Toolkit: State Strategies to Improve Health Outcomes for People Living with HIV


Collaboration between state health department HIV programs and Medicaid is integral to providing quality, comprehensive care to people living with HIV (PLWH). With consistent, well-coordinated care and access to antiretroviral therapy (ART) many PLWH can achieve virologic suppression. Those who achieve sustained virologic suppression tend to have better health outcomes and a reduced risk of transmitting HIV to others. Collaboration and partnership can be challenging in many states, particularly when the Medicaid and state health departments are housed in separate agencies. There are, however, numerous strategies states can implement to improve collaboration and partnership between Medicaid and state health departments to implement policy and program changes to achieve this goal.

In 2017, NASHP completed work with 19 states to support them in identifying and implementing policy and program changes to improve rates of sustained virologic suppression among Medicaid and CHIP beneficiaries living with HIV. While working with these states, NASHP identified that state officials needed additional resources on a variety of topics, such as data sharing and use and quality improvement.

This toolkit, supported through a cooperative agreement with the Health Resources and Services Administration, is intended provide state officials with tools and resources, including issue briefs, webinars, and presentations, they need to improve rates of sustained virologic suppression. New items will be added to the toolkit on a regular basis, providing state officials with up-to-date information and timely policy resources.


Tools and Resources

Publications

How States Use Medicaid and State Health Department Data to Improve Health Outcomes of People Living with HIV
December 2017

This issue brief discusses key considerations and promising state strategies to share and then analyze Medicaid claims and HIV surveillance and Ryan White HIV/AIDS Program data. Analyses of these interagency data sets can help inform state and local policy and program changes aimed at increasing rates of virologic suppression for Medicaid and CHIP beneficiaries living with HIV. The brief also provides an overview of select data sets that states may be interested in sharing. This issue brief was written as part of the HIV Health Improvement Affinity Group project.


Prioritizing Care: Partnering with Providers and Managed Care Organizations to Improve Health Outcomes of People Living with HIV
December 2017

This mini-brief highlights promising strategies for HIV Health Improvement Affinity Group states to successfully engage managed care organizations, health systems, and providers in quality improvement efforts aimed at increasing rates of virologic suppression. Louisiana, Michigan, New York, and Wisconsin are featured. This mini-brief was written as part of the HIV Health Improvement Affinity Group project. 


States Share Data to Improve the Health of People Living with HIV
December 2017

This blog presents lessons learned from three HIV Health Improvement Affinity Group states—Alaska, Louisiana, and Maryland—that are working toward sharing and analyzing Medicaid and state health department data to ultimately increase rates of virologic suppression among people living with HIV. This blog was written as part of the HIV Health Improvement Affinity Group project.


Better Together: How Cross-Agency Data Sharing Can Improve the Care Continuum for People Living with HIV/AIDS
October 2017

The state of Georgia leveraged a data sharing agreement between its public health and Medicaid departments in order to assess care quality for Medicaid beneficiaries living with HIV. Data use agreements are critical for agencies interested in sharing data. This blog was written as part of the HIV Health Improvement Affinity Group project.


Data, Delivery, and Decisions as Levers for Enhancing Whole-Person Care for People Living with HIV: Lessons from the Ruth M. Rothstein CORE Center
January 2017

As states continue to focus on integrated care and delivery system reform, meaningful opportunities exist to improve care for people living with HIV. The Ruth M. Rothstein CORE Center in Chicago, Illinois – part of the Cook County Health & Hospitals System – operates an integrated care model they call “one-stop shopping.” This issue brief showcases the CORE Center’s model and how it is partnering with the Illinois Department of Health to improve care for people living with HIV. The accompanying webinar can be accessed here. The webinar and issue brief were developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.


Advancing HIV Prevention Through Health Departments: Health Homes for People Living with HIV/AIDS
June 2016

This case study highlights Wisconsin’s health home program for Medicaid beneficiaries living with HIV, which is the first and only health home program exclusively for this population. Wisconsin’s experience may assist other states considering the health home state plan option as a strategy to support integrated care for Medicaid beneficiaries living with HIV. This case study was developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.


Advancing HIV Prevention Through Health Departments: HIV-Specific Quality Metrics for Managed Care
June 2016

This case study highlights New York’s use of HIV-related performance metrics to incentivize its Medicaid managed care plans to improve care for their members living with HIV. Their experience may assist other states considering how to incentivize quality improvement in their managed care program. This issue brief was developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention.


Strategies for Coordination Between Medicaid and Ryan White HIV/AIDS Programs
November 2013

This policy brief discusses the importance of coordination between a state’s Medicaid agency and the Ryan White HIV/AIDS Program (RWHAP) to ensure that people living with HIV have access to comprehensive, high-quality care. NASHP interviewed Medicaid and RWHAP officials in 14 states about successful coordination efforts. This brief highlights those examples, along with additional promising practices for coordination that facilitate delivery improvements for people living with HIV. An accompanying webinar can be accessed here. The Health Resources and Services Administration (HRSA) provided support for this issue brief and webinar.

Webinars and Presentations

Overview of state and federal HIV programs

State Health Department HIV Programs: An In-Depth Look
February 23, 2017
View the webinar | Download the slides

The purpose of this webinar was to provide Medicaid and other state officials with information about the structure and components of state health department HIV programs and resources, as well as opportunities for collaboration between these programs and Medicaid. The Centers for Disease Control and Prevention discussed state HIV surveillance and prevention programs and the Health Resources and Services Administration discussed the Ryan White HIV/AIDS Program. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Housing Opportunities for Persons with AIDS: Presentation for HIV Health Improvement Affinity Group
December 7, 2016
Download the slides

This presentation described the Housing Opportunities for Persons with AIDS (HOPWA), a federal program dedicated to assisting with the housing needs of people living with HIV, and work in Alabama focused on improving health outcomes for people living with HIV/AIDS through greater access to housing. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

Health Resources and Services Administration and HIV/AIDS Bureau Update
December 6, 2016
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Laura Cheever, Associate Administrator for the HIV/AIDS Bureau within the Health Resources and Services Administration presented an overview of the Bureau’s priority areas and a preview of 2015 Ryan White HIV/AIDS Program Services Report data. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides

This webinar was intended to provide context to HIV Health Improvement Affinity Group states about the importance of improving care and health outcomes for people living with HIV. Following presentations and remarks from senior federal agency officials, two Affinity Group states presented about their work. Louisiana shared their work to date using data to determine the proportion of Medicaid beneficiaries that are engaged in care and virally suppressed, and implementing a HIV-related metric into its MCO incentive-based performance metric set. Wisconsin shared its progress analyzing Medicaid claims and HIV-related clinical data to better evaluate health outcomes for Medicaid beneficiaries living with HIV.


Overview of state Medicaid programs

The Medicaid Program: An In-Depth Look
February 16, 2017
View the webinar | Download the slides

While Medicaid programs vary greatly across states, the purpose of this webinar was to provide state health department and other officials with information about the structure and components of this program, as well as opportunities for collaboration between Medicaid and state health departments. The Centers for Medicare & Medicaid Services and NASHP presented about Medicaid structure, eligibility, benefits, financing, payment and delivery, as well as waivers and state plan amendments. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.


Interagency collaboration

Rhode Island Lessons Learned: Relocating Ryan White
December 7, 2016
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Rhode Island presented on how Medicaid and its Ryan White HIV/AIDS Program are partnering on quality improvement projects and the implementation of Medicaid benefits, such as a targeted case management program. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group. 

Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination
August 29, 2013
Download the slides

This webinar highlighted strategies that California, Massachusetts, Tennessee, and Washington have used to improve interagency coordination, as well as implement policy changes to improve health outcomes for people living with HIV. An accompanying issue brief is available here. The Health Resources and Services Administration (HRSA) provided support for this webinar and issue brief.


Opportunities for state policy improvement

Webinar: Increasing Rates of Virologic Suppression: Promising Practices from HIV Health Improvement Affinity Group States
Wednesday, Dec. 6, 2017
View the webinar | Download the slides

Increasing rates of virologic suppression among people living with HIV is critically important to improving their quality of life and decreasing the risk of further HIV transmission. For the last 12 months, the HIV Health Improvement Affinity Group has worked with state health departments and Medicaid agencies from 19 states to develop and implement performance improvement projects aimed at improving rates of sustained virologic suppression among Medicaid beneficiaries living with HIV. This webinar featured leaders from the Office of HIV/AIDS and Infectious Disease Policy in the US Department of Health & Human Services, the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Centers for Disease Control and Prevention. It also featured Affinity Group states, Alaska and North Carolina, that shared lessons learned and best practices from their performance improvement projects.

Improving Quality of Care for Medicaid Beneficiaries Living with HIV: Strategies to Engage Managed Care Plans and Providers
August 17, 2017
View the webinar | Download the slides

It is important for states to engage key partners, such as managed care plans and providers, in order to improve the quality of care provided to Medicaid beneficiaries living with HIV. This webinar showcased New York state’s work to incentivize managed care plans to improve rates of virologic suppression for their members living with HIV. The New England AIDS Education and Training Center also shared resources and promising strategies to engage HIV providers in quality improvement. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

HIV Health Improvement Affinity Group: Policy and System Change
December 7, 2016
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This presentation highlighted the role that Medicaid plays in ensuring many people living with HIV have access to comprehensive, high quality care. It also showcased policy changes that states could implement to improve access to and quality of care for beneficiaries living with HIV, including increased access to HIV testing, benefit design changes, and network adequacy standards. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

Rhode Island Lessons Learned: Relocating Ryan White
December 7, 2016
Download the slides

Rhode Island presented on how Medicaid and its Ryan White HIV/AIDS Program are partnering on quality improvement projects and the implementation of Medicaid benefits, such as a targeted case management program. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group. 

Recent HIV Data to Care (D2C) Experiences in Maryland
December 6, 2016
Download the slides

Maryland presented on how it is using analyses of HIV surveillance and Medicaid claims data to identify people living with HIV who are not engaged in regular HIV care, and then developing policy and program changes to address these gaps in care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides

This webinar was intended to provide context to HIV Health Improvement Affinity Group states about the importance of improving care and health outcomes for people living with HIV. Following presentations and remarks from senior federal agency officials, two Affinity Group states presented about their work. Louisiana shared their work to date using data to determine the proportion of Medicaid beneficiaries that are engaged in care and virally suppressed, and implementing a HIV-related metric into its MCO incentive-based performance metric set. Wisconsin shared its progress analyzing Medicaid claims and HIV-related clinical data to better evaluate health outcomes for Medicaid beneficiaries living with HIV.

Better Together: State Strategies for Medicaid-Ryan White HIV/AIDS Program Coordination
August 29, 2013
Download the slides

This webinar highlighted strategies that California, Massachusetts, Tennessee, and Washington have used to improve interagency coordination, as well as implement policy changes to improve health outcomes for people living with HIV. An accompanying issue brief is available here. The Health Resources and Services Administration (HRSA) provided support for this webinar and issue brief.


Data sharing and use

Data Sharing and Use: Creating Platforms for Exchange, Insight, and Action
May 24, 2017
View the webinar | Download the slides

This webinar highlighted the importance of building technological infrastructure to link and use data sets across state agencies, programs, and provider groups, as well as provided details about available 90/10 match funding to support infrastructure development. Louisiana and the District of Columbia both shared their experiences with developing information technology infrastructure to share data among agencies and programs. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Data Transfer and Use: Navigating Federal and State Laws and Regulations
March 28, 2017
View the webinar | Download the slides

This webinar discussed various data sharing regulations at the state and federal level, such as HIPAA and 42 CFR Part 2, and how these regulations may impact the sharing and use of HIV-related data across state agencies. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

North Carolina’s Engagement in Care Database for HIV Outreach (NC Echo): A Collaborative Effort
December 7, 2016
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North Carolina presented on its Engagement in Care Database, which analyzes data from Medicaid claims and health department surveillance and Ryan White HIV/AIDS Program to identify people living with HIV that are not engaged in HIV care. State program staff then use this information to target outreach to these individuals to get them re-engaged in HIV care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group. 

Public Health Innovation: Emerging Opportunities for Leveraging Health Systems Data
December 6, 2016
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This presentation explained why data sharing between Medicaid and state health departments is critical to better understanding utilization patterns and health outcomes for people living with HIV. It also identified key considerations for states interested in advancing this work. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.


Data analysis and presentation

How Data Visualization Efforts Impact Care and Decision Making
July 20, 2017
View the webinar | Download the slides | Presentation handout

The way in which data is presented is important when trying to increase stakeholder understanding and engagement on a particular issue. This webinar discussed strategies states can use to tailor their communication of data to specific audiences. The Massachusetts Department of Public Health shared how it designed a new website about the impact of the state’s opioid epidemic to be a rich, user-friendly resource for policymakers and community members. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.

Recent HIV Data to Care (D2C) Experiences in Maryland
December 6, 2016
Download the slides

Maryland presented on how it is using analyses of HIV surveillance and Medicaid claims data to identify people living with HIV who are not engaged in regular HIV care, and then developing policy and program changes to address these gaps in care. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.

HIV Health Improvement Affinity Group Kickoff Webinar
October 12, 2016
View the webinar | Download the slides

This webinar was intended to provide context to HIV Health Improvement Affinity Group states about the importance of improving care and health outcomes for people living with HIV. Following presentations and remarks from senior federal agency officials, two Affinity Group states presented about their work. Louisiana shared their work to date using data to determine the proportion of Medicaid beneficiaries that are engaged in care and virally suppressed, and implementing a HIV-related metric into its MCO incentive-based performance metric set. Wisconsin shared its progress analyzing Medicaid claims and HIV-related clinical data to better evaluate health outcomes for Medicaid beneficiaries living with HIV.


Provider- and system-level quality improvement

Improving Quality of Care for Medicaid Beneficiaries Living with HIV: Strategies to Engage Managed Care Plans and Providers
August 17, 2017
View the webinar | Download the slides

It is important for states to engage key partners, such as managed care plans and providers, in order to improve the quality of care provided to Medicaid beneficiaries living with HIV. This webinar showcased New York state’s work to incentivize managed care plans to improve rates of virologic suppression for their members living with HIV. The New England AIDS Education and Training Center also shared resources and promising strategies to engage HIV providers in quality improvement. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group. 

Data, Delivery, and Decisions as Levers for Enhancing Whole-Person Care for People Living with HIV: Lessons from the Ruth M. Rothstein CORE Center
January 26, 2017
View the webinar

As states continue to focus on integrated care and delivery system reform, meaningful opportunities exist to improve care for people living with HIV. The Ruth M. Rothstein CORE Center in Chicago, Illinois – part of the Cook County Health & Hospitals System – operates an integrated care model it calls “one-stop shopping.” This webinar featured speakers from the CORE Center and the Illinois Department of Health who shared lessons learned from their partnership to improve care for PLWH. The accompanying issue brief can be accessed here. The webinar and issue brief were developed as part of HealthHIV’s Three D HIV Prevention Program, supported by the Centers for Disease Control and Prevention. 

Process Improvement Methods and Tools
November 18, 2016
View the webinar | Download the slides

Dr. Kevin Larsen from the Centers for Medicare & Medicaid Services shared methods and tools that states can use to design quality improvement initiatives. This webinar was originally produced for participants in the HIV Health Improvement Affinity Group.


Addressing social determinants of health

Housing Opportunities for Persons with AIDS: Presentation for HIV Health Improvement Affinity Group
December 7, 2016
Download the slides

This presentation described the Housing Opportunities for Persons with AIDS (HOPWA), a federal program dedicated to assisting with the housing needs of people living with HIV, and work in Alabama focused on improving health outcomes for people living with HIV/AIDS through greater access to housing. This presentation was originally developed for participants in the HIV Health Improvement Affinity Group.