Sharpening the Focus on States
The MMP, once improved, may be used to generate
national estimates of the health care experiences
of people with HIV. It cannot be used for
state-by-state analysis of health care coverage and
utilization because it does not include individuals
from every state. States, however, are responsible for implementing some of the most significant
provisions of the ACA, such as establishing insurance
exchanges and determining whether and
how to expand Medicaid.
To provide information about differences in
health care coverage and utilization by people
with HIV within and across states, ONAP and
HHS should use data from such sources as Medicaid,
Medicare, the Ryan White HIV/AIDS Program,
and private insurers to monitor the effect of
the ACA at the state and program level.
Monitoring Care Quality
Although health care reform is expected to
increase access to health care coverage for people
living with HIV, it does not guarantee linkage to,
retention in, or receipt of quality care. In addition,
the movement of a large number of previously
uninsured individuals with HIV into the health
care system may place increased demands on
the health care workforce. Health care provider
shortages and delays in providing service could
impair care quality.
Therefore, it will be important to monitor
trends in both care quality for individuals with
HIV and enrollment among the various sources of
care coverage as the ACA is implemented. Toward
this aim, ONAP, working with HHS, should take
steps to ensure the collection and linkage of data
on the core indicators, such as those identified in
the committee’s first report, to monitor quality of
care for people with HIV during and after implementation
of the ACA.
Developing an ongoing, dynamic strategy for monitoring
HIV is important for a variety of reasons.
The advent of advanced antiretroviral therapy
transformed HIV into a chronic disease, allowing
infected individuals to live longer, healthier
lives—but only if they receive adequate treatment
as early as possible. Monitoring can provide data
on the numbers and demographic characteristics
of people no longer receiving care at various
points along the HIV care continuum, as well as
track HIV-related health disparities.
More broadly, monitoring will provide an
enhanced means of assessing the effect of the
NHAS and the ACA on care received by people
with HIV—knowledge that can inform future
planning and guide potential redistribution of
resources to improve the efficiency and quality of
care and reduce health inequities.