SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements:
Volume 1, Issue 7 (July 13, 1996)

Information dissemination from 27 Innovative Models of HIV Care projects funded as Special Projects of National Significance by the HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA).

Introduction

Welcome to SPNS/Fax: An Electronic Report from HRSA/HAB's SPNS Cooperative Agreements. In each issue of SPNS/Fax, we will highlight findings from the HRSA Special Projects of National Significance Program Cooperative Agreements. The projects have been funded to develop innovative models of HIV/AIDS care. SPNS/Fax reports are distributed every two weeks by fax machine to all subscribers. All issues of SPNS/Fax are also available at this Web site. Due to slight differences in the media, issues distributed by fax machine may appear slightly different from those posted on this Web site, but the content is identical.

New York State Project

In the fall of 1994, the New York State Department of Health, AIDS Institute was awarded a four-year grant from HRSA/HAB's SPNS for the development and analysis of models of managed care for persons with HIV. In the spring of 1995, the State of New York proposed a program of mandatory Medicaid managed care for most New Yorkers, including those with HIV disease. In response to this proposal, the AIDS Institute developed a strategy for its project based upon three studies that will provide the state with the information it needs to develop managed care systems for persons with HIV disease.

I. Special Needs Plans Planning Grants. In December 1995, the governor of New York awarded planning grants to 18 provider organizations throughout the state experienced in HIV and/or managed care service delivery. The organizations will provide advice regarding organizational, administrative and financial models of managed care that may best serve the needs of persons with HIV infection. These planning grants will generate information regarding organizational and program models that may be the most appropriate for persons with HIV under a Medicaid managed care system. Information generated will assist New York in developing licensure and programmatic requirements that it will use in future HIV Special Needs Plans certification efforts.

II. Client Cohort Study. This is a self-reported, longitudinal study of access, quality of life, and patient satisfaction with care for persons with HIV disease as they transition from the fee-for-service system into a managed care system. The data collected will be used to assess differences in the impact of managed care among persons with HIV disease according to: stage of disease, risk history, gender, and other socio-demographic variables. Also, organizational information will help determine how the features of different managed care plans affect access to care, quality of care, and quality of life over the course of illness and treatment.

III. Provider Cohort Study. In this study, a data file will be created from Medicaid paid claims data, quality of care review data, and abstracted clinical data. This data file will be used to develop risk adjusted HIV capitation rates and associated risk sharing methodologies. Under New York's mandatory Medicaid managed care program, capitation rates will be determined by the state for both mainstream and HIV Special Needs Plans through analysis of the Medicaid paid claims file. This study will supplement and validate the Medicaid paid claims file for the purpose of developing HIV/AIDS specific rate groups and service delivery models.

There are several key issues of additional policy and programmatic concerns to be addressed by New York State. These issues include analyses of HIV service provider capacity, the provision of technical assistance to providers for Special Needs Plans service delivery structures and network development, and analyses of the marginal costs of specialized HIV services. Addressing these issues in the future should help assure successful implementation of managed care for persons with HIV disease or any other chronically ill population.

For more information, contact Humberto Cruz, AIDS Institute, NY State Department of Health, Corning Tower, Room 459, Empire State Plaza, Albany, NY 12237; by email at hxc01@health.state.ny.us.

SPNS/Fax is produced by The Measurement Group–PROTOTYPES Evaluation and Dissemination Center (EDC). Editorial comments should be made to The Measurement Group at 5811A Uplander Way, Culver City, California 90230, 310.216.1051, 310.670.7735 (fax).
 

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