ment of the epidemic by providing access to comprehensive care to the greatest number of low-income individuals with HIV infection.

The Committee defined four secondary objectives of the system around the essential concepts of access, quality, accountability, and efficiency.

  • Ensure low-income HIV-infected individuals early and continuous access to an appropriate, comprehensive set of medical and ancillary services that meet the standard of care.

  • Promote the delivery of high-quality services.

  • Facilitate the provision of services with a minimum of administrative costs (for payers and providers) and a minimum of duplication of effort.

  • Ensure financing system and service delivery accountability for meeting established standards of treatment and health outcomes for all eligible individuals.

Those four objectives define the goals of an integrative chronic care system that can appropriately meet and weigh the needs of both individuals with HIV/AIDS and the providers who serve them.

The Committee also reviewed the literature on quality of care and strategies for quality improvement as outlined and recommended in past IOM reports (IOM, 2000, 2002, 2003). It embraces those recommendations and believes that publicly funded programs to provide HIV care should make every effort to improve the quality of services they provide. As one way to meet systemwide goals and objectives, the Committee also examined the concept of Centers of Excellence: systems of care that emphasize access to clinical and supportive services that are clinically appropriate, comprehensive, integrated across providers, and seamless.

ALTERNATIVE STRATEGIES

In developing its recommendations, the Committee considered a variety of alternative approaches for improving the financing of HIV care and reducing service gaps. These approaches included entitlement programs, block grants, and discretionary programs.

The Committee considered the following seven alternative approaches:

  • Expand the Ryan White CARE Act

  • Provide Medicare coverage to all HIV-infected individuals

  • Expand the use of the 1115 Waiver for HIV care

  • Create an optional Medicaid eligibility category for people with HIV

  • Expand Medicaid coverage for HIV-infected individuals via enhanced federal match



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