Patient centered approaches that strengthen linkage to medical care: Results from the access NY project

Amida Care(AC), an HIV Medicaid managed care organization, implemented an innovative program, ACCESS NY, that actively promotes connection to care among its out-of-care members. An outcomes evaluation assessed the impact of low intensity outreach and health navigator components on reducing the time to initial medical care visit. AC members eligible for ACCESS NY were either unconnected-to-care or had dropped out of care for at least six months. At time of enrollment, ACCESS NY members received low intensity outreach in the form of letters and phone calls. Among ACCESS NY members out of care for at least six months, a random subgroup was assigned a health navigator(HN) to accompany members to their medical care appointment. Data were obtained from AC's membership files and claims data. Estimated effects of both components on time to initial medical visit were obtained from proportional hazard models. Between August 2010 and December 2011, 896 Amida Care members met eligibility requirements for ACCESS NY services and 221 were assigned an HN. The baseline hazard function showed a spike in rates of initial medical visits during the first three months of ACCESS NY enrollment, consistent with the beneficial impact of the low-intensity outreach services. Assignment of a HN reduced the expected time to first appoint by 34% (HR= 1.34, 95% C.I.=[1.04,1.71]), from 105 to 78 days. This study demonstrates the feasibility and effectiveness of a managed care organization based program to strengthen linkage to medical care among an HIV+ vulnerable population.