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States Share Data to Improve the Health of People Living with HIV
| 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.
Alaska – Medical Homes
In May 2014, Alaska DHSS, the Alaska Primary Care Association, and the Alaska Mental Health Trust Authority launched the Alaska Patient-Centered Medical Home Initiative (AK-PCMH-I), a patient-centered medical home pilot focused on achieving better health outcomes and patient experience for rural and frontier populations. NASHP provided technical assistance to the project team through a Medicaid-Safety Net Learning Collaborative, funded through a federal Health Resources and Services Administration (HRSA) cooperative agreement.
AK-PCMH-I provides grant funding and practice transformation support to five practices in the state, selected through a Request for Proposals (RFP) process. The project is funded in part by a capital grant from the Alaska State Legislature, allocated to the Alaska Primary Care Association in 2012 to support the transformation of a cohort of federally-funded community health centers into medical homes; these funds are supplemented with funding from Alaska DHSS and the Alaska Mental Health Trust Authority.
Alaska’s Department of Health and Social Services (DHSS) Division of Health Care Services medical home work focuses in particular on rural/frontier, tribal, independent and non-rural providers. In early 2012, the state contracted with Public Consulting Group, a national firm, to develop a strategy to advance medical homes in the state.
Federal Support: Alaska is also participating in the Tri-State Child Health Improvement Consortium (T-CHIC), a CHIPRA Quality Demonstration Project funded by the Centers for Medicare & Medicaid Services (CMS), in collaboration with Oregon and West Virginia. Through this project, the state is working to develop medical homes for children enrolled in Alaska Medicaid and Denali Kid Care as a way to increase access to EPSDT services. T-CHIC funding ends in 2015.
Last Updated: June 2014
| Forming Partnerships |
The Alaska Patient-Centered Medical Home Initiative (AK-PCMH-I) is a collaborative effort of the Alaska Mental Health Trust Authority, the State of Alaska Department of Health and Social Services, and the Alaska Primary Care Association.
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| Defining & Recognizing a Medical Home |
Definition: A 2011 Department of Health and Social Services (DHSS) Medicaid Task Force report offers the following definition: “The medical home: (1) puts the patient at the center of their health care decisions, (2) makes it easier for patients to get care and advice when they need it, (3) provides the right care at the right time and eliminates unnecessary procedures, (4) improves health outcomes, (5) coordinates care across multiple providers, and (6) partners patients with their own team of primary care providers.”
Recognition: Within 18 months of pilot launch, participating practices must achieve medical home accreditation or recognition under one of three national programs – NCQA PPC PCMH, Joint Commission, or Accreditation Association for Ambulatory Health Care (AAAHC).
In addition to the recognition requirements described above, the practice selection process favored sites that had a focus on behavioral health integration and mature health information technology capacity.
The AK-PCMH-I Request for Proposals (RFP) also identifies five core medical home competencies:
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| Aligning Reimbursement & Purchasing |
The Alaska Patient-Centered Medical Home Initiative (AK-PCMH-I) pilot sites will receive a one-time grant of up to $75,000 to support practice transformation efforts over the 18-month project budget period. Grants are supported in part by a capital grantfrom the Alaska State Legislature in addition to funds from the Alaska Department of Health and Social Services and Alaska Mental Health Trust Authority.
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| Supporting Practices |
According to the Alaska Patient-Centered Medical Home Initiative (AK-PCMH-I) Request for Proposals (RFP), technical assistance for the project is provided by the Alaska Primary Care Association’s Training and Technical Assistance Department. Pilot practices have access to a number of practice supports, including an initial readiness assessment, group learning sessions, peer learning opportunities, practice coaching sessions, teleconferences and webinars, and networking opportunities. A comprehensive technical assistance schedule is included in the RFP.
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| Measuring Results |
The Alaska Patient-Centered Medical Home Initiative (AK-PCMH-I) will use claims data, provider records, satisfaction surveys, and when available EHR data, to evaluate each pilot site on 5 outcomes:
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Alaska
In Alaska:
- All Medicaid services are delivered entirely on a fee-for-service basis through the Alaska Division of Health Care Services (DHCS), which is responsible for program and policy development; and the Alaska Division of Public Assistance (DPA), which is responsible for determining eligibility. There were a total of 120,611 beneficiaries enrolled in Alaska Medicaid as of July 2011.
- Alaska provides basic EPSDT services to children on a fee-for-service basis. This includes all behavioral health, mental health, and dental services provided through the benefit.
- A home and community-based services waiver for children with complex medical conditions offers Medicaid services to medically fragile children
As of 2012, 96,693 individuals were eligible for EPSDT through Alaska’s Medicaid program. According to CMS data from 2012, Alaska achieved an EPSDT screening ratio of 49% and a participation ratio of 38%. 42,646 children received dental services of any kind, with 37,540 receiving preventive dental services.
Last updated June 2014.
| Medical Necessity |
Alaskan relies on the federal definition through state legislation defining EPSDT covered services as follows:
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| Initiatives to Improve Access |
Alaska is part of the Tri-State Child Health Improvement Consortium (T-CHIC), in which it is collaborating with Oregon and West Virginia as part of the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Project. Through this project Alaska is working to develop medical homes for children enrolled in Alaska Medicaid and Denali Kid Care as a way to increase access to EPSDT services. |
| Reporting & Data Collection |
As part of Tri-State Child Health Improvement Consortium (T-CHIC), Alaska is requiring successful medical home pilots to address the following areas:
The participating medical homes also must comply with the CHIPRA Core Measures for voluntary use by Medicaid and CHIP programs.
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| Behavioral Health |
Behavioral and mental health services are covered on a fee-for-service basis as deemed medically necessary.
As described in Alaska’s Integrated Behavioral Health Regulations, Medicaid-covered behavioral health services for children include therapeutic behavioral health services and day treatment services for children.
The state’s EPSDT provider billing manual encourages developmental screenings and assessments. The Alaska Department of Health and Social Services recommends a number of developmental screening tools, including the Ages and Stages Questionnaire, the Battelle Developmental Inventory Screening Tool, and Parents’ Evaluation of Developmental Status.
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| Support to Providers and Families |
Support to Families
Alaska relies on mailings and newsletters to inform families about the EPSDT benefit.
Support to Providers
Alaska contracts with Xerox State Healthcare LLC, which maintains the Alaska Medical Assistance Health Enterprise Portal to support providers.
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| Care Coordination |
Alaska, through its contractor Qualis Health, provides case management services designed for patients with serious illness, injuries, and some chronic conditions. These services are available to children with disabilities and children covered by Alaska’s Children with Complex Medical Conditions Waiver. Upon receiving a referral for case management services, a Qualis Health nurse manager works with the patient and family on a number of things related to health care needs including working with the patient, family and medical providers to develop a coordinated care plan. Additionally, these managers also help coordinate the services provided by all professionals involved.
The coordination of EPSDT services – including dental, behavioral, and other need – for Medicaid children is also a primary goal of the practices participating in the T-CHIC initiative.
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| Oral Health |
Alaska Medicaid covers all dental services for children on a fee-for-service basis. This includes exams, X-rays, scaling, polishing, sealants, and fluoride varnish (physicians may apply fluoride varnish in Alaska). Alaska also covers dentures, crowns, caps, root canals and oral surgery, though some may require prior authorization. Alaska also covers orthodontia services, including braces, if deemed medically necessary and prior authorization is obtained. |
Alaska
NASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@oldsite.nashp.org.
Last updated: October 2012
Alaska – HIE
No HIE Strategic Plan available yet.
Alaska
Alaska’s PCO and PCA successfully and rapidly grew their CHC program from two health centers serving approximately 12,000 people, to 24 centers serving over 80,000 with their Alaska Frontier Initiative. Additionally, the two organizations received authorization for the Frontier Extended Stay Clinic (FESC) demonstration projects, which examines the effectiveness and appropriateness of a new type of provider, the FESC, in providing health care services in certain remote locations.
Alaska
The Alaska ABCD Screening Academy Project established a statewide stakeholder group, implemented the use of a standardized screening tool in several practices, and worked to identify and implement state policy improvements to support effective screening. Specifically, the ABCD Screening Academy project in Alaska improved structured developmental screening by:
- Recommending a revision in Early Intervention eligibility levels from 50% developmental delays to 25% and requesting additional funding for Part C/Early Intervention services.
- Developing universal referral and feedback forms in demonstration site areas designed to improve the referral and communication process, forms which can be adapted for other areas of the state, and developing resources for parents on "why to follow up with a referral" to be printed and distributed along with other information to primary care offices.
- Spreading the use of validated, objective screening tools by implementing screening in additional sites and sustaining these activities through funding from the Alaska Mental Health Trust.
| Title | Description | Date Published | Activity |
| Alaska’s Referral Process for Pilot Sites | (Alaska ABCD Project) Flow chart of referral process for pilot sites | December 2007 | Addressing Needs |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
