Monitoring HIV Care in the United States Indicators and Data Systems (2012) / Chapter Skim
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1 Introduction
1 Introduction
Pages 19-38
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from public and private HIV care databases to assess core indicators related to continuous care and access to supportive ser vices, such as housing, for people living with HIV?
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The 17-member committee comprises experts in clinical HIV care, mental health, health services research, private health insurance, health policy, housing policy, the Ryan White HIV/ AIDS Program, biostatistics, epidemiology, health disparities, and biomedical informatics (see Appendix A, Biographical Sketches of Committee Members)
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HIV disproportionately impacts populations with care and supportive service needs that, when unmet, reduce access and adherence to HIV care and treatment (Robertson et al., 2004; Weaver et al., 1 Being in HIV care may help to reduce risk of HIV transmission in ways besides having a reduced viral load as a result of being on antiretroviral therapy (ART)
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(Fleishman and Gebo, 2012) .3 A recent analysis of older data from the Medical Monitoring Project 2 Recognizing the need for aligned HIV care quality measurement, in 2007 the National Committee for Quality Assurance in partnership with the American Medical Association, HRSA, and the Infectious Diseases Society of America and HIV Medicine Association established "a single set of aligned HIV quality measures for care processes and intermediate outcomes for external accountability and individual quality improvement" (Horberg et al., 2010)
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, a component of the Ryan White HIV/ AIDS Program administered by states to cover the costs of Food and Drug Administration (FDA) -approved prescription drugs, is a common source of prescription drug coverage for low-income PLWHA.
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. The work of this IOM committee is named in the operational plans for the NHAS as one of the key activities that ONAP is undertaking "to address gaps in data collection, analysis, and integration of the care and treatment experiences of people living with HIV" within the NHAS goal to achieve a more coordinated national response to the HIV epidemic (ONAP, 2011b)
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. • Increased Private Health Insurance Access and Consumer Protec tions: The ACA will increase access to private health insurance and protect beneficiaries from being denied coverage and other unfavor 6 As of April 2010, states had the option to phase in expansion of Medicaid to the newly eligible as long as the state does not offer coverage to (1)
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Increasing Access to Care and Improving Health Outcomes for People Liv ing with HIV Action Steps • stablish a seamless system to immediately link people to continuous and E coordinated quality care when they are diagnosed with HIV. • ake deliberate steps to increase the number and diversity of available T providers of clinical care and related services for people living with HIV.
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. In 2014, a guaranteed availability of insurance provision ensures the issuance and renew ability of health insurance regardless of health status, and without increased premiums, for people with preexisting conditions.
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.8 • Expansion of Coverage for Preventive Health Services: As of Sep tember 2010, the ACA requires new private health insurance plans to cover the cost of preventive services that have been determined by the U.S. Preventive Services Task Force (USPSTF)
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, and private insurance programs, as well as by increasing access to preventive services and bolstering support to CHCs. It is important to 10 Federally Qualified Health Centers (FQHCs)
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However, the Ryan White HIV/AIDS Program and other safety net providers will continue to fill gaps in medical and social services not covered by Medicaid. The Ryan White HIV/AIDS Program also will continue to be an important source of care and supportive services for PLWHA who remain uninsured under the ACA (such as undocumented immigrants)
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Consistent with the NHAS objective to increase access to care and improve health outcomes for PLWHA, the committee focused on identifying core indicators and data systems to track linkage and access to appropriate HIV care and related supportive services among diagnosed PLWHA. The committee also considered how indicators could be used to monitor HIVrelated health disparities.
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REPORT ORGANIZATION Chapter 2 of this report addresses the parts of the committee's statement of task that pertain to data elements and core indicators related to continuous care and access to supportive services for PLWHA. The relative merits of each type of data are discussed, as well as whether the differences among data types (in particular, claims data and clinical data)
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Chapter 3 discusses sources of data for estimating the core indicators identified in Chapter 2, considers ways to maximize their usefulness, and recommends approaches for supplementing current data systems to gauge the impact of the NHAS and the ACA on HIV care. Chapter 3 also discusses similar data collection and standardization efforts that should be utilized, as well as how to regularly obtain data to capture the care experiences of PLWHA without substantial new investments.
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2011. Essential components of effective HIV care: A policy paper of the HIV Medicine Association of the Infectious Diseases Society of America and the Ryan White Medical Providers Coalition.
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2011a. Affordable Care Act Ensures Women Receive Preventive Services at No Addi tional Cost.
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2010. Mental health treatment to reduce HIV transmission risk behavior: A positive prevention model.
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List of Preventive Services that Have a Rating of A or B that Are Relevant for Implementing the Affordable Care Act. http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.
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