion


To date, there is no broad evidence base to support the assumption that disease management improves health outcomes and can reduce the cost of care for populations with multiple chronic illnesses. Most of the evidence currently available about DM is for diabetes, asthma, congestive health failure, and chronic obstructive pulmonary disease – primarily among commercial DM programs. Research on DM has not focused specifically on HIV/AIDS in Medicaid programs. Therefore, it is debatable whether DM can be an effective cost containment tool for Medicaid populations, who often have a high prevalence of co-occurring illnesses or mental health issues that make management of their conditions more complex. The research conducted to date offers limited evidence that DM can help improve health outcomes for some conditions; more investigation is needed regarding the specific program features, infrastructure, and techniques for provider coordination that are needed to provide the most cost-effective care for patients with multiple chronic conditions. Long-term studies are needed to assess the effectiveness of DM programs for Medicaid populations overall.

Until a cure for HIV is developed, DM may be a useful approach to improve care coordination and promote treatment compliance among HIV patients. CDC’s most recent estimates indicate that 1,106,400 adults and adolescents were living with HIV in the United States in 2006, an increase of 11 percent compared to 2003 HIV prevalence estimates. Considering the number of individuals living longer with HIV infection and the significant role Medicaid plays in providing HIV treatment, it will be important to monitor whether DM can help improve outcomes among enrollees with complex health conditions including HIV/AIDS. Studying DM in the HIV population may yield information about how to effectively manage combinations of comorbidities, including chronic diseases that become common with aging. Finally, studying DM for individuals with HIV may help determine the value that care coordination approaches offer beyond cost savings.

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