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Robbing Peter to Pay for Paul's HIV Care
Jesse Fry
Coverage Continuum
Private Health Insurance˄˅
Patient Assistance Programs˄˅
AIDS Insurance Continuation Program (AICP)˄˅
AIDS Drug Assistance Program (ADAP or Part A pharmacy)˄˅
“Medicaid-pending” (possibly with RW wrap-around˄˅
Medicaid (w/o Medically Needy or other waiver programs)˄˅
Medicaid (w/o Part D)˄˅
Medicare (w/o Part D)
DISCLAIMER:If you're already doing this stuff, or the state in which you advocate is doing this stuff, don't take offense, pronounce it! Show off! Also, I'm not trying to 86 anybody's job...just making suggestions to make things better.
AIDS Insurance Continuation Program (AICP)
AICP sustains private health insurance coverage for PLWH at risk of losing it.
Key advantage: Patient stays with her established care team, including pharmacist.
Factoid: About two-thirds of AICP clients medically and financially qualified for Florida Medicaid.
“Saturation is for sponges.”
Ray CrocFounder of McDonald's
MAX-OUTAICP !!!
Coverage Continuum
Private Health Insurance˄˅
Patient Assistance Programs˄˅
AIDS Insurance Continuation Program (AICP)˄˅
AIDS Drug Assistance Program (ADAP or Part A pharmacy)˄˅
“Medicaid-pending” (possibly with RW wrap-around˄˅
Medicaid (w/o Medically Needy or other waiver programs)˄˅
Medicaid (w/o Part D)˄˅
Medicare (w/o Part D)
What's so bad about Medicaid?
Virtually 100% coverage of antiretrovirals in most states
Choice of doctors, nurse practitioners, healthcare team (AAHIVM, ID society...)
Fun fact about HIV diagnostic tests: In Florida, it's written into state law, every year, in the appropriations bill that Florida Medicaid shall pay for genotypic and phenotypic assays.
Jesse's Favorite Data Integrity and Use Rules:
(I know, such a nerd...)
1. Get your data into a format you can easily query.
2. Query the bat snot out of it.
Part B Grantees:Review new client intake processes, statewide, and if necessary, standardize to make sure the
first two data points every case manager collects are:
1. Does she have any healthcare coverage?
2. Does she qualify financially and medically for Medicaid?
Not just for eligibility determinations; Use data liberally, lather, rinse, repeat.
Case Question:If he qualifies for Medicaid and doesn't have
health insurance, and ADAP is on a waiting list, what do you do?
State ADAP's:
Share your goals and successeswith state-based advocacy groups.
Ryan White Grantees:
Don't wait for HRSA to tell you to do something with data, for Pete's sake, just do it.
And not just to get a SPNS grant, either.
Partner with pharmaceutical companieson their Patient Assistance Programs.
What works, what doesn't, how it could be better.
“It's easier to criticize than to praise.”
Barbra Streisand(I know, I know, super gay. But she said it, so there you go.)
It's still the low...(That's law, pronounced, LOW...)
Funds from HRSA budget, allocated for Ryan White programs are:
FUNDS OF LAST RESORT
Suggested Solution: The softer side.
Transition from “inventory-based” dispensing to “specialty and retail pharmacy-based” dispensing.
Makes fiscal sensePatient self-sufficiency
Patient adherenceConvenience
Own the position in the minds of members of Congress as credible sources of information on
HIV treatment advocacy.
Book on “Positioning”:
Positioning: The Battle for your Mind
Ever had an empty file folder shaken in your faceby a screaming memberof Congress?
Let's break this down...
Don't put all of your political eggs
in the same partisan basket?
Urge HRSA to require that all “overlapping” Consortia and Planning Councils to merge,
forming one planning body.
Fun Fact:
If Congress doesn't pass a budget this session
it will be the first time since 1974.
“Creative Destruction”
Google it.
“ANTI-CAPITALISM”
“ANTI-GOVERNMENT”
ANTI-CREATIVITY
Knock it off, already.
“Samson killed 1,000 Philistineswith the jawbone of an ass.
Everyday, at least as many sales are killedwith the same weapon.”
AnonymousPosted on copier room wall
at an advertising agency.
Books on Creativity:
A Whack on the Side of the Head
A Kick in the Seat of the Pants
Coverage Continuum
Private Health Insurance˄˅
Patient Assistance Programs˄˅
AIDS Insurance Continuation Program (AICP)˄˅
AIDS Drug Assistance Program (ADAP or Part A pharmacy)˄˅
“Medicaid-pending” (possibly with RW wrap-around˄˅
Medicaid (w/o Medically Needy or other waiver programs)˄˅
Medicaid (w/o Part D)˄˅
Medicare (w/o Part D)
“If you're not transitioning clients toward self-sufficiency, you're not doing your job.”
Suzanne StevensBureau of HIV/AIDS, DOH, Florida
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