New Orleans LA December 15 2015 Laura Cheever MD ScM Associate Administrator Department of Health and Human Services Health Resources and Services Administration ID: 746366
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Slide1
HIV/AIDS Bureau Update
Ryan White HIV/AIDS Program Clinical ConferenceNew Orleans, LA December 15, 2015
Laura Cheever, MD,
ScM
Associate Administrator
Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS BureauSlide2
HAB Vision and Mission
Vision
Optimal HIV/AIDS care and treatment for all
Mission
Provide leadership and resources to assure access to and retention in high quality, integrated care and treatment services for vulnerable people living with HIV/AIDS and their families Slide3Slide4
2016 Priorities
Continue to integrate Ryan White HIV/AIDS Program (RWHAP) with the new health care landscape Implement National HIV/AIDS Strategy: Updated to 2020 (NHAS 2020)
Focus on greatest health disparities and care continuum
Augment partnerships
Advance data utilization to improve health outcomes
Enhance national and international leadership
Improve HIV/AIDS Bureau (HAB) operationsSlide5
2016 Priorities
Continue to integrate RWHAP with the new health care landscape Documenting what the RWHAP is and doesUnderstanding the dynamic intersections of the Affordable Care Act (ACA) and the RWHAP- 2014 and beyond
Considering how the program should change
, to respond to an evolving population of people living with HIV (PLWH)Slide6
Ryan White HIV/AIDS Program Moving Forward FrameworkSlide7
Special Study-Emerging Issues Related to ACA Implementation:
The Future of Ryan White Services: A Snapshot of Outpatient Ambulatory Medical CareFinal Project Report Briefing
September 29, 2015Slide8
Service Visit Length
Clinic visits can vary in length from 15 minutes to four hours, the median times reported ranged from 41 minutes to 145 minutes.
Interview DataSlide9
Drivers of OAMC Visit Length
The activities most often associated with longer OAMC times are primary care treatment and screening and patient education.
Interview DataSlide10
Conclusions
Outpatient Ambulatory Care Visits (OAMC) are complex and more than just “
reimburable
services ”
First category: services that insurers typically cover
e.g
., diagnostic testing, preventive care and screening, practitioner examination, medical history taking, diagnosis and treatment Second category: intensive OAMC activities that are critical for improved outcomes but may not be reimbursedEducation and counseling around prescribing and managing of ARVs, education and counseling on prevention, adherence, and other health issues, care management of chronic HIV-related conditions and referral/provision of specialty care (e.g., behavioral health and support needs)Slide11
Overview
Two recent papers illustrate Ryan White HIV/AIDS Program impact using Medical Monitoring Project (MMP) dataService delivery and patient outcomes in Ryan White HIV/AIDS program-funded and non-funded
h
ealthcare facilities (Weiser et al.,
JAMA Internal Medicine
, 2015)
Ryan White HIV/AIDS program assistance and HIV treatment outcomes (Bradley et al., Clinical Infectious Diseases, 2015)CDC and HRSA collaborationSlide12
Service
delivery and patient outcomes in Ryan White HIV/AIDS program-funded and non-funded healthcare facilities (Weiser et al., JAMA Internal Medicine, 2015)
2009 and 2011 MMP data show:
34% of facilities received Ryan White HIV/AIDS Program (RWHAP) funding
73% of patients received care at RWHAP-funded facilities
Weiser (paper #1): Main FindingsSlide13
Services provided by RWHAP-funded and non-RWHAP-funded outpatient facilities Slide14
ART prescription and viral suppression
RWHAP-funded
(%)
Non-RWHAP funded
(%)
P
-value
Prescribed ART*
90
91
0.53
Viral suppression
§
74
79
0.02
*Documentation in the medical record of prescription of antiretroviral therapy
§
Documentation in the medical record of most recent viral load undetectable or <200 copies /mLSlide15
Viral suppression
* among low-income§ patients
% (95% CI)
Adjusted
prevalence ratio
(95% CI)
P-value
RWHAP
73 (70 – 75)
1.09 (1.02 – 1.16)
0.01
Non-RWHAP
67 (62 – 71)
Reference
*Most recent viral load undetectable or <200 copies /mL
§ Living at or below the federal poverty levelSlide16
Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes (Bradley et
al., Clinical Infectious Diseases, 2015)
2009 – 2012 MMP data show:
41% of patients received RWHAP assistance
25% received RWHAP assistance as a supplement to another healthcare payer type
15% relied solely on RWHAP assistance for HIV care
Bradley (paper #2): Main FindingsSlide17
Adjusted* prevalence of viral suppression by healthcare payer type and RWHAP assistance
*Results from logistic regression model adjusted for age, race, place of birth, poverty, education, homelessness, and HIV disease stageSlide18
Uninsured and underinsured HIV-infected patients receiving RWHAP assistance were more likely to be prescribed ART and to be virally suppressed than those with other healthcare payer types.
Bradley (paper #2): Primary ConclusionSlide19
Preliminary Analysis of Ryan White Services Report Data from 2014
How is the Affordable Care Act affecting Ryan White HIV/AIDS Program clients, services, and clinical outcomes?Slide20
Years of Analysis
Prior to the Affordable Care Act2012
2013
After the Affordable Care Act
2014
PRELIMINARY DATASlide21
Health Care Coverage
Among HIV-Positive RWHAP Clients, 2012–2014
PRELIMINARY DATASlide22
Health Care Coverage, by Medicaid Expansion Status, 2012
–2014
PRELIMINARY DATASlide23
How the RWHAP Needs to Change in Response to Projected Workforce Shortage
Gap in understanding of best models of care to support improved outcomesRegional AIDS Education and Training Centers (AETC) program revamped in 2015Focus on multidisciplinary teams, workforce pipeline, low-volume providers, practice transformation
Shift to national curriculum, National Clinical Conference and National Clinical Consultation Center to support more experienced cliniciansSlide24
2016 Priorities
Continue to integrate RWHAP with the new health care landscape Implement NHAS 2020Focus on greatest health disparities and care continuum
Augment partnerships
Advance data utilization to improve health outcomes
Enhance national and international leadership
Improve HAB operationsSlide25
National HIV/AIDS Strategy: Updated to 2020Slide26
National HIV/AIDS Strategy Updated
to 2020Slide27
Integrated HIV Prevention and Care
Plan Guidance, including the Statewide
C
oordinated
S
tatement
of Need, CY 2017- 2021Health Resources and Services Administration, HIV/AIDS Bureau/Centers for Disease Control and Prevention, Division of HIV/AIDS PreventionSlide28
2016 Priorities
Continue to integrate RWHAP with the new health care landscape Implement NHAS 2020Focus on greatest health disparities and care continuum Augment partnerships
Advance data utilization to improve health outcomes
Enhance national and international leadership
Improve HAB operationsSlide29
Retained in care
:
>= 1
OAMC visit before
Sept. 1 of the measurement year
and
at least
2 visits 90
or more days
apart
Viral suppression
:
Percent with last
viral load
test in year < 200 copies
Source:
2014 Ryan White Services Report
Retention and Viral SuppressionSlide30
Viral Suppression by State
Viral suppression: had at least
one OAMC
visit, at least one viral load
count
, and last viral load test <
200 Source: 2014 Ryan White Services ReportSlide31
Retention and Viral Suppression Race/Ethnicity, RSR 2010-2013Slide32
RSR 2013 Viral
Suppression - Age
Viral
suppression:
had at least one OAMC visit, at least one viral load count, and last viral load test <200Slide33
Reducing
Viral Load Suppression Rate Disparities for Young People in the RWHAP, RSR 2010 - 2013
VL suppression rate disparity
has decreased by ~20% in only 3 years
G
rowth
rate in
viral suppression is
8.8%, compared to only 4.0% in rest of populationSlide34
Ongoing Efforts
All-Grantee Meeting in 2016Tentative dates: August 23-26, 2016 in Washington, DCNew Webpage: http://ryanwhite2016.org
/
Clinical Conference 2016- it will return!
Stay tuned for detailsSlide35
Thank You!
Dr. Laura CheeverHIV/AIDS Bureaulcheever@hrsa.gov