Florida program offers disease management for HIV
Medicaid clients are automatically enrolled and allowed to opt out
Florida has launched a novel statewide disease management program in order to provide patients with a better continuum of care and make the state’s Medicaid funding for HIV/AIDS more cost-effective.
The program, funded with about $9 million from the state, will track health care services for about 7,500 Floridians who have HIV and who qualify for the state’s Medicaid program.
The program, Positive Healthcare/ Florida, was created by the AIDS Healthcare Foundation of Los Angeles, which has a contract with the state’s Agency for Health Care Administration.
AIDS Healthcare Foundation is a nonprofit, community-based provider of AIDS care in California, and the organization has the first and largest Medicaid capitation demonstration project for AIDS. The foundation has established a managed care type of health services model for Florida.
HIV-infected enrollees receive health care coverage from the state’s Medicaid program. The program’s goal is to keep HIV patients healthier with fewer hospital admissions or emergency room visits.
"We’re applying a level of scrutiny and different interventions to HIV care under Medicaid, and we’re infusing them into the model to make them more streamlined for people with AIDS," says Peter Reis, director of business development at AIDS Healthcare Foundation.
Education important
The program also entails holding educational forums for providers to bring them up to date on the latest medical advances in HIV treatment.
The educational component is especially important because 40% of the HIV patients in Florida are receiving their primary care from providers who have fewer than 20 HIV patients, Mr. Reis says. "We have our own HIV protocols that are indexed, and we make those available to providers. A lot of physicians don’t have the time or experience to navigate dense treatment guidelines."
The program ultimately will provide Florida officials with outcomes data, showing how well patients have done maintaining their disease and how much money it has cost the state to pay for their health care services, says Fred Goldstein, president of Specialty Disease Management Services in Jacksonville, FL.
Mr. Goldstein is in charge of implementing the program. Here’s how the program works:
• Enrolling clients. All Florida Medicaid-eligible HIV-infected patients are enrolled unless they choose not to be involved. The program has an opt-out model in which people receive a letter from the state telling them they’re eligible for Positive Healthcare/Florida, Mr. Goldstein says.
To protect clients’ privacy, the letters do not refer specifically to HIV or AIDS. Instead the letters mention all of the disease management programs the state has. People have 30 days in which to choose not to be in the program. They can disenroll by calling a state district office.
One of the program’s earliest challenges was locating the clients. In the first month, the state sent out 850 letters and enrolled 723 clients.
Few people opted out of the program, but many could not be enrolled because the letters were returned with no forwarding addresses, Mr. Goldstein explains.
• Making initial assessments. The program, when fully implemented later this year, will have about 70 registered nurses and 10 support employees.
Nurses meet with each client to introduce the program and cover a detailed, six-page clinical assessment tool that helps them determine the status of the client, assess how well the client understands HIV disease, and identify specific client needs. They also ask patients the names of their treating physicians, which they later match with state information on patients’ listed primary care physicians. They identify the client’s case manager and AIDS service organization.
One of the biggest obstacles the program has faced so far involves setting up that initial consultation with clients, says Judy White, RN, BS, director of health operations for Specialty Disease Management Services. Patients sometimes didn’t have telephones and were difficult to reach.
• Assigning risk. Using the patient’s CD4-cell count data, nurses assign patients to a risk category of low (CD4 cell count of 500 or more), medium (CD4 cell count between 200 to 500), or high (CD4 cell count of less than 200).
Those in the low category are contacted once a month; clients in the medium-risk category are contacted at least twice a month, and people in the high-risk category are contacted at least weekly, Ms. White says.
• Reviewing medical records. The staff use patient release forms to obtain clients’ medical records to see what type of care has been provided.
They pull out information on patients’ CD4 cell counts and types of antiretroviral medications prescribed, and determine whether patients were receiving prophylaxis drugs for certain opportunistic infections.
The staff chart this information to identify trends among the entire group of clinicians serving the Medicaid HIV patients and to give individual physicians a look at how they are doing when compared to national and state norms, Mr. Goldstein says.
• Meeting with physicians. Physician education is a priority of the program. Nurses meet with physicians or their staff to explain how the program works and what educational services are available. They show doctors how their HIV treatment compares with state and national treatment guidelines and statistics.
• Cutting costs. Nurses will stay in close contact with clinicians to discuss outcomes and more efficient ways to provide care, Mr. Reis says.
For example, some physicians may be unaware of how often their HIV patients are admitted to the hospital. If they aren’t contacted while the patient is admitted, then they can’t supervise the inpatient stay to make sure the hospital is motivated to discharge the patient in a reasonable amount of time, Mr. Reis explains.
"We’re interested from a patient care perspective to take a look at some of these issues and communicate information to physicians in an ongoing dialogue," he adds.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content