Assessing the impact of medical insurance gaps on HIV treatment
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
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
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.