HIV HEALTH IMPROVEMENT AFFINITY GROUP

WHAT IS THE HIV HEALTH IMPROVEMENT AFFINITY GROUP?

The HIV Health Improvement Affinity Group (HHIAG) offers federal support for state-level efforts to improve rates of sustained virologic suppression among Medicaid and Children’s Health Insurance Program (CHIP) enrollees who are living with HIV. Those efforts are guided by teams of state public health and Medicaid/CHIP agencies collaborating to improve health outcomes by identifying opportunities to strengthen the HIV care continuum among these populations.

The HHIAG is a 12-month joint initiative between the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA), in collaboration with the HHS Office of HIV/AIDS and Infectious Disease Policy, and in partnership with the National Academy for State Health Policy.

Participating states will develop and implement one or more performance improvement projects that address gaps along the HIV care continuum to increase the proportion of Medicaid and CHIP enrollees living with HIV who achieve better outcomes along that continuum.

READ ABOUT THE AFFINITY GROUP ON THE AIDS.GOV BLOG

CORE PARTICIPANTS

The response to the invitation to join the group was greater than expected. Based on prior experience with these groups, it was expected that 6 to states would elect to participate, but a total of 19 states applied to join the group. These states represent diverse regions from around the country and account for more than half of all people in the United States who were living with diagnosed HIV in 2013. The participating states are: Alaska, California, Connecticut, Georgia, Illinois, Iowa, Louisiana, Maryland, Massachusetts, Michigan, Mississippi, Nevada, New Hampshire, New York, North Carolina, Rhode Island, Virginia, Washington, and Wisconsin.

State teams may include:
State Medicaid agency staff who will support the project to improve access to, utilization of, and quality of HIV preventive and care services
State health department staff who will coordinate with State Medicaid/CHIP programs to support and extend their efforts to bolster access to, utilization of, and quality of HIV preventive and care services among Medicaid eligible and enrolled populations
Staff from CDC, CMS, and HRSA, who will provide or facilitate access to needed technical assistance
Other state and local partners, such as primary care associations, federally qualified health centers, local health departments, and other relevant public and private entities.

HOW DOES THE AFFINITY GROUP WORK?

Group members began their work via webinar in October 2016, and at an in-person meeting in Washington, DC, in December 2016. For a 12-month period, they will participate in monthly state team calls with CMS, CDC, and HRSA, and in monthly HHIAG virtual meetings with other states and quality improvement experts.

State-level teams work together in three different learning communities: data linkage and outcomes; data analysis and utilization for delivery system improvement; and provider engagement and quality improvement. The communities give participants an opportunity to learn from one another and to receive technical assistance as they develop and refine a viral suppression improvement plan for their state.

What are the benefits for participants?

State participants receive direct technical assistance that supports improved HIV-related outcomes among Medicaid and CHIP enrollees through better organization, coordination, delivery, and assessment of high-quality HIV prevention, care, and related support services.
The Affinity Group also provides an opportunity for state-to-state learning and sharing of best and promising approaches to improve viral load suppression among people living with HIV (PLWH) who are enrolled in Medicaid and CHIP.
The HHIAG also builds stronger collaborative relationships among state Medicaid/CHIP programs, state public health departments, and other partners (public or private; federal, state, or local) who are well-positioned to advise and support efforts for maximum impact.

In addition to the direct benefits that states gain from their participation, HHS and the HHS agencies that are supporting this effort expect to gain valuable lessons from the work of the Affinity Group that will be useful to other states wanting to improve viral suppression and may identify other opportunities to further improve HIV and other health outcomes.

LEARNING COMMUNITIES

Learning communities will give participants opportunities to learn from one another and to receive technical assistance at the meeting and throughout the year, as they develop and refine plans to improve viral suppression in their states.

DATA LINKAGE AND OUTCOME LEARNING COMMUNITY

The improvement plans for the six states in this learning community (California, Georgia, Iowa, Maryland, North Carolina, and Wisconsin) will focus on instituting or expanding currently limited data-sharing activities, as well as analyzing these data to identify targets for performance improvement.

All the members of this learning community have some foundation on which to build broader data-sharing agreements, including some history of exchanging data. In addition, many of these states indicated that they will use shared data to evaluate outcomes along the care continuum for HIV-positive Medicaid/CHIP beneficiaries, as well as to report results for the viral load suppression (VLS) measure included in the CMS Adult Medicaid core set. These states also intend to use their newly improved capacity to evaluate system effectiveness at multiple levels and along multiple dimensions (e.g., specific beneficiary subpopulations, service providers, and care delivery models) for continuous quality improvement and public health actions.

DATA ANALYSIS AND UTILIZATION FOR DELIVERY SYSTEM IMPROVEMENT LEARNING COMMUNITY

All six states participating in this learning community (Illinois, Louisiana, Maryland, New York, Rhode Island, and Washington) have elected to expand Medicaid coverage under the Affordable Care Act. As the majority of Medicaid/CHIP beneficiaries living with HIV in these states receive their health care through a managed care organization (MCO), increasing collaboration and engagement with Medicaid MCOs is crucial for accomplishing these states’ goals. This group’s focus is on using data to identify quality-improvement opportunities. Some states hope to use aggregate or state-level data analyses to identify areas where they can make delivery-system improvements. In their preliminary plans, these states propose several mechanisms to create change in delivery systems, including: using existing Medicaid authorities to make new evidence-based services available to people living with HIV/AIDS; promoting integration of services funded by Medicaid and the Ryan White HIV/AIDS Program; encouraging systems that focus on interdisciplinary care teams; and accelerating value-based purchasing through accountable care organizations.

While data analysis at program and state levels is useful for improving delivery systems and health policies, it is necessary to integrate and analyze client-level data across federally funded HIV programs to improve care coordination and avoid duplication or misalignment of services. While these states have made great strides in overcoming barriers to sharing data and information, more work can be done to reduce the administrative burden of data-sharing and to include MCO care-management and quality-improvement projects focused on HIV care, especially those aimed at measuring, reporting, and reducing HIV viral load among those enrolled in Medicaid.

PROVIDER ENGAGEMENT AND QUALITY IMPROVEMENT LEARNING COMMUNITY

Members of this learning community (Alaska, Connecticut, Michigan, Mississippi, Nevada, New Hampshire, and Virginia) plan to improve clinical outcomes and achieve greater VLS rates through increased efforts to engage providers and improve quality of care. Because engagement and retention in care are critical to help PLWH achieve and maintain VLS, the improvement plans in this group focus on developing mechanisms to better share data between their state’s public health and Medicaid organizations. These improved information-sharing mechanisms will help states to identify people who may have been unable to access care or who have fallen out of care and get them into treatment.

Each state already has a unique system for collecting clinical and diagnostic information on its clients. While these states have made great strides in increasing their VLS rates, the teams will be doing more work to determine the unmet needs of PLWH and help to navigate them into care. Specific plans focus on collaborations between the public health and Medicaid teams to improve screening and testing, identify gaps in care, increase engagement in care, and improve surveillance techniques to identify quality-improvement opportunities.