Achievements & Lessons Learned-E: East Boston Neighborhood Health Center

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

East Boston Neighborhood Health Center

The East Boston Neighborhood Health Center (EBNHC) has provided coordinated, non-fragmented, comprehensive care to individuals 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:*Prepared data for EBNHC to negotiate capitation rates: utilization costs of care for HIV/AIDS patients.
Key Elements for Success: Medicaid Working Group.	Factors that Limited Success: Difficulty of collecting comprehensive billing data.	Factors that Ensured Success: Hiring the Medicaid working group.

Achievement 2: Modeled the process by which a community based provider prepares for capitation.
Key Elements for Success: Involvement of CMO, CEO, COO throughout project.	Factors that Limited Success: Financial difficulties of health center.	Factors that Ensured Success: None listed.

*Achievement 3:* Developed a model of care for HIV/AIDS patients that can work well within a full service community health center and in a capitated care setting.
Key Elements for Success: Process reviews; clinical case management.	Factors that Limited Success: Departure from original model.	Factors the Ensured Success: Flexibility, and ability to identify needs and make changes in the model design.

*Achievement 4:* Dissemination of model, evaluation, interim results, and lessons learned locally, nationally, and internationally.
Key Elements for Success: Collaboration – EBNHC and MWG. Writing, speaking, and presentation preparatory skills.	Factors that Limited Success: Need for more venues.	Factors the Ensured Success: None listed.

*Achievement 5:* Prepared one paper for publication with plans for three others.
Key Elements for Success: Collaboration between EBNHC and MWG.	Factors that Limited Success: Revisions made by others who do not know the project.	Factors the Ensured Success: Leadership of HRSA.

*Achievement 6:* Development, implementation, and evaluation for Mobile Unit Site.
Key Elements for Success: Dedication of staff, funding.	Factors that Limited Success: Lack of dollars.	Factors the Ensured Success: Dedication of staff, funding.

1. Lesson Learned: Model development: Clinical case management is a key aspect of HIV/AIDS care model.

How related to achievements: Developed model of care that can work well in a general community health center. Related to Achievement #3, "Developed a model of care for HIV/AIDS patients that can work well within a full service community health center and in a capitated care setting."

2. Lesson Learned: Realized the difficulty of and the need for collecting cost/utilization data prior to negotiating with the payer. Solved this by utilizing multiple approaches to data collection and accepting approximations.

How related to achievements: Related to Achievement #1, "Prepared data for EBNHC to negotiate capitation rates: utilization costs of care for HIV/AIDS patients."

3. Lesson Learned: Realized the need for a threshold number of patients involved in capitated programs to support a managed care infrastructure. Experienced the opposite incentives of fee-for-service and managed care.

How related to achievements: Related to Achievement #2, "Modeled the process by which a community based provider prepares for capitation."

4. Lesson Learned: Realized the need to adequately address patient's mental health/substance abuse issues to improve medical outcomes, cost/utilization, as well as quality of life.

How related to achievements: Related to Achievement #3, "Developed a model of care for HIV/AIDS patients that can work well within a full service community health center and in a capitated care setting."

5. Lesson Learned: Hospitalization reflects major costs of HIV/AIDS care. Efforts to reduce costs should focus on reducing and managing hospitalizations.

How related to achievements: Related to Achievement #1, "Prepared data for EBNCH to negotiate capitation rates: utilization of costs of care for HIV/AIDS patients."

6. Lesson Learned: Patients not on HAART utilize more services.

How related to achievements: Related to Achievement #1, "Prepared data for EBNCH to negotiate capitation rates: utilization of costs of care for HIV/AIDS patients."

7. Lesson Learned: Risk factor is an important variable in HIV/AIDS costs/utilizations! Injection drug users use more services.

How related to achievements: Related to Related to Achievement #1, "Prepared data for EBNCH to negotiate capitation rates: utilization of costs of care for HIV/AIDS patients."

8. Lesson Learned: Smaller providers may consider negotiating partial capitations.

How related to achievements: Related to Achievement #2, "Modeled the process by which a community based provider prepares for capitation."

Completed By: Judith Steinberg, M.D.; Lisa Maisels, M.S.W.
Last Updated: May 1999

Project Resource Page

East Boston Neighborhood Health Network

Evaluation Data

Service Population Demographics

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.