Knowledge Item: CA-Initiative Impact-99A
 Major Achievements and Lessons Learned: 1994-1999

AIDS Healthcare Foundation

The AIDS Healthcare Foundation (AHF) has operated four healthcare centers to provide direct medical services to individuals living with HIV/AIDS under a capitated system of care.

In 1999, the Evaluation and Dissemination Center asked each project to state its major achievements and the lessons it had learned from conducting the project. Those stated achievements and lessons learned are reproduced here (with minor editing) as reported to the Evaluation and Dissemination Center. The summary statements given here are those aspects of the program's experiences that the Project Director wished to emphasize.

Achievement 1: Secured Medicaid contact to deliver Capitated AIDS Care.

Key Elements for 
Success:

Legislative action that created a vehicle.

Factors that Limited
Success:

The State Department of Health’s unwillingness.

Factors that Ensured
 Success:

AHF’s vigor as it pursued the contract.

 

Achievement 2: Launched Positive Healthcare.

Key Elements for 
Success:

Clinical preparation; financial preparation.

Factors that Limited
Success:

Voluntary enrollment vs. mandatory enrollment.

Factors that Ensured
 Success:

Strong desire to set a precedent for risk adjusted AIDS care.

 

Achievement 3: Four years of clinical and financial success.

Key Elements for 
Success:

Health plan is specialized and run by experienced professionals.

Factors that Limited
 Success:

Somewhat uncooperative relationship with State of California.

Factors that Ensured
 Success:

Experienced administration and quality medical direction.

 

Achievement 4: Completed data collection on evaluation portion of project.

Key Elements for 
Success:

Addition of a qualified evaluator and data manager.

Factors that Limited
 Success:

Internal lack of capacity initially.

Factors that Ensured
 Success:

Concerted effort in the final 2 years.

 

Achievement 5: Linkage with other projects for form a more powerful voice specialized, risk-adjusted, capitated AIDS care.

Key Elements for 
Success:

Cooperative spirit, mutual respect.

Factors that Limited
 Success:

Distance/scheduling.

Factors that Ensured
 Success:

None listed.

1. Lesson Learned: Risk adjusted service reimbursement rates are vital if quality specialized care is to be delivered.

How related to achievements: The clinical and financial success of the program has largely been the result of adequate financing.

 

2. Lesson Learned: Providers hoping to be successful in capitated medical care must have the capacity to adequately assess cost and utilization in order to make proper clinical, financial, and managerial decisions.

How related to achievements: Not specified.

 

3. Lesson Learned: Closed capitated networks benefit those with chronic diseases.

How related to achievements: The network approach allows HIV specialists to control the process and the money.

 

4. Lesson Learned: Managed care for Medicaid patients is fast becoming the only option. Providers must begin the process of positioning themselves for the inevitability.

How related to achievements: This knowledge prompted AHF to pursue the capitated pilot.

Completed By:        Peter D. Reis
Last Updated:         May 1999

Project Resource Page

Evaluation Data

Last Updated: August 02, 2001; data through June 15, 1999; analyses conducted January 2000.

Knowledge Base Citation: The Knowledge Base and this Knowledge Item were designed and authored by G. J. Huba, Ph.D.; in collaboration with Lisa A. Melchior, Ph.D.; A. T. Panter, Ph.D.; and the staff of The Measurement Group. Cite this work as "Huba, G. J., Melchior, L. A., and Panter, A. T. (1998 - 2001). The Measurement Group Knowledge Base on HIV/AIDS Care. On the World Wide Web: http://www.TheMeasurementGroup.com."

Questions or Comments: Contact The Measurement Group.

Use of Knowledge Base Information: Acceptable Uses and Limitations.

Collaborators from Participating Projects: Cooperative Agreement Steering Committee 1999. 

Participating Projects: This Knowledge Base is based on the service delivery experiences of 27 Cooperative Agreement Projects on Innovative Models of HIV/AIDS Care. These projects and the Evaluation and Dissemination Center which produced this Knowledge Base were funded by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) as Special Projects of National Significance (SPNS) between 1994 and 1999.

Why This Evaluation was Conducted: Editorial.

More Information: Design of this Knowledge Base.

Recommended Citation Format for Web Materials: American Psychological Association Publication Manual Section, Revised 2001.

Work on the Knowledge Base and the cross-cutting evaluation was supported in part by Grant Number 5 U90 HA 00030-05 from the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau's (HAB) Special Projects of National Significance (SPNS). The contents of this Knowledge Base are solely the responsibility of The Measurement Group and do not necessarily represent the official views of HRSA or HRSA/HAB's Special Projects of National Significance nor may they represent the positions of the individual grantees whose projects are included in the cross-cutting evaluation.

Copyright © 2005 by The Measurement Group LLC. All rights reserved. This may not be current and will not be updated.