additional questions on HIV care experiences for HIV-infected individuals in national surveys would not be adequate to generate nationally representative estimates of their health care coverage and utilization. Thus, the committee did not consider national surveys as practical sources of data to establish a nationally representative baseline of health care coverage and utilization for people with HIV prior to 2014, nor to continue to obtain such data after 2014.
There currently is no single source of data to generate a baseline of care coverage and utilization for people with HIV. MMP is an ongoing federal supplemental HIV surveillance project designed to obtain nationally representative estimates of the care experiences of adults with HIV in care that collects data pertinent to monitoring the impact of the ACA on health coverage and utilization. However, as discussed in the following section, MMP currently has limitations to its design and participant response rate that raise concerns about the representativeness of the data. Combining data from multiple data sources is the most viable option for generating a baseline of care coverage and utilization prior to 2014.
In its first report, the committee identifies 14 core indicators to monitor the impact of the ACA and National HIV/AIDS Strategy (NHAS) on improvements in HIV care (see Table 1-4 in Chapter 1). The committee also identifies sources of data to estimate the indicators, including HIV-specific data sources (e.g., the National HIV Surveillance System, the Ryan White HIV/AIDS Program, and ongoing epidemiologic studies of people with HIV) as well as data sources that are not HIV-specific but that collect data relevant to monitoring care for people with HIV (e.g., Medicaid, Medicare, Veterans Health Administration, and private health insurer data). The committee revisited these data sources for this second report and found that many capture data pertinent to monitoring the impact of the ACA on care for people with HIV such as health coverage and service utilization information and receipt of recommended preventive health services. While none of these systems are designed to be nationally representative, together they can provide a reasonably accurate baseline of care coverage and utilization before 2014. As is outlined in the committee’s first report, these data systems also provide a collective platform for estimating indicators of care quality and, thus, can be used to generate estimates of care quality before full implementation of the ACA (IOM, 2012).