HIV/AIDS Bureau Update Ryan White HIV/AIDS Program Clinical Conference New Orleans, LA December 15, 2015 Laura Cheever, MD, ScM Associate Administrator Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau 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 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) operations 2016 Priorities Continue to integrate RWHAP with the new health care landscape Documenting what the RWHAP is and does Understanding the dynamic intersections of the Affordable Care Act (ACA) and the RWHAP and beyond Considering how the program should change, to respond to an evolving population of people living with HIV (PLWH) Ryan White HIV/AIDS Program Moving Forward Framework Special Study-Emerging Issues Related to ACA Implementation: The Future of Ryan White Services: A Snapshot of Outpatient Ambulatory Medical Care Final Project Report Briefing September 29, 2015 Abt Associates | pg 8 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 Data Abt Associates | pg 9 Drivers of OAMC Visit Length The activities most often associated with longer OAMC times are primary care treatment and screening and patient education. Interview Data 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 reimbursed Education 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) Overview Two recent papers illustrate Ryan White HIV/AIDS Program impact using Medical Monitoring Project (MMP) data Service delivery and patient outcomes in Ryan White HIV/AIDS program-funded and non-funded healthcare 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 collaboration 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 Findings Services provided by RWHAP-funded and non- RWHAP-funded outpatient facilities ART prescription and viral suppression RWHAP-funded (%) Non-RWHAP funded (%) P-value Prescribed ART* Viral suppression *Documentation in the medical record of prescription of antiretroviral therapy Documentation in the medical record of most recent viral load undetectable or