Exploring the Medical Home in Ryan White HIV Care Settings: A Pilot Study

Abstract

Amid increased attention to the cost of health care, health information technology, and specialization and fragmentation in medicine, the medical home has achieved recognition as a model for more effective and efficient health care. Little data are available on recently funded HIV medical home demonstration projects, and no research richly describes existing medical home characteristics, implementation challenges, and impact on outcomes in longstanding HIV outpatient settings. The Ryan White HIV/AIDS Program (RWP) provides federal funding for primary and specialty care for people living with HIV. Although RWP clinics developed independently of the medical home model, existing data indirectly support that, with emphasis on primary, comprehensive, and patient-centered care, RWP clinics operate as medical homes. This study explores the development, definition, and implementation of medical home characteristics by RWP-funded providers in order to better understand how it fits with broader debates about medical homes and health care reform.

Ryan White HIV/AIDS Program Assistance and HIV Treatment Outcomes

“…These pathways include provision of medications, core medical and nonmedical case management, and supportive services such as substance abuse counseling, which are needed to promote ART treatment adherence, viral suppression, and overall health [9, 20, 21]. Importantly, RWHAP facilitates provision of these medical and supportive services using a coordinated approach similar to that of the medical home model, and many health providers in RWHAP facilities see HIV-infected patients exclusively [8, 12]. Patients with RWHAP only may have been more likely than those with other payer types, including those receiving supplemental RWHAP assistance, to receive coordinated care from RWHAP facilities serving as medical homes.…”

“…RWHAP provides funding for medical services directly to HIV care facilities, and previous research suggests these facilities perform favorably to other facilities providing HIV medical care [4–8]. RWHAP also provides assistance with HIV medical care for persons who are uninsured or have incomplete coverage for HIV-related medications and services [9], but less is known about the impact of this assistance.…”

Unmet Needs for Ancillary Services Among Hispanics/Latinos Receiving HIV Medical Care — United States, 2013–2014

“…In previous research, Hispanic/ Latino immigrants living with HIV cited inadequate knowledge about available services as obstacles to receiving HIV care and often held erroneous beliefs about service eligibility for undocumented persons (8). Case managers might consider providing targeted support to Hispanic/Latino clients who of the program, and might increase access to these services for persons in HIV medical care (10). The findings in this report are subject to at least four limitations.…”

Unmet Needs for Ancillary Services Among Men Who Have Sex with Men and Who Are Receiving HIV Medical Care — United States, 2013–2014

“…Co-locating ancillary services with routine HIV medical care using a medical home model is a hallmark of the Ryan White HIV/AIDS Program (10). Expansion of the medical home model for HIV care by health departments, health care providers, and community-based organizations would likely increase access to needed ancillary services.…”