HIV-AIDS disease management program cuts costs, increases quality of life
Nurses visit with patients in the field
A disease management program for HIV-AIDS generated savings of $323.99 per member per month for the Florida Medicaid population.
The program cut down on the use of emergency room visits, hospital bed days, and overall costs, according to Frederic S. Goldstein, MHA, president of Specialty Disease Management Services Inc., the Jacksonville, FL-based company that developed and administered the program for two years.
Pharmaceutical costs increased, probably because the patients were filling their prescriptions and taking their prescribed medication properly, Goldstein adds.
"One of our goals was to get everybody on antiretroviral drugs and get them out of trouble," adds Judith A. White, RN, CCM, BHSA, director of operations.
The company was hired by the state to implement a disease management program for HIV-AIDS, Florida’s most expensive disease to treat. The contract was for 65 of 67 counties in Florida.
The program started with about 3,800 HIV-AIDS patients being serviced by Florida Medicaid. Initially, they were identified by claims screening and given the opportunity to participate in the HIV-AIDS disease management program.
The program is a combination of patient and physician education, clinical interventions, and collaboration with community service organizations, providers, family members, and patients.
"The real focus of the program is to empower the patients with enough information to manage themselves. What we saw as a success was when the nurses could pull away a little and allow the patients to make their own decisions," White adds.
Specialty Disease Management hired full-time nurses throughout Florida to work with the patients in the program. The nurses were highly trained in dealing with HIV-AIDS.
"Much of the area is rural. We had to have people out in the field. We couldn’t ask them to come into a metropolitan area," White says.
The nurses managing care for the HIV-AIDS patients began with a comprehensive assessment during a face-to-face meeting. "With asthma and other diseases, you can do phone interviews. We discourage it with HIV-AIDS because you can pick up many triggers by entering their environment," White says.
Because of confidentiality issues associated with HIV-AIDS, the program gave the patients 30 days to opt out of the program before they had to provide information to the nurses.
During the initial meeting, the nurses explained the program, got releases signed, and did a comprehensive clinical assessment that included a patient history, disease comorbidities, drug use, and lifestyle issues.
The nurses use a knowledge survey and other screening tools to determine how well the patients understand their disease. They collected information on the various physicians, pharmacies, hospitals, and case management organizations the patients were using or working with.
Nurses in the program spent a lot of time gathering information on the HIV-AIDS patients to ensure that they had complete information. They verified the information gathered in the patient assessment through the patients’ primary care providers under Florida Medicaid.
They often searched the medical records at multiple physician’s offices, gathering enough data to get an accurate picture of the patient.
"There was no way through the claims that they could know the blood test results. By examining pharmaceutical records, they knew what prescriptions were filled, but they didn’t know if the patient understood how to take the medicine or if they took it correctly," White points out.
The nurses developed a plan of care for each patient. The care plan depended on the patient. Some received personal visits every week. The nurses shared the care plan with the primary care physicians and with the community services case manager in some cases.
"It is critical that everybody understands what everybody else is doing so they can reinforce and collaborate," White says.
The nurses called the patients frequently, visited them in the hospital, and helped with discharge planning.
From a clinical approach, the goal was to concentrate on prevention measures that would help patients avoid the need for acute care. The nurses carefully monitored the prescription drug use of the patients. In some cases, they found that patients had demanded prescriptions for drugs that were not necessarily beneficial for them.
The program targeted some high-cost drugs that had not been appropriately prescribed. "Certain products are heavily marketed and are not necessarily inappropriate, but less-expensive pharmaceuticals showed similar results. It was a matter of educating the physicians and working with the state to change," Goldstein says.
The overall pharmaceutical costs went up as the patients began to take their medicine appropriately. "When we started, the medication problems ran the gamut from missing doses to just not filling the prescriptions," Goldstein says.
Other components of the program included monthly educational mailers to providers and patients, an intensive HIV educational program for providers with fewer than 30 patients, and one-on-one education for providers.
Results of HIV-AIDS DM Program in First Year
- Pharmacy utilization jumped from $722 to $877.
- Bed days in the hospital were reduced by 50%.
- Patient knowledge of disease, drugs, and treatment improved.
- Key tests increased. For instance, in the baseline year, there were .56 CD4 quantification tests performed per member. The next year, the figure jumped to 1.57. Viral load quantification tests jumped from .56 per member in the baseline year to 2.27 per member in the second year.
- Overall cost decreased by $323.99 per member per month.
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