Halt the progression of HIV/AIDS

It wasn't until 1984 that the Human Immunodeficiency Virus (HIV) was determined to be the cause of AIDS. Celebrities Rock Hudson and Liberace died from AIDS, as did half of the patients who were diagnosed during the decade. Many HIV/AIDS patients would also become victims of violence and discrimination.

The first antiretroviral drug treatment-zidovudine or AZT-was fast tracked to approval in 1987, but even so, HIV/AIDS had become the number one cause of death in the United States by 1992, affecting not just homosexual men, but women, drug users, those with hemophilia and people in prison. In 1995, highly active antiretroviral therapy (HAART) drugs reached the market, which led to a dramatic decline in deaths but still no cure.

Each year, 50,000 people in the United States are newly diagnosed with HIV, and the virus disproportionately affects homosexual men, blacks/African Americans and Hispanic/Latinos. New York and Washington, D.C., record particularly high concentrations of diagnoses.

Caring for about half of the HIV/AIDS patients in regular care, Medicaid is the predominate source of health coverage. However, low-income people with the condition typically cannot qualify for Medicaid until they become disabled. Last year, Medicaid spending alone for HIV/AIDS care reached $9.3 billion. Lifetime costs are estimated at $385,200 per member.

AmidaCare, a Medicaid Special Needs Plan (SNP) developed by the New York state departments of health and managed care specifically for HIV/AIDS members, enrolled its 5,500th member in May. CEO Doug Wirth says the plan has been able to improve health and reduce costs of care through specialized providers, member/peers who council other members, and personal outreach efforts.

"We've actually been able to achieve about a 25% cost savings resulting from a significant reduction in hospitalization, length of stay and emergency room use that we have sustained over a significant period of time," Wirth says. "We're proud of that because many Medicare studies found that this sort of aggressive care coordination hasn't resulted in cost savings."

It's particularly critical for HIV patients to stay adherent and avoid progressing to AIDS. More than 90% of the plan's members engage in primary care-a higher percentage than many commercial plan populations.

As managed care organizations enroll more Medicaid members in the next three to five years, they could find a high prevalence of HIV/AIDS among their new populations. Care coordination, adherence and engagement will be the essence of controlling costs and maintaining quality of life.

Sources: Kaiser Family Foundation; Centers for Disease Control and Prevention: Med Care 2006;44: 990–997