Research Reveals HIV Health Benefits of Targeted Case Management

Providing comprehensive, holistic case management to people dealing with multiple comorbid conditions, including HIV, can yield tangible health improvements and long-term cost savings, according to a new study released by Amida Care, a New York City nonprofit health plan, and ACRIA, an HIV/AIDS research organization.

The report, "The Impact of Comprehensive Case Management on HIV Client Outcomes," provides unique insight into the effectiveness of Comprehensive Medicaid Case Management, also known as Targeted Case Management (TCM), which provides wraparound supportive services to help people with complex needs to navigate the health care system and improve their health outcomes.
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"Targeted Case Management provides the critical structure that people with chronic conditions need to improve their well-being and long-term health by working with a dedicated care coordination team," said Doug Wirth, President and CEO of Amida Care. "TCM addresses the social determinants of health such as unstable housing and food insecurity that prevent people from staying in care and adhering to their treatment."

"The study shows a clear connection between care coordination and significant immune system improvements," concluded Wirth. "This is powerful evidence that treatment adherence and staying in care produce improved health outcomes, which in turn can lead to lower hospitalization rates and health care cost savings."
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In past findings from 2008 to 2014, Amida Care observed a dramatic 74 percent reduction in hospitalizations and a 64 percent decline in emergency room visits due to improvements in immune system function associated with its TCM model of care, as well as over $88 million in in-patient cost savings to New York State.

Amida Care's Medicaid special needs health plan (SNP), the largest in New York, is specifically designed to provide coordinated care to people living with chronic conditions, including HIV/AIDS and behavioral health disorders. The plan is also available to Medicaid members who are homeless, regardless of HIV status.

Over a 21-month period, the current study examined the effectiveness of TCM services for individuals with HIV in New York State by analyzing changes in clinical, cost, and pharmacy and hospital utilization data among more than 2,000 Amida Care members with HIV. The study showed that through TCM, clients significantly increased their CD4 counts -- a key indicator of immune system health -- to be on par with Amida Care's non-TCM clients, who do not require the level of care that TCM provides and who already had substantially higher CD4 levels at the beginning of the study.

"The rebound we saw in the CD4 count among those who received Targeted Case Management is remarkable. The findings clearly demonstrate that TCM is able to achieve its goals of improving sustained care engagement and treatment adherence," said Dr. Stephen Karpiak, Senior Director for Research and Evaluation at ACRIA.

"There is a direct connection between these results and the supportive services that TCM provides. The Targeted Case Management teams are highly skilled and become a vital connection for those with multiple social and health challenges," he continued. "This study provides important evidence illustrating the value of care coordination to improve health outcomes. If we don't provide these coordinated supports, we won't be able to end the AIDS epidemic."

The study demonstrates the clear benefits of TCM for those who previously lacked the support systems that enabled them to adhere to a treatment regimen. TCM also benefits the community at large, because people with low viral loads are less likely to transmit HIV to others, which not only saves lives but also helps to prevent the high long-term cost associated with new cases of HIV.

As New York State implements Governor Andrew Cuomo's groundbreaking Blueprint to End the AIDS Epidemic in the state by the year 2020, programs like TCM that prevent HIV transmission and improve the health of those who are already HIV-positive are of critical importance.

The full study can be accessed here.