In 1990, New York State
instituted Comprehensive Medicaid Case Management, also known as Target Case
Management (TCM), for people dealing with multiple comorbid conditions,
including HIV.
The goal of TCM is to assist clients in navigating the health
care system to increase care engagement and treatment adherence for individuals
with complex needs. HIV-positive individuals engaged in care are more likely to
be virally suppressed, improving clinical outcomes and decreasing chances of
HIV transmission.
The purpose of this study was to understand the impact of TCM
management on outcomes for people with HIV. Data were obtained from Amida Care,
which operates not-for-profit managed care Medicaid and Medicare Special Needs
Plans (SNPs) for HIV clients. Changes in clinical, cost, as well as medical and
pharmacy utilization data among TCM clients were examined between January 2011
through September 2012 from the start of case management enrollment through the
end of the study period (i.e., up to 6 months after disenrollment).
Additionally, CD4 counts were compared between Amida Care TCM clients and
non-TCM clients.
Notable findings include increased CD4 counts for TCM clients
over the one-year study period, achieving parity with non-TCM clients (i.e.,
Mean CD4 count > 500). When looking exclusively at TCM clients, there were
increases in medication costs over time, which were concomitant with increased
care engagement. Current findings demonstrate that TCM is able to achieve its
goals of improving care engagement and treatment adherence.
Subsequent policy
changes resulting from the Affordable Care Act and the New York State Medicaid
Redesign have made the Health Home the administrator of TCM services.
Government entities charged with securing and managing TCM and care
coordination for people with HIV should provide thoughtful and reasonable
guidance and oversight in order to maintain optimal clinical outcomes for TCM clients
and reduce the transmission of HIV.
Full article at: http://goo.gl/Lz1c6Z
By:
- 1Center on HIV and Aging, ACRIA, New York, New York, United States of America.
- 2College of Nursing, New York University, New York, New York, United States of America.
- 3Graduate School of Social Service, Fordham University, New York, New York, United States of America.
- 4BOOM! Health, Bronx, New York, United States of America.
- 5Amida Care, Inc., New York, New York, United States of America.
- 6Human Resources Administration, City of New York, New York, New York, United States of America.
- 7Columbia University, New York, New York, United States of America.
- PLoS One. 2016 Feb 5;11(2):e0148865. doi: 10.1371/journal.pone.0148865.
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