important to clinical practice because it allows HMOs to refer HIV-infected pregnant women to specialized care, including antiretroviral therapy, without incurring additional expenses. (5) Among the centers contacted by Dr. Daily, counseling is consistently offered; however, test acceptance varies, depending upon the "pitch." Patients are less likely to accept testing if they feel it means they are identifying themselves as high risk. They are more likely to accept testing if they see the test as a means of helping providers to better manage their care. It may be helpful to provide specific language to be used in counseling. (6) There is a need for additional HIV funding, since good, comprehensive services are expensive.

Discussion

During the discussion, Dr. Kubota pointed out that in his experience, physicians who treat HIV are frozen out of HMO provider panels, since their care is seen as too expensive.

National Committee for Quality Assurance

Joseph Thompson represented the National Committee for Quality Assurance (NCQA), a private, non-profit organization located in Washington, D.C. The mission of NCQA is to maintain and improve the quality of care within the managed care environment by holding managed care organizations (MCOs) accountable and providing purchasers of care with information on quality. This is accomplished through two NCQA activities: on-site accreditation and the use of standardized HEDIS measures to compare plans. Using HEDIS measures, NCQA last year provided information to the public on the care of 37 million commercial enrollees, all Medicare enrollees, and Medicaid enrollees in 35 states.

In his presentation, Dr. Thompson focused on the clinical measures within HEDIS as the area in which there is the greatest opportunity for NCQA to affect the quality of HIV/AIDS care. In general, NCQA evaluations show great variation across plans in the quality of clinical care. While there are HEDIS measures in place to reflect primary prevention of vaccine-preventable disease (immunization) or early detection of breast cancer (mammography), there are gaps in HEDIS with regard to measures for several chronic diseases, including HIV/AIDS.

With funds from the Kaiser Family Foundation, NCQA has started to look at HEDIS measures for HIV/AIDS care. An expert panel has targeted three potential measures: (1) HIV evaluations, either counseling or screening; (2) PCP prophylaxis; and (3) adequate antiretroviral therapy. Dr. Thompson noted that measures for PCP prophylaxis and adequate antiretroviral therapy are problematic because they require identification of people with HIV/AIDS and therefore run into confidentiality issues. In addition, from the HEDIS perspective, there is a sample size issue because of the small number of HIV-infected individuals in any given plan.



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