|Virologic Suppression occurs when the amount of HIV in the blood is lowered to below 200 copies per milliliter or undetectable levels.PLWH are more likely to achieve and maintain virologic suppression when they have access to high-quality, coordinated and comprehensive care, antiretroviral therapy, and support services. A substantial body of research shows that virally-suppressed people have better health outcomes and are at significantly reduced risk of sexually transmitting HIV to others.
Source: Centers for Disease Control and Prevention. “HIV Treatment as Prevention.” Accessed November 13, 2017. https://www.cdc.gov/hiv/risk/art/index.html.
Research shows that people living with HIV (PLWH) who achieve and maintain virologic suppression at undetectable levels have better health outcomes and reduced risk of transmitting HIV to others. As a result, many states have made increasing rates of virologic suppression in Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries living with HIV a high priority. States are increasingly using data analytics to better understand PLWA’s health care engagement and outcomes in order to improve state policies and programs.
In 2016, Medicaid and health departments from 19 states with diverse geographic regions and varying HIV rates joined the HIV Health Improvement Affinity Group. The states represent more than 50 percent of people living with HIV in the United States as of 2014.
Each affinity group state developed a quality improvement project and received technical assistance to strengthen state strategies that increase virologic suppression for Medicaid and CHIP beneficiaries living with HIV. Overwhelmingly, these states identified the need to understand this population’s service utilization and health outcomes in order to inform policy and program improvements. To do this, states can share and compare data sets from HIV prevention, treatment, and surveillance programs and Medicaid. While data sharing and analysis can be complex — due to federal and state laws and the need for a strong information technology (IT) infrastructure — states in the affinity group are leading the way.
|HIV Health Improvement Affinity Group
The HIV Health Improvement Affinity Group (HHIAG) provided support to 19 state Medicaid and public health department teams (highlighted in blue) working to increase rates of sustained virologic suppression among Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries living with HIV.The HHIAG was a joint initiative of the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Health Resources and Services Administration, in collaboration with the Health and Human Services’ Office of HIV/AIDS and Infectious Disease Policy, and in partnership with NASHP.
Prior to the Affinity Group, there was a very limited working relationship between the Alaska HIV Program and Medicaid. Their collaboration throughout the affinity group allowed leaders from both programs to establish a data use agreement (DUA), providing the HIV Program access to Medicaid claims data. HIV Program staff have completed a match of HIV surveillance data to Medicaid claims to better understand the utilization of services by people living with HIV enrolled in Medicaid and their HIV viral load. HIV Program and Medicaid staff believe this data analysis will allow them to better target limited resources to PLWH who are not regularly seeking HIV care and/or filling their medications.
Maryland state officials recognized the need for a DUA between the Maryland Department of Health and the Office of Health Care Financing (Medicaid) so that HIV program staff could access Medicaid claims data. They are now in the process of finalizing a DUA that will allow regular transfers of Medicaid claims data to the state’s HIV Program. While the DUA was being written, Maryland created a list of claims-based codes that could indicate if a beneficiary is HIV positive, received HIV testing, or received pre-exposure prophylaxis (PrEP). Once the DUA is in place, these codes will be used by data analytics staff to identify and describe beneficiaries using that criteria. Maryland will also create data files of HIV-positive beneficiaries for future analysis of claims utilization.
Louisiana finalized a DUA in 2014 that allows Medicaid claims data to be shared with the state health department. The state runs quarterly analyses that compare Medicaid claims data with HIV surveillance data to identify Medicaid beneficiaries who have an HIV diagnosis, but are not accessing or engaging in HIV care, and whether or not they are virally suppressed. Medicaid managed care plans in the state receive updates about their enrolled members’ results from each quarterly analysis. Based on these reports, plans can reach out to members who are not yet engaged in HIV care and/or not virally suppressed, and help them access necessary services. Louisiana currently incentivizes plans to increase virologic suppression rates by including viral load suppression as one of nine incentive-based quality metrics. If plans do not achieve an established target for an incentive-based measure, they may be subject to monetary penalties.
More promising strategies, state examples, and technical assistance resources describing how states can improve rates of viral load suppression will soon be published in a NASHP toolkit and explored in a national webinar. Visit NASHP.org and read its weekly e-newsletter for information about the release of the toolkit in mid-December.
To register for the webinar on Dec. 6, 2017, click here.