Disease Stage Adjusted Utilization and Cost of Care Analyses for Persons With HIV/AIDS in New York State. J Whitaker, I Feldman, D Jemiolo, H Plavin. New York State Department of Health, AIDS Institute, Albany.

Issue: Managed Care is proposed as a tool to efficiently coordinate access to a full continuum of HIV/AIDS care services. Financial risk sharing and provider network development are two necessary components of this approach. To fairly and appropriately transfer financial risk to HIV health service providers, HIV/AIDS specific actuarial classes need to be developed. The New York State AIDS Institute is engaged in the development of these rates using existing data systems where possible and collecting new data when necessary.

Project: Medicaid claims and clinical data bases were combined to provide a unique look at the cost of care and service use patterns for persons with HIV/AIDS. Data modeling is currently underway and will examine the utilization patterns and costs of care for the standard actuarial classes of age and gender. HIV/AIDS specific clinical information contained in the data base will be used to explore the utility of disease specific actuarial classes based on health status indicators and other morbidities.

Results: The new data system contains billing and clinical information on more than 27,000 individuals receiving treatment for HIV/AIDS throughout the period from 1990-1994. Results for the actuarial class analysis will be available in time for the conference. This work will permit the development of a reimbursement system appropriate to the risk assumed by capitated HIV providers under managed care.

Lessons Learned: Existing administrative and clinical data systems can be merged creating a substantial data base that is low cost and that permits the construction of HIV disease stage-specific actuarial classes.

Contact: JA Whitaker, ESP, Corning Tower, Rm. 372, Albany, NY 12237 USA. Telephone: 518.486.1383, Fax: 518.473.0031, email: jaw12@health.state.ny.us.

Back to Abstracts from the XIth International AIDS Conference