Achievements & Lessons Learned-N: New York State Department of Health

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

New York State Department of Health

The New York State Department of Health AIDS Institute has developed, implemented, and evaluated a managed care system for persons with HIV.

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:* Completion of a multi-year developmental process for the creation of fiscally and programmatically viable HIV SNPs, resulting in the release of the HIV SNP procurement document (RFA) on May 3, 1999.
Key Elements for Success: Existing HIV infrastructure; information from client and provider cohort research; and government agency’s collaborative effort with maximum input from providers of care, advocates and consumers.	Factors that Limited Success: Development, dissemination, reviews and revisions of work products took longer than anticipated.	Factors that Ensured Success: Expertise of AIDS Institute and cooperative efforts between AIDS Institute and Office of Managed Care.

Achievement 2: Development of a Consumer Train-the-Trainer Curriculum: “Making the Right Choice: A Health Care Selection Guide for People Living with HIV/AIDS” to assist persons with HIV/AIDS to identify and advocate for their health needs within the context of managed care and to select the best plan/provider among the many competing options (including HIV SNPs) that will be available to them.
Key Elements for Success: Cooperative effort with significant consumer involvement.	Factors that Limited Success: Changing nature of the health care environment in New York State.	Factors that Ensured Success: Expertise of AIDS Institute and experience working with consumers and providers.

*Achievement 3:* Development of educational materials and implemented activities designed to assist Ryan White and community-based providers of AIDS -related services to successfully join NYS’ developing managed care environment. Materials included a handbook: Establishing Linkages Between Ryan White Providers and Managed Care Organizations, and a desk reference for managed care organizations. Activities included a series of strategic planning conferences for Ryan White and CBOs held in four New York State locations during 1998.
Key Elements for Success: Long history of AIDS Institute creating a developmental partnership with the provider community.	Factors that Limited Success: Quick-changing environment and resources for ongoing TA.	Factors that Ensured Success: AIDS Institute to bring providers together for TA.

*Achievement 4:* Completion of longitudinal study (client cohort).
Key Elements for Success: Ability to retain more than half of the original subjects.	Factors that Limited Success: Difficulty in contacting subjects.	Factors that Ensured Success: Alternative contacts to locate subjects and persistence.

*Achievement 5:* The development of open-ended coping, decision making, and quality of care assessment.
Key Elements for Success: More in depth picture of problems in health care system.	Factors that Limited Success: Developing a coding system.	Factors that Ensured Success: Are able to capture actual experience of participants.

*Achievement 6:* Flexibility of medications module.
Key Elements for Success: Ability to capture latest medication information.	Factors that Limited Success: Inability of subjects to recall the correct name.	Factors that Ensured Success: Utilizing illustrations.

1. Lesson Learned: Critical importance of building on an existing infrastructure of services, and utilizing a collaborative process among the government agency, providers of care, advocates and consumers.

How related to achievements: Providers and consumers have "bought-in" and accepted the HIV Special Needs Plan Model.

2. Lesson Learned: Extremely complex financial risks associated with the development of HIV Special Needs Plans (SNPs) - i.e., the need for appropriate capitation rates, risk adjustment methods to limit risk, and capitalization responsiveness to varying needs of potential HIV SNPs.

How related to achievements: The complex rate-setting developmental activities took longer than anticipated. The fiscal model will hopefully ensure success of the program.

3. Lesson Learned: Difficulty with tracking and retention of clients in the cohort study.

How related to achievements: We found that it can be offset both by intensive outreach and utilizing new data analytic techniques for missing data at different points.

4. Lesson Learned: Positive skewness of Quality of Life measures in the cohort study.

How related to achievements: There is a need for more sensitive instruments. We are utilizing in the final wave.

5. Lesson Learned: Need for more in-depth assessment of drug and sexual risk behavior as they relate to experience in care.

How related to achievements: This would help in formulating further research and intervention to address important issues pertaining to drug and sexual risk behavior.

Completed by: David Jemiolo, M.S.
Last Updated: July 1999

Project Resource Page

New York State Department of Health

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.