141st APHA Annual Meeting and Exposition

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Recorded Annual Meeting Presentations (RAMP) are now available for purchase.
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290020
Assessing the impact of medical insurance gaps on HIV treatment


Monday, November 4, 2013

Carol Katz, MCRP, MSN, ANP-BC, AACRN, Zinberg Clinic, Cambridge Health Alliance, Cambridge, MA
Kathleen Xu, MPH, Institute for Community Health, Cambridge, MA
Melanie Adem, LICSW, Zinberg Clinic, Cambridge Health Alliance, Cambridge, MA
Fatima Braga, Cambridge Health Alliance, Cambridge, MA
Fabiana Capozzoli, BA, HIV Community Services, Cambridge Health Alliance, Somerville, MA
Gaenslie Lamour, MBA, Cambridge Health Alliance, Somerville, MA
Ranjani Paradise, PhD, Institute for Community Health, Cambridge, MA
Catherine Vaughan, ACRN, Zinberg Clinic, Cambridge Health Alliance, Cambridge, MA
Gerard Coste, MD, Zinberg Clinic, Cambridge Health Alliance, Cambridge, MA
Background: Adherence to antiretroviral therapy is crucial to maintaining a suppressed viral load (VL) for HIV patients. Gaps in insurance coverage can be a major barrier causing interruptions in treatment and care. This project evaluated the extent, causes, and impact of insurance gaps at a multidisciplinary HIV clinic.

Methods: An Insurance Incident Report form was developed that tracked: date incident occurred, date resolved, status of incident, immigration status, causes, and impacts. Over an 18-month time period, staff completed this form for patients who experienced health insurance problems. Data were tracked and reviewed monthly. Aggregate data were analyzed to determine the effect of insurance gaps on delays or interruptions in treatment and on VL suppression.

Results: Over 18 months, 101 Insurance Incident Reports were filed for 81 unique patients; 68 of those incidents resulted in delays or interruptions in medication access, delays in initiating medical visits/lab tests, or interruptions in care. Patients who experienced insurance gaps were more than twice as likely to have detectable VLs as those who did not experience gaps. The most common reason for insurance gaps was patients not completing the required paperwork for continuing coverage. In response, improved data tracking systems, formalized clinical processes and pro-active outreach plans have been implemented to better address insurance issues.

Conclusion: Insurance status plays a major role in patients' access to care. Continued attention to minimizing insurance gaps is important to maintaining adherence to ART and viral suppression both at the individual and community levels.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Discuss the effect of insurance gaps on HIV treatment and medication adherence. Describe a method for tracking insurance incidents at an HIV clinic.

Keyword(s): Insurance-Related Barriers, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the data manager for the HIV Services Quality Improvement Team. I work very closely with all the clinicians who were involved in this project. I am also very familiar with the clinical processes and the main barriers to care relevant to the HIV population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3297.0: HIV testing and linkage to care