Lowered Costs for Comorbid HIV-Positive Patients Treated in Medical Homes

Patients with human immunodeficiency virus (HIV) covered by Medicaid who had medical comorbidities and behavioral health disorders had fewer inpatient services, more outpatient services, and overall lower costs when treated in a patient-centered medical home. Researchers published their findings in the August 2018 issue of The American Journal of Managed Care.

The study focused on utilization and costs under the Pennsylvania Chronic Care Initiative (CCI), a statewide patient-centered medical home initiative that ran from 2008 through 2011.

“These findings have important implications for the future of HIV care,” researchers wrote. “HIV-positive individuals are more likely than the general population to have psychiatric and/or substance use disorders, and their comorbidities may be more difficult to manage. Whether HIV itself causes this complexity or characteristics that predispose people to HIV interfere with managing comorbid illnesses, the burden on providers to coordinate and implement effective care is greater for HIV-positive populations than for most other patient groups.”

Researchers compared services and costs for 302 patients with HIV treated in a CCI patient-centered medical home and 2577 patients with HIV in the state who received treatment elsewhere. All patients in the study were covered by Medicaid and had chronic medical conditions (diabetes, chronic obstructive pulmonary disease, asthma, or congestive heart failure) and a psychiatric and/or substance use disorder.

Patients in patient-centered medical homes had an average cost savings of $214.10 per month compared with patients who received care outside of patient-centered medical homes, researchers reported. A $415.69 reduction in inpatient medical costs and a $4.86 drop in outpatient substance abuse treatment costs per month were the most significant contributors to the savings.

The number of pharmacy claims unrelated to HIV and outpatient medical claims per month, meanwhile, were a respective 9.7% and 11.7% higher for patients in patient-centered medical homes compared with other patients.

“The CCI intervention apparently was successful,” researchers wrote, “in shifting inpatient costs and utilization to outpatient care and use of non-HIV medications.”

—Jolynn Tumolo

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