APHA 1996 Abstract: HIV Managed Care Through a Community-Based System of Care

APHA 1996 Abstract: HIV Managed Care Through a Community-Based System of Care: The AIDS Healthcare Foundation of Los Angeles

Presented at: American Public Health Association 124th Annual Meeting, November 1996

HIV Managed Care Through a Community-Based System of Care: The AIDS Healthcare Foundation of Los Angeles. Craig Thompson. AIDS Healthcare Foundation (AHF) is the largest community-based provider of HIV care in America. On April 1, 1995, AHF began the first comprehensive managed care program for people with HIV/AIDS in the United States. The program represents an innovative approach to addressing the issue of HIV care in a managed care setting. The program, named Positive Healthcare is supported by a grant from the Health Resources and Services Administration, Special Projects of National Significance program. It was created under a contract with the California Department of Health Services to provide managed care to Medicaid (Med-Cal) recipients. AHF devised a plan to lower inpatient care costs, raise physician reimbursement and save the state money while maintaining high quality patient care. Positive Healthcare is a fully capitated program, with a fee paid monthly by Medi-Cal for each enrollee. The monthly rate covers all care except for hospice, dental and long-term care. AHF reduces cost through medical case management of enrollees and negotiated hospital contracts that have resulted in lower day rates for inpatient care compared to the state rate. Patient eligibility, cost and service utilization, rate calculation and quality indicators for care have all been considered in the design of Positive Health care. The cost and quality of HIV care can be managed through a well planned system.

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