Performance Improvement 2000. HIV/AIDS Services

01/01/2000

Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources

The purpose of this study is to compare demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Increasing demands for accountability, shifts in the populations affected by the HIV epidemic, and the development of effective combination therapies have been associated with increases in the number of people living with HIV who will need care for longer periods of time. While a great deal is known about the types of services and providers supported under the CARE Act, the demographic characteristics of, and services used by, patients are less clear because of a lack of client-level reporting mechanisms. The findings of this study will help to develop an empirical basis for program accountability and performance measurement.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Conviser, Richard
301-443-3075

PIC ID: 7123

PERFORMER: Johns Hopkins Medical Institutions
Baltimore, MD

EXPECTED DATE OF COMPLETION: 10/31/1999

HIV Service Utilization and Health Outcomes for PLWH with Comorbidities in RWCA-Funded Programs

The purpose of this study is to evaluate (a) the additional demands placed on the health care system by individuals living with HIV infection who have comorbid conditions and (b) the benefits and costs of integrating and coordinating treatment for these conditions. Two separate projects are underway. The Johns Hopkins University will describe and quantify the delivery of comorbidity services, compare this delivery with established guidelines and standards, and analyze the outcomes of the HIV infection and selected comorbidities (substance abuse, psychiatric illness, and hepatitis C). The Washington University School of Medicine will study comorbidities of adult and adolescent women with HIV. Conditions include chemical dependency, mental illness, TB, STD, cervical dysplasia and cancer, diabetes, hypertension, renal failure, and hepatitis B and C. Homelessness and encounters with the criminal justice system will also be explored. The project will analyze how many clients are receiving services for comorbid conditions and HIV, the standard of medical care for those with these conditions, and changes in this standard during 1996-1998. At least one publishable article is to discuss how grantees and planning bodies can use study findings to optimize the delivery of services under the Ryan White CARE Act.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Pounds, Moses B., P.hD.
301-443-2894

PIC ID: 7267

PERFORMER: Johns Hopkins University School of Medicine
Baltimore, MD and Washington University School of Medicine, St. Louis, MO

EXPECTED DATE OF COMPLETION: 09/30/2000

HIV/AIDS Cost Analysis and Development of Capitation Rate Methodology

The purposes of this study are to a) determine how utilization of services for people living with HIV (PLWH) is associated with comorbidities (especially substance abuse and mental illness); b) develop a method(s) for determining capitation rates for HIV/AIDS populations under Medicaid managed care systems (MCOs) that take comorbidities into account; and c) evaluate the impact of protease inhibitor combination therapy on care costs. Most capitation rates paid for people with HIV-- that has not yet developed into AIDS-- are substantially lower than the cost of care. High enrollments of PLWH place MCOs at financial risk. Preliminary studies in Maryland suggest that there is nearly as much variability in the costs of HIV care as there is in the costs of AIDS care; a key factor may be comorbidities that have a major impact on the cost of HIV care. This study will analyze Maryland State Medicaid data from FY 1997 to determine the extent to which comorbidities are associated with variations in demand for services. Evaluation will be made of rate setting methodologies that take into account comorbidities in determining per member, per month costs of treatment. Maryland's Medicaid reimbursement for protease inhibitors above capitation rates also will be assessed. The study will illuminate the possible need to factor comorbidities into capitation rate-setting methods and the adoption of special HIV as well as AIDS capitation rates for MCOs.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Conviser, Richard
301-443-3075

PIC ID: 7095

PERFORMER: Univ. of Maryland, Ctr. for Health Prog. Dev. Management
Baltimore, MD

EXPECTED DATE OF COMPLETION: 01/31/2000

Impact of RWCA Title I Funding on HIV Services Utilization and Health Outcomes in Las Vegas, Nevada and Norfolk, Virginia

The purpose of this collaborative project with CDC is to examine the impact of Ryan White CARE Act Title I funding on HIV service use and outcomes in newly eligible metropolitan areas (EMAs). Title I grants are expected to increase each EMA's financial base for planning, developing, and expanding HIV-related health and support services. This project will determine how these funds affect the availability, accessibility, quality, continuity, and integration of care, and HIV-related morbidity (e.g., the incidence of opportunistic infection) and mortality among underserved and vulnerable populations with HIV/AIDS. A cross-sectional pre- and post-analysis of the effects of Title I funding will be conducted in two new EMAs-- Las Vegas, Nevada and Norfolk- Newport News, Virginia. The analysis will provide additional information about the nature and magnitude of the impact of Ryan White program funding on health care services and outcomes for persons with HIV/AIDS.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Malitz, Faye
301-443-3259

PIC ID: 7215

PERFORMER: HIV/AIDS Bureau
Rockville MD

EXPECTED DATE OF COMPLETION: 09/30/2002

Population- and Data-Based Assessment of Unmet HIV Service Needs

The purpose of this 2-year study is to provide methods for Ryan White CARE Act planning bodies to assess unmet needs for HIV health and support services. Products are to include a qualitative and quantitative assessment of unmet needs for a particular catchment area covered by one or more CARE Act-supported programs in 1999. A complete description of a generalizable and suitable methodology for CARE Act programs to conduct these assessments is also to be provided. The catchment area analysis is expected to include an estimation of overall service needs and the degree to which existing private and public health insurance streams provide health and social services that meet these needs. Estimates are to be compared with catchment area service capacity and client perceptions of unmet need and barriers to care, which can include financial constraints, logistical problems, insufficient availability of services, and lack of provider experience.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Conviser, Richard
301-443-3075

PIC ID: 7105

PERFORMER: Partnership for Community Health
New York, NY

EXPECTED DATE OF COMPLETION: 09/30/2000