Monitoring HIV Care in the United States A Strategy for Generating National Estimates of HIV Care and Coverage (2012) / Chapter Skim
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The report also addressed a series of questions related to the collection, analysis, and dissemination of data necessary to estimate the indicators. In this second report, the committee addresses how to obtain national estimates that characterize the health care of people with HIV within the context of the ACA, both before 2014 and after 2014 when key provisions of the ACA will be implemented (see Box S-1, Statement of Task)
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that will improve access to health coverage and care for people with HIV include expansion of the Medicaid program in some states2 to include nonMedicare-eligible individuals with incomes up to 133 percent of the federal poverty level3; closure of the Medicare Part D prescription drug coverage gap; increased access to private health insurance and consumer protections; and expansion of coverage for preventive services. This report addresses how to monitor the anticipated changes in health care coverage, service utilization, and quality of care for people with HIV within the context of the ACA.
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The committee revisited these data sources for this second report to identify those that capture data relevant to monitoring the care experiences of people with HIV within the context of the ACA, such as health care coverage and utilization. The committee considered which data collection efforts could best produce nationally representative estimates of people with HIV in the United States and which best capture data on health coverage and utilization at the state level.
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Recommendation 1. Given that there currently is no single data collec tion system that can be used to establish a baseline for health care cov erage and utilization for a nationally representative sample of people with HIV in the United States, the Office of National AIDS Policy should use multiple existing data sources to establish this baseline prior to 2014.
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How to Continue to Obtain Data to Monitor Health Care Coverage and Utilization After 2014 The committee's first report describes a number of challenges to collecting and combining data from multiple sources to create a picture of the overall care experiences of people with HIV in the United States. For example, the various sources of care and care coverage have their own health information technology systems with disparate architectures and vocabularies that impede the sharing of data across systems.
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Although MMP's response rate has improved over time, the overall patient response rate for 2010, the most recent year for which data are available, was 56 percent. Another concern is that MMP does not currently include people who have a diagnosis of HIV infection but who are not in care, many of whom stand to benefit from provisions of the ACA that will improve access to health care coverage.
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The Office of National AIDS Policy and the De partment of Health and Human Services should use the Medical Moni toring Project, once improved, to obtain nationally representative data on health care coverage and utilization for people with HIV. Historically, priorities for HIV surveillance have shifted with changes in the distribution of HIV burden among people living with HIV, new knowledge about transmission risk, clinical indicators of health for people with HIV, HIV treatment guidelines, and other factors.
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In addition to data from the Medical Monitoring Project, the Office of National AIDS Policy and the Department of Health and Human Services should use data from Medicaid, Medicare, the Ryan White HIV/AIDS Program, and private insurers to monitor the impact of the Patient Protection and Affordable Care Act on health care coverage and utilization at the state and program level. Although health care reform will increase access to care coverage for people with HIV, it does not guarantee linkage to, retention in, and receipt of quality care.
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Data tracking health care coverage sources, enrollment, service utilization, and core outcomes among people with HIV are important for monitoring the impact of the ACA and the NHAS on access to and quality of HIV care in the United States over time. The data may be used to identify any difficulties encountered as individuals with HIV transition among sources of care coverage and to inform future planning related to the health care workforce and possible redistribution of resources to improve the quality and efficiency of care and reduce HIV-related health disparities.
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10 MONITORING HIV CARE IN THE UNITED STATES Sufficient resources will be required for the collection and analysis of data from MMP, Medicaid, Medicare, the Ryan White HIV/AIDS Program, and other sources to monitor trends in access to care and care coverage for people with HIV as well as to assess the quality of care for this population. The production and dissemination of a report at least once every 2 years summarizing the care experiences of people with HIV based on analysis of data from these sources will also require adequate staff and funding.
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