Reducing HIV-Related Health Disparities

Vision for the National HIV/AIDS Strategy “The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socio-economic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

NHAS Plan to Reduce HIV-Related Disparities and Health Inequities Disparities in HIV prevention and care persist among racial/ethnic minorities, as well as among sexual minorities. While working to improve access to prevention and care services for all Americans, the following steps will help to reduce inequities across groups: Reduce HIV-related mortality in communities at high risk for HIV infection. Adopt community-level approaches to reduce HIV infection in high-risk communities. Reduce stigma and discrimination against people living with HIV.

Anticipated Results By 2015 Increase the proportion of HIV diagnosed gay and bisexual men with undetectable viral load by 20 percent. Increase the proportion of HIV diagnosed Blacks with undetectable viral load by 20 percent. Increase the proportion of HIV diagnosed Latinos with undetectable viral load by 20 percent.

Recent Developments Targeting Health Disparities Patient Protection and Affordable Care Act (ACA) Health Equity and Accountability Act (HEAA) Revised treatment guidelines issued by the Department of Health and Human Services (DHHS) National Partnership for Action Revised CDC Health Department FOA

ACA: Performance Based Measurement The Affordable Care Act will dramatically alter the way providers are paid, shifting payment for volume to payment for value. This potentially transformative policy approach has been one of a few to achieve bipartisan support and promises to mitigate challenges to providing and receiving quality health care. Payment approaches specifically identified in the Affordable Care Act for pilot testing include bundled episodes, shared savings, and partial capitation to accountable care organizations and other providers, as well as development of payment options for patient-centered medical homes.

ACA: Patient Bill of Rights In an effort to reduce health disparities and improve health outcomes, the ACA ends a number of the insurance industry’s worst practices Ends pre-existing condition exclusions (and establishes Pre-Existing Condition Insurance Plans in the interim period until 2014) Ends arbitrary withdrawal of insurance coverage Ends annual and lifetime limits on coverage Coverage for certain recommended preventive health services with prohibited cost-sharing for such services

ACA: Accountable Care Organizations Accountable care organizations (ACOs) are partnerships between doctors and hospitals that provide financial incentives to providers for more efficient and better care. ACOs will be a part of Medicare by 2012 and are attracting wider interest among commercial payers and state legislatures. ACOs receive a lump sum payment to cover care for a specific population of patients with the ability to keep any savings resulting from meeting performance goals. Patients are assigned to a particular ACO, but are not restricted to receiving care from providers in a particular network (like traditional managed care). Experts believe ACOs are a promising model for improving costs and efficiency, and that their more proactive approach to care could lead to improved health outcomes.

ACA: Office of Minority Health Sec establishes the Office of Minority Health in the Office of the Secretary at Health and Human Services - Will be headed by the Deputy Assistant Secretary for Minority Health and report directly to the Secretary - Sec. 1707A Establishment of Individual Offices of Minority health within the Department of Health and Human Services

ACA: National Strategy for Quality Improvement in Health Care Sec “to improve the delivery of health care services, patient health outcomes, and population health” - Secretary shall define national priorities for improvement that among many things - (viii) – reduce health disparities across health disparity populations

HEAA: Targeted Resources to Eliminate Health Disparities The focus of the HEAA is to compliment the Affordable Care Act by providing targeted federal support, resources, and policies to tackle disparities in health status and the health care system at all levels Permits HHS to consult with minority organizations and award grants to develop curricula for training primary care providers in HIV prevention and care for minority communities Requires HHS to submit an annual report to Congress on information about the progress, opportunities, challenges and federal funding needed to reduce the impact of HIV/AIDS in racial and ethnic minority communities Requires the Bureau of Prisons to develop a comprehensive policy within one year to provide HIV testing, treatment, and prevention for inmates within the correctional setting.

HHS: Updated Treatment Guidelines Newly issued HHS guidelines state that antiretroviral therapy (ART) is recommended for all HIV-positive individuals. Regardless of CD4 count, initiation of ART is strongly recommended for HIV-positive individuals Patients may continue to choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.

National Partnership for Action The HHS Action Plan to Reduce Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities. HHS also released the National Stakeholder Strategy for Achieving Health Equity, a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities and other underserved groups reach their full health potential. The strategy, a product of the National Partnership for Action (NPA), incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. The NPA was coordinated by the HHS Office of Minority Health.

CDC Funding Opportunity Announcement PS The goals for this funding opportunity announcement (FOA) include: Increase testing among populations disproportionately affected by HIV – primarily, (1) African American and Hispanic men and women, and (2) MSM and IDUs, regardless of race or Expanded, targeted HIV counseling, testing, and referral (CTR) services in non-clinical settings or venues where high- risk members of these populations can be accessed. Ensuring that persons testing positive for HIV infection (new positives and previously diagnosed positives not in care) receive prevention counseling and are linked to medical care, partner services, and HIV prevention services.

CDC Funding Opportunity Announcement PS Promoting adoption of sustainable, routine HIV screening programs in healthcare facilities, consistent with CDC’s 2006 Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. Supporting integration of HIV testing with testing and prevention services for other infections, such as hepatitis C virus (HCV), hepatitis B virus (HBV), other sexually transmitted diseases (STDs), and tuberculosis (TB).

Stable Housing Improves Health Outcomes Effectively addressing HIV risk & health care disparities requires attention to structural factors —environmental or contextual factors that influence health. Housing affects an individual’s ability to avoid exposure to HIV; an HIV-positive individual’s ability to avoid exposing others to HIV; and the ability to access & adhere to care. Housing status is likely the most important characteristic of each PLWHA who seeks services - the most significant determinant of each PLWHA’s health and risk outcomes.

Augmented Behavioral Health Improves General Health Outcomes Behavioral health services improve health status and reduce health care and other costs to PLWHA. Effectively targeting substance abuse and mental health services to the people most in need translates to higher treatment adherence and care retention Continued improvement in the delivery and financing of prevention, treatment and recovery support services is provided for in the advancement of the goal of the National HIV AIDS Strategy to “increase access to care and optimize health outcomes.”

Thank you for your attention! Kali Lindsey Director of Legislative and Public Affairs