How the HIV Care Model Can Inform Today’s Value-Based Movement

It’s no secret that healthcare providers are facing a sea change as fee-for-service care delivery gives way to value-based medicine. This shift to population health management can pose significant challenges. While many healthcare providers have been making quality improvements and succeeding in containing pockets of costs, there remains a need to innovate in how care itself is delivered in a value-based world.

As we approach the commemoration of World AIDS Day on Dec. 1, 2019, it is fitting that we look to the crisis that started almost forty years ago as a model for care redesign.

When HIV/AIDS was discovered, the modern world had not seen an epidemic of such catastrophic proportions.

In the 1980’s, the effects of HIV/AIDs were heartbreaking with most infected individuals dying within 6-18 months of their diagnosis. But today, the life expectancy of HIV-positive individuals has been extended to almost match that of the non-HIV-positive population. The factors that led to this incredible management of a once deadly epidemic can be applied to the current need for healthcare providers to innovate and implement value-based care delivery models.

Looking at the HIV care model, there were three notable components working together to achieve successful population health management.

While many assume that the successes in HIV management are tied solely to the discovery of life-saving medications, the epidemic was – in large part – contained by the application of a carefully designed care model.

Reviewing some of the elements of the HIV care model can lend insights to health systems grappling with the needs of population health management to achieve value-based care today.

1. HIV care delivery employed a capitated payment system.

Due to the outpouring of public and private grants, much of the care in HIV delivery was tied to unrestricted funding, similar to the current capitated funding model where a health system is given a “pot” of money to manage a population of patients.

These unrestricted funds meant that HIV clinics could invest in nontraditional methods of caring for their high-risk populations, such as:

• Hiring staff that included members of the HIV-positive community as care managers and outreach personnel;
• Providing group visits or massage therapy for patients; and
• Offering solutions to social determinant health problems such as the cost of transportation.

This unrestricted financial model allowed HIV clinics to make the proactive choices they needed to engage their patient population and positively impact health outcomes.

2. HIV care delivery had clear measures of success.

Today, a primary care clinician may be asked to measure and monitor more than 35 quality scores for a patient with multiple medical conditions such as hypertension, heart disease and diabetes. In contrast, the success of HIV management was around having a small set of clearly defined metrics that indicated success. These measures, which included retention in care, CD4 count and viral load suppression, were chosen because of their direct correlation to an HIV-positive patient’s health and well being.

Furthermore, the simplicity of these few measures meant that all members of the care team were clearly focused on what it meant to achieve success for their HIV+ patient population. In contrast, patients with multiple chronic conditions now have numerous screening, prevention and disease-specific measures, as well as various specialists who may care for them.

3. HIV care delivery was based on team-based care.

The HIV care model was built on the importance of team-based care, with non-clinical staff holding a central role. These non-clinical associates included social workers, care coordinators and outreach counselors – all representing important members of a care team who were vital to addressing the medical and psychosocial needs of HIV-positive patients.

The non-hierarchical structure of these teams meant that anyone – from the front desk staff to the outreach counselor – could provide input on how best to manage a patient’s care. This represents a stark contrast to most traditional care models where a clinical staff of nurses and doctors are relied on to direct and coordinate all aspects of a patient’s care.

These are just a few of the elements that can be applied to the management of chronic diseases to improve population health today. When health systems are determining how multidisciplinary teams can best address hard-to-control chronic conditions, the team-based care delivery which was so vital to the success of HIV patients, should be looked to as the North Star.