Getting Patients ACA Coverage, Access to Care, and Viral Suppression

Abstract

With the Affordable Care Act, there are opportunities to improve the health insurance coverage and access to care of people living with HIV (PLWH). The Virginia AIDS Drug Assistance Program transitioned from primarily direct medication provision to purchasing qualified health plans for eligible clients. With this change, the state saw an increase in access to care for clients and improved viral suppression.

Proposal Summary

Background: With the Affordable Care Act (ACA), the Virginia AIDS Drug Assistance Program (ADAP) innovatively shifted its healthcare delivery model from primary direct medication provision to purchasing qualified health plans (QHPs) for eligible clients. About one-fifth of PLWH in Virginia live in rural communities. We aimed to characterize the demographic and healthcare delivery factors associated with Virginia ADAP clients’ QHP enrollment and to assess the relationship between QHP coverage and HIV viral suppression. Methods: Virginia ADAP analyzes the costs and the formularies of the available ACA plans before the enrollment period and submits documentation every year to the federal government that demonstrates paying for insurance (premiums and medication cost shares- deductibles, copayments) with Ryan White funds is less expensive than directly paying only for medications for uninsured patients. Virginia ADAP prioritized ACA-related communication across the Commonwealth and some clinics enrolled ADAP clients into QHPs on site. We studied all people living with HIV who were enrolled in Virginia ADAP (n = 3,933) who were eligible for ADAP-funded QHPs during the first year of ACA open enrollment. Results: For the first year, less than half of the eligible ADAP clients enrolled in QHPs, and enrollment varied significantly based on demographic and healthcare delivery factors. Factors significantly associated with achieving HIV viral suppression included QHP coverage, an initially undetectable VL, HIV rather than AIDS disease status, and HIV clinic. For ADAP clients who had a viral load in the year before the ACA was available and in the second half of the year after the ACA was implemented, demonstrating a level of engagement in care, we found that the viral suppression rate of those who shifted to QHPs was 84.6% compared with 78.6% for those who stayed on Direct ADAP. Conclusions: QHP coverage was associated with viral suppression, an essential outcome for individuals and for public health. Promoting QHP coverage in clinics that provide care to PLWH may offer a new opportunity to increase rates of viral suppression.

Relevance And Significance

This presentation is based on timely ACA enrollment data from our state health department and academic institution collaboration. It will highlight challenges and best practices for achieving improved health care access for PLWH with a focus on rural Southeast populations. This work also highlights that statewide, Virginia ADAP transitioned patients from primarily direct medication provision to ACA insurance as an intervention that improved access to healthcare, increased viral suppression rates, and reduced ADAP-incurred costs of care for the population.

Session Format

Workshop

Keywords

HIV, Health Insurance, Patient Protection and Affordable Care Act, Affordable Care Act, AIDS Drug Assistance Program, ADAP, Virginia, Southeast, Rural, Viral Suppression

Location

Room 129

Publication Type and Release Option

Presentation (Open Access)

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Sep 9th, 10:15 AM Sep 9th, 11:05 AM

Getting Patients ACA Coverage, Access to Care, and Viral Suppression

Room 129

With the Affordable Care Act, there are opportunities to improve the health insurance coverage and access to care of people living with HIV (PLWH). The Virginia AIDS Drug Assistance Program transitioned from primarily direct medication provision to purchasing qualified health plans for eligible clients. With this change, the state saw an increase in access to care for clients and improved viral suppression.