New Report from George Washington University and Amida Care Details Importance of HIV Special Needs Plans in Improving Health Outcomes and Ending the HIV Epidemic

Report chronicles history, challenges, and impressive results of  HIV Special Needs Plans in New York State, which can be a model for the nation

George Washington University Milken Institute School of Public Health, together with Amida Care released a new report outlining the history of HIV Special Needs Plans (HIV-SNPs) in New York State. The report documents how this approach to health care plays a critical role in the state’s progress toward ending the HIV epidemic. The report also demonstrates the value of HIV-SNPs as a model for health systems to meet the challenges of caring for individuals living with complex conditions, including HIV.

The report, HIV Special Needs Plans in the New York State Medicaid Program, provides an overview of HIV-SNPs. HIV-SNPs were officially introduced by New York State Medicaid in 2003, as an alternative to “mainstream” managed care plans. HIV-SNPs develop and implement interdisciplinary care plans for enrollees, connecting them with specialty care providers and other resources that take into account their complex health histories. HIV-SNPs are designed with expertise and purpose, facilitating access to care for individuals who experience significant barriers to living their healthiest lives. These specialized health plans help them address needs including—but going far beyond—doctor appointments and prescriptions refills.

HIV-SNPs are proof of concept that payers, providers, and members can all work together to the benefit of each. While not every state in the U.S. can implement the HIV-SNP model, many can. Doing so brings us closer to ending the national HIV epidemic once and for all.

“This report shows the foundational importance of HIV-SNPs, like Amida Care, in supporting New Yorkers living with HIV. HIV-SNPs have played a key role in progress towards the goal of Ending the HIV Epidemic in New York State,” said Doug Wirth, President and CEO of Amida Care. “The HIV epidemic will not be over until it is over for those people living with and placed at risk for HIV who are most vulnerable and whose health conditions are most complex. It is our hope that other states can design health plans with intention, and successfully connect members with complex health and social needs to providers with deep expertise in the communities they support. The HIV-SNP model proves that when you take a holistic approach to health care—including a person’s housing, employment, and food security—HIV-SNPs can improve health outcomes and save money at the same time.”

“New York’s HIV-SNP model have innovated a range of best practices for addressing the needs of people with complex health conditions,” said Naomi Seiler, JD, Associate Research Professor, Milken Institute School of Public Health, George Washington University. “Based on our research and interviews with experts, it is clear that HIV-SNPs have a lot of lessons to offer the rest of the U.S. as we consider how to end the HIV epidemic across the country.”

The HIV-SNP model of comprehensive health care works to combat the isolation and poverty concentrated in neighborhoods that are disproportionately impacted by HIV, especially in communities of color and in LGBTQ communities. This model of care works closely with each member to address complex medical, behavioral, psychosocial, and pharmaceutical needs.  Each member is connected with an integrated care team of experts, including HIV specialist providers, in-house pharmacy teams, social workers, addiction specialists, and treatment adherence counselors.

This holistic approach has proven particularly effective in supporting New Yorkers living with HIV who are aging—a cohort that continues to grow as HIV treatment becomes more effective. Recent research shows that states like New York are facing a “silver tsunami” that will hit by 2030: a marked increase in older Americans living with HIV who are managing multiple health conditions and multiple prescription drugs. It is estimated that by 2030, one-third of U.S. residents living with HIV will have more than two non-HIV comorbidities. The U.S. health care system will have to adapt quickly to this new reality, and New York HIV-SNPs’ success in multimorbidity and polypharmacy in supporting older people living with HIV offers a national model.

HIV-SNPs are also breaking ground in promoting access to gender-affirming health care, which contributes to ending the HIV epidemic. For example, Amida Care has helped more than 1,100 transgender members access gender-affirming surgery, and many of these members have had multiple procedures. In bridging access to gender-affirming care, HIV-SNP members become engaged in primary care and sexual health services, which results in impressive health outcomes. 94% of Amida Care’s transgender members living with HIV are undetectable, well above national averages. HIV-SNPs also support their HIV-negative transgender members in accessing pre-exposure prophylaxis (PrEP)—a critical prevention tool that helps HIV-negative individuals stay negative.

HIV-SNPs’ results speak to the efficacy of their model of care. HIV viral suppression among HIV-SNP members increased from 55% to 80% from 2012-2019 and has remained steady, and over 2,000 members have been cured of Hepatitis. These improvements show that the HIV-SNP model leads to Medicaid savings. Between 2008 and 2019, Amida Care alone saw a 63% reduction in emergency room visits among members; a 74% reduction in admissions per 1,000 members; and a 34% decrease in average length of stay; ultimately facilitating $170 million in savings to New York State Medicaid.

While HIV-SNPs have provided valuable contributions toward Ending the Epidemic in New York State, the report concludes that their focused work has also yielded key lessons for the response across the entire country, including:

• The health care system can reach communities disconnected from care/for whom traditional health care modalities have failed.
• Managed care can be used to improve the quality of care for people living with HIV.
• Effective pharmacy design can improve health and save money for people living with HIV.
• By providing access to comprehensive gender-affirming care, designing comprehensive wraparound services, training staff, and understanding the complex interplay between body image and mental health, health systems can engage transgender people in the full continuum of care—including HIV prevention and treatment—and improve overall health outcomes.
• As HIV treatment becomes more effective, the U.S. health care system will need to quickly learn how to support older people living with HIV, which involves patients experiencing multiple chronic conditions associated with aging much sooner. HIV-SNPs offer their experience in care coordination, pharmacy care management, and a holistic approach to address health outcomes and health care costs as a national model.

Read the full report to learn more.