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AmeriChoice MSO staff consists of experts in HIV/AIDS care and service delivery with experience in program feasibility analysis, development, implementation, and operations management for HIV/AIDS service programs. Our team of skilled professionals works collaboratively with the state HIV/AIDS Administration Departments to address a wide range of HIV program and service-related challenges. Some of the key challenges that we have encountered and examples of solutions we have used and recommend to address these challenges are presented in the table below:
Challenge |
Potential Strategies |
| Decline of Ryan White Grant funding and uncertainty of future funding. |
- Maximize federal (CMS) funding for HIV services
- Write
and obtain approval for Medicaid Waivers and Changes
Grants
- Implement Waiver Programs in a seamless, timely fashion
|
| Funding is locked into capacity-related grants. This may not
be just grants, rather "lump sum" contracts. |
- Develop Quality Assurance and Improvement Programs
- Develop
and implement performance indicators and measurement
systemsn Develop and/or update clinical standards and service
guidelines
- Evaluate
current rate systems to identify opportunities for enhancements.
- Create
and adapt "service staff-driven" rate
system based on an actuarially-sound and clinically-valid
methodology for determining FFS reimbursement rates based
on actual costs, appropriate clinical practices, and established
standards of care.*
|
| Evaluating quality of care is difficult widespread variation of HIV clinical practices. |
| Rapidly changing nature of the illness and treatment modalities. |
| Patients live longer; hence, social, psychological, and supports needs are increasing. |
- Implement integrated and targeted case management program
strategies
|
| Escalating costs of treatment, especially pharmaceutical agents. All service costs are increasing, residential as well. |
- Develop drug utilization protocols
- Implement integrated
pharmacy purchasing and distribution strategies that
maximize the use of federal drug discount programs including
340B
|
*Rate Architecture Design and Implementation Strategies
are done with the expert involvement of Johnston, Villegas-Grubbs and
Associates, an established leader in the area of Service Staff-Driven
Rate System Development. |
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