title: The Impact of Comprehensive Case Management on HIV Client Outcomes.
abstract: In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM), for people dealing with multiple comorbid conditions, including HIV. The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs) for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment). Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500). When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of HIV.
authors: Center on HIV and Aging, ACRIA, New York, New York, United States of America.|College of Nursing, New York University, New York, New York, United States of America.
authors: Mark
authors: M
authors: Brennan-Ing
authors: Center on HIV and Aging, ACRIA, New York, New York, United States of America.|Graduate School of Social Service, Fordham University, New York, New York, United States of America.
authors: Liz
authors: L
authors: Seidel
authors: BOOM! Health, Bronx, New York, United States of America.
authors: Leslie
authors: L
authors: Rodgers
authors: Center on HIV and Aging, ACRIA, New York, New York, United States of America.|Amida Care, Inc., New York, New York, United States of America.
authors: Jerome
authors: J
authors: Ernst
authors: Amida Care, Inc., New York, New York, United States of America.
authors: Doug
authors: D
authors: Wirth
authors: Human Resources Administration, City of New York, New York, New York, United States of America.
authors: Daniel
authors: D
authors: Tietz
authors: Columbia University, New York, New York, United States of America.
authors: Antonio
authors: A
authors: Morretti
authors: Center on HIV and Aging, ACRIA, New York, New York, United States of America.|College of Nursing, New York University, New York, New York, United States of America.
authors: Stephen E
authors: SE
authors: Karpiak
mesh_terms: D018791:CD4 Lymphocyte Count / Q000379:methods; D019090:Case Management / Q000191:economics*; D003191:Comprehensive Health Care / Q000191:economics / Q000379:methods; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology